Selective Dorsal Rhizotomy
Paul Burstow Excerpts(12 years, 8 months ago)
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The Minister of State, Department of Health (Paul Burstow)
I congratulate my hon. Friend the Member for Daventry (Chris Heaton-Harris) on securing the debate and bringing this very important matter to the attention of the House. The contributions of other hon. Members demonstrated just how strongly people feel about the issue. He outlined with great clarity the huge impact on the lives of children and of their families. Such debates are often prompted by casework but, interestingly and quite rightly, they can be prompted by the diligent work of local journalists reporting in the local press, which is testament to the importance of our local papers.
As my hon. Friend is aware, cerebral palsy is a brain condition that affects movement, posture and co-ordination. It might be seen at or around the time of birth or might not become obvious until early childhood. Some children will have lower limb spasticity, which can cause problems with walking and sitting, as well as discomfort, cramps and spasms. Sadly, there is no cure for cerebral palsy and as no two children are exactly the same, which means that they will not be affected by cerebral palsy in exactly the same way, treatment programmes vary widely.
Occupational therapy, speech therapy, medication and surgery all have a role to play in reducing the impact of the condition, but, because all children with cerebral palsy have movement problems, physiotherapy, to which the hon. Member for Strangford (Jim Shannon) referred, is undoubtedly the bedrock of the condition’s good management.
NHS physiotherapy services, including post-surgery physiotherapy for children with cerebral palsy, are provided on the basis of assessed clinical need, but initiatives such as the self-referral-to-physiotherapy pilots, the allied health professional referral-to-treatment revised guide and the AHP service improvement project are all supporting improvements to access and outcomes, and I will certainly look further at the point that my hon. Friend made about ensuring the provision of such access, when treatment has been delivered outside the NHS, so that people receive the appropriate aftercare.
My hon. Friend also made powerful references to several cases and, in particular, to the one from his constituency, that of Holly Davies, whose life, from my hon. Friend’s own testimony today and from her diary entries, has clearly been transformed by undergoing selective dorsal rhizotomy, SDR, under the care of Dr Tae Sung Park—whom my hon. Friend rightly described as one of the world’s leading paediatric neurosurgeons—at St Louis children’s hospital in Missouri.
Dr Park and his colleagues have pioneered the use of this procedure, which has benefited many thousands of children from throughout the world. We also heard today how Holly’s family have worked tirelessly to raise both awareness of the procedure and the funds to send their daughter to the USA to receive the treatment, and I can well understand the frustration, expressed by hon. Members in this debate, at the sense that the NHS might in some way be denying people access to the procedure.
Of course, those of us who are parents—even those of us who are not—want the best for our children, and in many cases SDR has been shown to improve a child’s comfort and quality of life. Even the simplest day-to-day tasks, such as standing and walking, can be made easier due to the increased flexibility in their limbs, so SDR is a major surgical procedure that aims to reduce the amount of information, as my hon. Friend rightly described, that the sensory nerves carry. As he also said, after the procedure patients need long-term physiotherapy and aftercare, and it is important to ensure that such continuity of care is part of the service that they receive.
The current technique, in which only those nerve rootlets that contribute most to the spasticity are divided, was introduced as far back as 1978, but it is important to stress that SDR is not a cure for cerebral palsy, nor is it suitable for the treatment of abnormal movements or of balance problems. Indeed, it is suitable only for appropriate children, as Members have acknowledged in this debate, after assessment by clinicians. It is therefore unlikely to be suitable for other types of cerebral palsy.
As my hon. Friend will be aware, the Department does not make central decisions or directions on the funding of treatments; it is for local commissioners to decide whether to approve funding for treatments, based on proper consideration of the clinical evidence and—it is important that I stress this—the patient’s individual circumstances.
Tom Brake
Given that the Minister and the hon. Member for Daventry (Chris Heaton-Harris), who opened the debate, have identified that a relatively small number of children would benefit from SDR, what role will specialist commissioning or, indeed, the NHS Commissioning Board play in looking at treatment throughout the whole country for those young people?
Paul Burstow
My right hon. Friend makes a rather important point. One of the opportunities that the Health and Social Care Act 2012, which we have taken through the House, provides is through the establishment of the NHS Commissioning Board. For the first time, all specialised commissioning will be done in one place and at one level, and, although no decisions have yet been made about the area under discussion, it is one of many, involving rare conditions or where specialist expertise needs to be brought to bear, in which the board can contribute to driving improvement.
Parliament has given the job of assessing the clinical evidence to the National Institute for Health and Clinical Excellence in order to provide clinicians with guidance on the safety and efficacy of procedures. NICE does so through its interventional procedures programme, which is different from the more recently published guidance, to which I shall turn in a moment. NICE’s interventional procedures guidance protects patient safety and supports people in the NHS in the process of introducing new procedures. Many of the procedures that NICE investigates are new, but it also looks at more established procedures of the sort that we are discussing and at issues of safety and how well procedures work. By providing guidance on how safe procedures are and how well they work, NICE makes it possible for new treatments and tests to be introduced into the NHS in a responsible way. NICE’s interventional procedures guidance has a slightly different, but equally important, purpose from that of its other guidance products. Interventional procedures guidance does not provide advice on whether treatments are clinically and cost effective, but it does provide advice on whether such procedures are safe and efficacious enough to use in clinical practice.
As my hon. Friend said, NICE published its updated interventional procedures guidance on SDR for spasticity in cerebral palsy in December 2010 in the light of the emerging evidence base from this country and around the world. NICE’s guidance states that the procedure may be used provided that normal arrangements for clinical governance and audit are in place. While the evidence suggested that the operation can improve the comfort and mobility of some people who have cerebral palsy, it was recognised that there are none the less serious risks that would have to be mitigated and managed as part of the procedure, not least in relation to harm to bladder function and walking ability. NICE was clear that if appropriately trained health care professionals wish to offer this treatment, they must fully explain to the families what is involved and that further surgery and intensive aftercare may be needed. NICE is also aware that the surgical techniques used within this procedure are still evolving, and that is why it has made recommendations about further ongoing research, although my hon. Friend made a very powerful case about the evidence base that has developed in the United States over many years of the treatment’s use in that country.
My hon. Friend will be interested to know that NICE is currently developing clinical guidelines on the management of spasticity in children and young people that will provide guidance to the NHS on whether SDR represents a clinically and cost-effective use of NHS resources. NICE consulted on the draft guidance last October. The draft guidelines explained that the available evidence for the procedure shows that it is most likely to be effective in children with particular symptoms, but that the evidence of sustained benefit was not currently available or weak. That is another area where it says that there is a need for research.
I assure my hon. Friend that I will ensure that this debate is provided to the decision makers within NICE so that they can see the additional material that he has brought to the House’s attention and the contributions of other hon. Members. That is very important. I hope that others who are championing this cause have taken the opportunity to respond to the consultation on the draft guidance. I understand that the final version of the published guidance will come out in June this year.
My hon. Friend referred to the work of Kristian Aquilina in Bristol and touched on the work of Support4SDR. I strongly commend the work that both are doing to raise awareness of SDR as a treatment. I know that in December they had a very productive meeting with officials from my Department, not least Dr Sheila Shribman, the national clinical director for children and young people. I gather that the meeting was useful and that a number of avenues were set out for further pursuit and exploration. Throughout the health and social care system, more information for patients and their families and clinicians can help to ensure that more informed decisions are made. The key challenge for Mr Aquilina and Support4SDR will be to increase the awareness of SDR as a possible treatment for some children with cerebral palsy. At the meeting, a number of possible avenues were suggested, not least engagement with the Royal College of Surgeons, working closely with the Council for Disabled Children, and updating the relevant section of the NHS Choices website. My officials stand ready to continue to engage and to work with those wishing to pursue this.
The issues spoken of tonight are very important because of the impact that cerebral palsy can have on children and their families and the hope of a better future that can be offered by appropriate treatment, which, for some children, might mean SDR. Raising public awareness about the procedure is undoubtedly part of what tonight’s debate has done. I commend my hon. Friend and others for contributing to that and for continuing to do so beyond the debate. I hope that the debate will be a contribution to NICE’s deliberations.
Clearly, promoting SDR as a safe procedure for appropriate children can be done only at a clinician-to-clinician level, so I urge my hon. Friend and others to continue to work with Support4SDR and Mr Aquilina carefully to document and spread the results of this surgery. The compelling stories of those mentioned in the debate, whether it be Holly, or Dana—the constituent of my right hon. Friend the Member for Carshalton and Wallington (Tom Brake)—or Finlay, or many others, all bear testament to how this can make a difference to people’s quality of life. I look forward to seeing the work that is produced by NICE and others in the coming months.
Question put and agreed to.
Oral Answers to Questions
Paul Burstow Excerpts(12 years, 8 months ago)
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Mr Virendra Sharma (Ealing, Southall) (Lab)
3. What assessment he has made of progress in tackling tuberculosis in England.
The Minister of State, Department of Health (Paul Burstow)
Provisional numbers of tuberculosis cases in England in 2011 increased by 556 compared with 2010, although the number of cases is lower than in 2009. This may indicate that TB is stabilising, but it is too early to draw firm conclusions. We expect local NHS organisations, in partnership with other agencies, to sustain their efforts to control TB. On 23 March, the National Institute for Health and Clinical Excellence published new guidance to help the NHS manage TB in hard-to-reach groups, including collaborative commissioning.
Mr Sharma
I thank the Minister for his answer. London has the highest rate of TB of any city in western Europe, with more than 3,000 cases a year. When faced with the same problem in Paris and New York, respective Governments committed to increasing resources and a clear model of care. Given the scale of the problem here, and the growing concern about drug-resistant TB, will the Secretary of State commit to implementing the London model of care for TB services that was developed by TB health professionals and advocacy groups to stop this ever-worsening problem?
Paul Burstow
I know that the hon. Gentleman takes a close interest in this matter. He is a member of the all-party group on tuberculosis, and I believe he is meeting the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton) to discuss these matters further. He is right that this is a big issue in London as well as a global issue. The Department is working closely with TB Alert, the tuberculosis charity, which is running a series of programmes to raise awareness. It is working with the NHS and the voluntary sector, particularly in communities with higher risk populations, and we are working with the Royal College of General Practitioners to develop an online resource to promote the better detection and treatment of TB in primary care. I hope that he can explore these issues further, but the Government take them very seriously and are working with other agencies to make progress.
Tony Baldry (Banbury) (Con)
It was 50 years ago that my dad moved on from being research secretary at the British Tuberculosis Association at Harefield because, in the 1950s, TB had ceased to be a killer in the UK. It is a tragedy that it has now come back, largely as a consequence of people with infectivity from overseas bringing TB into the country. What more can be done to enhance the screening of travellers from high-infection areas entering the UK so that those infected with TB can be identified and treated before they infect others in the population here?
Paul Burstow
My hon. Friend makes an important point about one aspect of the better control of TB and its spread. The Home Office has been running a pilot programme for some years. It continues to evaluate the effectiveness of that programme with a view to establishing whether it is more widely applicable. We know that this disease has moved from the general population to specific high-risk groups, which is why the targeted approach I mentioned in my initial answer is the key to controlling it.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The Minister has heard that TB is a particular problem in London—there was an 8% rise last year—and he will be aware that the current difficulties concern delays in detection and referral and the variability of commissioning and service provision. Given that the Health and Social Care Bill will necessarily lead to further fragmentation, separating health protection and public health from commissioning, how will he ensure that the Bill does not make a bad situation, in respect of TB in London, worse?
Paul Burstow
The Bill will not lead to fragmentation. It actually supports greater integration of health, social care and public health and, at a local level, it allows health and wellbeing boards to become the means by which to co-ordinate all the agencies that have a part to play when it comes to tackling TB, not least in ensuring that the advice of public health officials benefits not just the NHS but wider public services that also have a role to play in raising awareness of the disease and ensuring that it is properly tackled.
Ian Lucas (Wrexham) (Lab)
4. What discussions he has had with Ministers in the Welsh Government on the treatment by the NHS of patients with defective breast implants.
Dr Phillip Lee (Bracknell) (Con)
6. What the average cost has been of a consultation at an NHS walk-in centre since 2008.
The Minister of State, Department of Health (Paul Burstow)
The average cost of an attendance at an NHS walk-in centre was £36 in 2008-09; £42 in 2009-10; and £39 in 2010-11.
Dr Lee
I thank the Minister for his detailed answer. Does he agree that in the future new commissioning groups, such as those that will serve my constituency in Bracknell, might choose not to fund walk-in centres—whether ones already established or those in the future—based on clinical justification terms? I, for one, remain to be convinced—indeed, I am far from convinced—of the long-term financial justification for, or clinical benefit of, walk-in centres.
Paul Burstow
There is not a nationally mandated programme of walk-in centres; rather, it will be for local commissioners to make decisions based on the evidence and their evaluation, and ensuring that they fulfil their contractual obligations.
Mr Kevin Barron (Rother Valley) (Lab)
Is it not the case that the walk-in centre that opened in Rotherham a few years ago has given communities that are higher on bad health indices access to health care 12 hours a day, seven days a week? Getting rid of it—it was opposed by some local doctors, because it threatened their business—would be a backwards step. Can we expect the new commissioning groups to start commissioning GPs in areas such as mine, which are higher on bad health indices and do not have enough general practitioners?
Paul Burstow
I am grateful to the right hon. Gentleman for his question, because he outlines the need to reduce health inequalities—something that the party of which he is a member failed to do in government. I can assure him that the Bill, which has now gone through all its parliamentary stages, will place a duty on clinical commissioning groups to seek to reduce health inequalities —something that his Government never did.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Is the Minister aware that when walk-in centres fail—or when any aspect of the national health service fails—it is because of poor management? Does he realise that good managers up and down the country are leaving the national health service? Doctors are not trained as managers. The Institute of Management has said that 43% of our managers are not up to the job, and we are not training our managers in the national health service because they are GPs.
Paul Burstow
This Government respect the contribution that NHS managers make, and we respect the contribution that the NHS Confederation makes as well. However, we also want to ensure that clinicians are at the heart of commissioning services. They are the people who understand patients most, and they are the people we are giving that responsibility to, because we think that is the way to drive improvement in the NHS.
Meg Munn (Sheffield, Heeley) (Lab/Co-op)
10. What steps he is taking to ensure that people receiving care at home funded by the NHS are involved in making the arrangements for that care.
The Minister of State, Department of Health (Paul Burstow)
Our ambition is to enable shared decision making for all NHS patients. We expect people who are eligible for NHS continuing care funding to be fully involved in discussions about their care. Subject to the results of the current personal health budget pilots, everyone eligible for NHS continuing health care, including many people receiving care at home, will have the right to ask for a personal health budget, including a direct payment, from April 2014.
Meg Munn
I have received a letter from one of my constituents who has had direct payments for 15 years under social services. Following a stay in hospital, she was moved on to health funding, and her life has changed dramatically for the worse. She says that she no longer has any choice in who cares for her and finds it hard to find the right people with whom she feels comfortable. She concludes:
“I’m tired of being bullied. I’m just miserable.”
Will the Minister do something to bring forward the measures more quickly, so that people who have been directing their own care under social services can have the same quality of life and the same choices that they have become used to?
Paul Burstow
I absolutely agree with the hon. Lady’s constituent, and with the hon. Lady. We need to ensure that, as soon as possible, the benefits and the control that direct payments give to individuals in social care are available to people in regard to their long-term health care and particularly to continuing health care. It is realistic to say that we can roll this out nationwide by 2014, but I know that the hon. Lady is having discussions with the authorities in Sheffield, and I encourage her to carry on those conversations about the way in which people can use the current arrangements to access those facilities.
Mr Stephen Dorrell (Charnwood) (Con)
Does the constituency case raised by the hon. Member for Sheffield, Heeley (Meg Munn) not highlight the increasingly urgent need to achieve much more integration between health and social services, and indeed between different parts of the national health service, in order to provide joined-up care that focuses on patients’ needs and delivers better value for money to the taxpayer?
Paul Burstow
My right hon. Friend is absolutely right. I urge the hon. Lady to write to me about the matter so that I can respond in more detail, but let me say to my right hon. Friend that it is not just a question of delivering more integration within health care—which is often still too fragmented—or between health and social care; it is also a question of recognising that issues such as housing and leisure are critical to the delivery of greater well-being, and to an improvement in the health of the nation. The Health and Social Care Bill, which has now completed all its stages, gives people in every part of the system a clear duty to collaborate, integrate, and deliver better care for individuals.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
There are currently severe constraints on the availability of incontinence pads and on the bed linen laundry service, which is causing immense distress to the many poor families in my constituency. Will the Minister look into the problem? Will he recognise that it is simply impossible for people who are already in difficulties, and who are poor, to find the money for those extra things?
Paul Burstow
If the right hon. Lady sends me the details, I will look into the individual case. I agree with her that it is unacceptable for such products to be rationed. I think it essential to base their provision on an assessment of individuals’ needs, and for those individuals to receive what they need for a good quality of life.
Ian Swales (Redcar) (LD)
My constituent Joyce Benbow was discharged from Redcar hospital last November, but is still there owing to a failure to agree on her care package. When will the managers of health and social care budgets be more joined up so that people receive the right provision at the right time?
Paul Burstow
My hon. Friend has raised an important point about the importance of joining up hospital care, community care and social care, which has often been overlooked. We have invested more than £300 million this year in developing more re-ablement services, and in January we invested an extra £150 million in support for them. We are also extending our plans for more tariff reform to ensure that local hospitals have the means to drive the development of such services in their communities.
Miss Anne McIntosh (Thirsk and Malton) (Con)
11. What recent representations he has received on the 111 pilot telephone service; and if he will make a statement.
Mr Jim Cunningham (Coventry South) (Lab)
12. If he will introduce proposals to require a minimum ratio of nurses to patients in hospitals.
The Minister of State, Department of Health (Paul Burstow)
Guidance on staff ratios and the proportion of registered and unregistered staff can play a useful part in supporting local decisions about setting safe and sustainable staffing levels. Both the Royal College of Nursing and the NHS Institute for Innovation and Improvement have produced such guidance. We have no plans to impose centrally determined ratios, as in our view that would undermine professional judgment.
Mr Cunningham
Is the Minister aware that the RCN says that nurses are overstretched, with too much reliance on cheaper, unqualified assistance? What impact does he think that will have on care for the elderly?
Paul Burstow
First, let me say that we greatly welcome the survey the RCN published last week, and the work it has done for many years to highlight ratios such as the ratio of nurses to beds. The hon. Gentleman will be pleased to know that the ratio has improved under this Government. We are working with the RCN and others to identify the processes and paperwork within the NHS that occupy nurses’ time and take them away from the bedside, which is the priority.
Mr Jamie Reed (Copeland) (Lab)
When I last asked the Minister from the Dispatch Box about the loss of 3,500 nursing posts, he told the House that that was “factually incorrect”. He was right, and I apologise: the actual figure, published last week, is 4,096. In what will surely be one of the Secretary of State’s final outings in his current post, before he is reshuffled to where he can do no further harm, will he tell the House how many of those nursing posts would have been secured by the £500 million spending cut he agreed with the Treasury in last week’s Budget?
Fiona Bruce (Congleton) (Con)
13. What steps he is taking to provide services for people diagnosed with Raynaud’s disease and scleroderma.
The Minister of State, Department of Health (Paul Burstow)
Routine commissioning is a local responsibility, which in future will be led by clinicians, who best understand patients’ needs. From April 2013, the NHS Commissioning Board will have a clear focus on commissioning services for people with rare, specialised conditions. The commissioning of those services directly through one national commissioner to a national standard should ensure better planning and co-ordination of services, which will be of benefit to patients. The scope of this commissioning, and the extent to which it will cover complex rheumatology services, is still being considered.
Fiona Bruce
I thank the Minister for that reply. I am very proud to have the headquarters of the Raynaud’s and Scleroderma Association based in my constituency. It was founded 30 years ago by a remarkable lady, Anne Mawdsley. It is still run from a terraced house in Alsager, and she has raised £12 million through undertaking some remarkable feats, including, I think, swimming with dolphins. Will the Minister commend her work and assure her that scleroderma patients will be able to access the best specialist centres for diagnosis and treatment?
Paul Burstow
I pay tribute to the work my hon. Friend does and to the work the Raynaud’s and Scleroderma Association has done over many years in raising funds, raising awareness and making sure there is a greater focus on these issues. I can assure my hon. Friend that the work we have done in establishing the NHS Commissioning Board will mean that in future, for the first time, there will be one organisation that will be able to look at issues involving specialised and complex needs that require a national focus.
Greg Mulholland (Leeds North West) (LD)
14. What recent progress he has made on the review of adult congenital cardiac services.
Nick Smith (Blaenau Gwent) (Lab)
16. What recent assessment he has made of the performance of services for older people.
The Minister of State, Department of Health (Paul Burstow)
A number of inspections, reports, independent audits, and investigations have revealed long-standing and unacceptable variations in the standard of care that older people receive in the NHS, and in social care. The Government are determined to root out poor-quality care wherever it is found. We have established the national Nursing and Care Quality Forum to work with patients, carers and professionals to spread best practice.
Nick Smith
The British Geriatrics Society’s “Quest for Quality” report identified that too many people in care homes were without access to NHS services, including psychiatric, physiotherapy and continence services. What action are the Government taking to ensure that care home residents get the high-quality NHS care that they deserve?
Paul Burstow
In England, one of the things that we are doing is making sure that a programme of special inspections of care homes, conducted by the Care Quality Commission, looks at those issues to ensure that we provide the right range of support services for people in care homes. In addition, the National Institute for Health and Clinical Excellence has produced quality standards; in particular, it has been working on quality standards relating to issues affecting older people—incontinence, nutrition support for adults, patient experience, delirium, dementia, and many others. All that is critical to delivering really good-quality care in care homes.
Margot James (Stourbridge) (Con)
22. Russells Hall hospital, which serves my constituency, has reviewed recent reports, and done its own research, on dignity and care for older patients. It has elevated the qualities of care and compassion to the top of its criteria for recruiting health care assistants. Does my hon. Friend agree that the Nursing and Midwifery Council should apply similar learning to nurse training?
Paul Burstow
It is important that that is applied to all who have direct responsibility for delivering care, and hands-on care in particular. The work that Russells Hall hospital is doing on care and respect, and in its responsibility programme, is a good example of that. On issues such as dementia, we are clear that we need to ensure good advice, training and support for all nursing staff—we are working with the Royal College of Nursing on this—so that they treat people who have dementia with dignity.
Liz Kendall (Leicester West) (Lab)
The Government are rightly building on Labour’s national dementia strategy, and the Minister should know that the dementia crisis cannot be addressed without tackling the crisis in care. Yet his Government have cut more than £1 billion from local council budgets for older people’s care, services are being withdrawn and care charges for dementia sufferers are soaring. The Alzheimer’s Society and Age UK say that these cuts have pushed the system to breaking point. Does the Minister agree with them, yes or no?
Paul Burstow
The hon. Lady, of course, offers no solution, merely a problem. I say to her that this Government identified £7.2 billion of additional investment to go into social care over the life of this Parliament, and those resources are being used creatively by some local authorities to protect front-line services. I urge her to applaud the authorities that are doing that and join me in condemning those that are cutting services despite being given the resources.
Caroline Dinenage (Gosport) (Con)
17. What steps he is taking to raise the professional standards of health care workers and care assistants.
The Minister of State, Department of Health (Paul Burstow)
The Government have commissioned Skills for Health and Skills for Care to develop a code of conduct and minimum training standards for health care support workers and adult social care workers in England. That will inform the development of a system of assured voluntary registration for this group, which will be reviewed after it has been established for three years.
Caroline Dinenage
Have the Government made any assessment of the cost of rolling out mandatory regulations to health care support workers?
Paul Burstow
I will write to the hon. Lady with any specific details about the precise costs of rolling out such a register. I say to her that, for the first time, we have a Government who have decided that leaving unclarified the training requirements, standards and codes of conduct for health care assistants and care assistants is unacceptable. That is why we have commissioned this work. It will involve working with unions and other health care professionals to make sure we get those standards right, because we know that that is key to delivering dignified care.
Jo Swinson (East Dunbartonshire) (LD)
T1. If he will make a statement on his departmental responsibilities.
Simon Wright (Norwich South) (LD)
T7. Many hospitals, including the Norfolk and Norwich university hospital, have reported a dramatic increase in alcohol-related admissions over the past 10 years, so I welcome the latest alcohol strategy. But what steps is the Secretary of State taking to support the expansion of treatment and early interventions for dependent and harmful drinkers in Norfolk and elsewhere?
The Minister of State, Department of Health (Paul Burstow)
I am grateful to my hon. Friend for his question, and he is absolutely right to identify the priority that this Government are now placing on dealing with the harm caused by alcohol, not least because of the 1.2 million alcohol-related hospital admissions. The strategy outlined by the Home Secretary last week is about education and raising awareness; enforcement; and treatment—making sure that the treatment services are more widely spread. It is also about recognising that this is a cross-government responsibility, not the responsibility of any one Department. That is why the proposals to use a national minimum unit pricing policy will tackle cheap booze and the binge culture.
Grahame M. Morris (Easington) (Lab)
T3. We now know that the Conservatives have received more than £8 million in donations from private health care companies since 2001. This goes beyond simply cash for access to a much more sinister issue of cash for policy influence. Ministers have said that they do not expect any increase in private sector provision in the NHS, but how will this be measured in years to come?
Chris Ruane (Vale of Clwyd) (Lab)
T5. Mindfulness-based meditation techniques have been deemed by the National Institute for Health and Clinical Excellence to be more effective than drug-based therapy in the treatment of recurring depression in many circumstances. Will the Minister tell the House his views on mindfulness-based techniques and say what other conditions and diseases he thinks would benefit from such therapy?
Paul Burstow
The Government are committed to extending the range of NICE approved therapies when it comes to access to talking therapies. Certainly, we will look very carefully at how we extend it in the area he has suggested. I will write to him in further detail about this.
Andrew George (St Ives) (LD)
What reassurance can the Secretary of State give to Members of Parliament representing areas that have received an allocation from the formula which has been significantly below their target, given the change in arrangements to clinical commissioning groups in future?
Simon Danczuk (Rochdale) (Lab)
On 24 February, my constituent, Audrey Kay, died after a litany of poor treatment. Will the Minister meet her son and me to hear Audrey’s treatment story?
Chris Skidmore (Kingswood) (Con)
Is the Minister aware of the publication today of the industrial action review by the London ambulance service, which details that on 30 November, the day of the public service strikes, in the afternoon and the evening, requests for front-line staff to return to front-line ambulances were made by the London ambulance service. However, of the three unions to strike, only Unison responded to say that it would not ask staff to return to work. Three hours later, after three repeated requests for help, a patient who had been unable to get an ambulance had died. The report has called—
Diabetes
Paul Burstow Excerpts(12 years, 8 months ago)
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The Minister of State, Department of Health (Paul Burstow)
I congratulate the right hon. Member for Leicester East (Keith Vaz) on securing this debate and on making such an effective and compelling case for raising awareness of diabetes and preventing, postponing and better managing the condition. I know of his personal experience and the leadership that he has shown in his constituency and in the House on these issues over many years. The centre of excellence that he talked about is there as a testament to his determination to make this happen, and I pay tribute to him for that. He rightly paid tribute to the work of the all-party parliamentary group and, in particular, my hon. Friend the Member for Torbay (Mr Sanders), who has proved an excellent chair of the group and has done some excellent work, as the right hon. Gentleman described.
The case for action is absolutely compelling. As the right hon. Gentleman said, the number of people with diabetes is rising, with profound effects on their quality of life. As he rightly said, there are huge health inequalities, for which some of the most deprived and excluded pay the highest price. It is therefore a big responsibility for any Government to tackle these issues. The costs to our society and to the NHS are substantial.
We currently have the most accurate picture ever of the state of diabetes care in England, with the national diabetes audit, the detailed analysis by the national diabetes information service and the atlas of variation, all serving to expose an unjustifiable variation in the levels of care and treatment from one postcode to another—the classic postcode lottery. We now plan to go further in providing more information than ever before by publishing a specific themed atlas on diabetes, which will prove to be an invaluable tool for commissioners and campaigners, and patients and carers, to use to make sure that we get the very best diabetes care in every part of England.
The data show that there has been significant progress, but, as the right hon. Gentleman says, there are still shocking, inexplicable and unjustifiable variations that we have to bear down on. We know what works at three levels—population-level interventions, targeted interventions, and what can be done better to manage the condition. Let me go through what we are doing in those contexts. First, it is vital to raise awareness among the population. The right hon. Gentleman and other hon. Members, the NHS, and other organisations—including, in future, Public Health England—have an important role in raising overall awareness. Supporting healthy behaviours that improve the population’s health is absolutely key to successful prevention. We need to tackle the main risk factors that are particularly relevant to type 2 diabetes.
One of the key strands from the Government’s point of view is the work done through Change4Life, which has a clear focus on maintaining healthy weight and increasing levels of physical activity, as that is very important in addressing obesity. That also requires much more effective collaborative working between local authorities and the NHS to ensure that we exploit the full range of levers that local authorities have in making a real difference in those two areas. Our planned health and wellbeing boards will provide a new and important lever for driving improvement on the public health side.
The right hon. Gentleman talked about other interventions. We are addressing this through our public health responsibility deal. Some of these issues are not about regulation but getting the relevant industries to move further and go faster, and that has already borne fruit, not least in reducing trans-fats in products. I appreciate his welcome for the comprehensive approach that the Home Secretary outlined today with regard to reducing alcohol harm—the harm that it does to the individual and the harm that its effects can have on others on our streets—and the decision to move, after consultation on the details, towards minimum unit pricing. The right hon. Gentleman is right that that can have a profound effect, not just on liver disease, but on many of the other aspects that we are discussing.
The second area is targeted interventions. The right hon. Gentleman rightly raised the importance of NHS health check and of targeted interventions for high-risk people. We can reduce and even reverse the worst effects of diabetes if we are effective in identifying at an earlier stage those who are at risk. That is why risk assessment and diagnosis are essential to the strategy that has been in place for some time. It is important to identify more people at an earlier stage and to give them the messages and support that can enable them to mitigate the worst effects of diabetes. The national roll-out of NHS health check is a key component in that. We have signalled our determination, through the NHS operating framework, to ensure that that continues.
The proactive identification of people who are at risk of vascular diseases, including diabetes, is key. The right hon. Gentleman mentioned that that covers a population of people from 40 to 75 years of age. I can tell him that in some parts of the country, high-risk individuals are being targeted specifically—for example, those in the south Asian population, where there is a greater risk of type 2 diabetes. We know that the risk in that population is four or five times greater than that in the European population. That will be reinforced shortly by the guidance that the National Institute for Health and Clinical Excellence is finalising on the detection and prevention of diabetes in high-risk individuals.
Paul Burstow
I will gladly do that.
Accurate and timely diagnosis is key, but diabetes can be hard to spot and some of its symptoms, such as extreme tiredness and weight loss, can be attributed to other diseases. Again, NICE has produced advice on preventing adult pre-diabetes and on early detection. It is key for GPs and others to be more effective at early diagnosis. The national clinical director for diabetes, Rowan Hillson, has been supporting that work to raise professional awareness, which is critical.
The third area is long-term management and self-care. There has to be a team effort across primary and secondary care, and the patient has to be at its centre. A person with diabetes must know how to spot and report changes in their health that might result in serious complications with life-changing or even life-shortening consequences. Integrated multi-disciplinary care is crucial to delivering the best outcomes in diabetes.
I will give a couple of examples that pick up on the right hon. Gentleman’s references to the scandalous picture in respect of amputations in England. He rightly rehearsed the variations from one part of the country to another, which are inexplicable and shocking. On average, 73 amputations take place every week, but eight out of 10 of those operations are unnecessary because they could be prevented simply by following what we know works. It is critical that we get that message out and translate it into practice by clinicians. For example, we know that when a foot care team is established, which is a relatively modest investment, it can cause as much as a 50% drop in the rate of amputations. Such investments can release resources. That is why they are part of the quality, innovation, productivity and prevention work and the Nicholson challenge, which the right hon. Gentleman talked about.
There is also room for further progress in the use of insulin pumps, which are particularly relevant to type 1 diabetes. They provide for the slow release of insulin. The NICE guidance clearly recommends the use of insulin pumps for type 1 diabetes when daily injections are not working, and yet many primary care trusts are dragging their feet and not making pumps available. That is why we have established the NHS Diabetes insulin pump network and why it is oversubscribed for its first meetings, with more than 270 members. I think that it will prove an invaluable way of beginning to drive out unacceptable practices. We are also auditing the availability of insulin pumps so that we can identify where use is not adopted properly.
Paul Burstow
I am coming to that almost straight away.
I welcome the fact that there will be a type 1 diabetes parliamentary lobby by the Juvenile Diabetes Research Foundation in the next month or so to highlight some of the relevant issues.
Population levels, targeting, and management and self-care are all critical, and I want to say a bit about what we are going to make happen. First and foremost, NHS Diabetes leads on improvements, spreads best practice, supports professionals and develops professional networks of the type that I have described. The national service framework for diabetes is reaching the end of its life, and we now need to set new ambitions and new directions towards making the further progress that the debate is highlighting the need for. That will be reflected in both the new cardiovascular strategy and the long-term conditions strategy, which the Department is working on in collaboration with many other stakeholders.
We also need the system to be supported by incentives such as payment by results. That was why we rolled out new tariffs last April to recognise paediatric diabetes care as a discrete specialism, and why we will continue to develop tariffs to support best practice.
The right hon. Gentleman asked about Eucreas, which is a glucose-lowering drug. It is composed of two drugs, metformin and vildagliptin, and I understand that although there may well be supply problems with the combined drug, the industry is not aware of any supply problem with the two separate tablets. I will gladly write to him about that in further detail, but that is what I have learned about that drug so far.
More generally, the Department is working to address the issue of parallel exporting of UK medicines in conjunction with the Medicines and Healthcare products Regulatory Agency and the pharmaceutical supply chain, to ensure that medicine supplies are not compromised and we do not have the tragedies to which the right hon. Gentleman referred. I will write to him about the progress of that work.
The right hon. Gentleman also asked about Copenhagen. I look forward to the opportunity to meet colleagues to share best practice and learn about it from others.
As the right hon. Gentleman says, diabetes is a complex, lifelong, progressive condition. When it is well managed, with the right education and support, it is possible to prevent the most severe, sometimes fatal complications. We have the data to guide us and the evidence of what works, and we have the economic case. We are setting our strategy with the ambition of making even more progress. Now, we need commissioners and clinicians to act so that the best is not the exception but the norm across the national health service.
Question put and agreed to.
Health
Paul Burstow Excerpts(12 years, 9 months ago)
Ministerial CorrectionsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Keith Vaz
To ask the Secretary of State for Health what proportion of diabetes patients in Leicester City Primary Care Trust did not have a foot check in 2011.
[Official Report, 13 March 2012, Vol. 542, c. 185W.]
Letter of correction from Paul Burstow:
An error has been identified in the written answer given to the right hon. Member for Leicester East (Keith Vaz) on 13 March 2012. The exception rate in Leicester City was reported as 5.5% for DM09 and 5.5% for DM10. The correct figures were 5.2% and 5.2%.
The full answer given was as follows:
Paul Burstow
There are two sources of data for assessing the extent to which foot checks are provided: the National Diabetes Audit and the Quality and Outcomes Framework (QOF) achievement data.
The National Diabetes Audit shows that, from data received by 92.3% of practices, 18.3% of diabetics registered in Leicester City Primary Care Trust (PCT) did not have a foot check.
The QOF indicators for diabetic foot care in 2009-10 were as follows:
DM09: The percentage of patients with diabetes with a record of the presence or absence of peripheral pulses in the previous 15 months; and
DM10: The percentage of patients with diabetes with a record of neuropathy testing in the previous 15 months.
According to Leicester City PCT's QOF data for 2009-10, for DM09 the average underlying achievement for practices in the PCT was 89.5% and for DM10 89%. Underlying achievement means the percentage of eligible patients (excluding those who were excepted from the indicator) who received the checks. This indicates that for DM09, 10.5% and for DM10, 10.6% of patients (excluding those who were exception reported) did not receive the checks. The exception rate in Leicester City was reported as 5.5% for DM09 and 5.5% for DM10.
The differences in results between the audit and QOF may be ascribable to variations in scope and data assessment methodology. We are working with stakeholders to understand the reasons for the differences and to identify what needs to be done as a result.
The correct answer should have been:
Paul Burstow
There are two sources of data for assessing the extent to which foot checks are provided: the National Diabetes Audit and the Quality and Outcomes Framework (QOF) achievement data.
The National Diabetes Audit shows that, from data received by 92.3% of practices, 18.3% of diabetics registered in Leicester City Primary Care Trust (PCT) did not have a foot check.
The QOF indicators for diabetic foot care in 2009-10 were as follows:
DM09: The percentage of patients with diabetes with a record of the presence or absence of peripheral pulses in the previous 15 months; and
DM10: The percentage of patients with diabetes with a record of neuropathy testing in the previous 15 months.
According to Leicester City PCT's QOF data for 2009-10, for DM09 the average underlying achievement for practices in the PCT was 89.5% and for DM10 89%. Underlying achievement means the percentage of eligible patients (excluding those who were excepted from the indicator) who received the checks. This indicates that for DM09, 10.5% and for DM10, 10.6% of patients (excluding those who were exception reported) did not receive the checks. The exception rate in Leicester City was reported as 5.2% for DM09 and 5.2% for DM10.
The differences in results between the audit and QOF may be ascribable to variations in scope and data assessment methodology. We are working with stakeholders to understand the reasons for the differences and to identify what needs to be done as a result.
Winterbourne View Hospital
Paul Burstow Excerpts(12 years, 9 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Minister of State, Department of Health (Paul Burstow)
I promised to update the House about ongoing activity in relation to Winterbourne View private hospital and other services for people with learning disabilities.
The House will wish to note that four people employed at Winterbourne View hospital appeared in Bristol Crown court on 16 March and pleaded guilty to offences under the Mental Capacity Act 2005. They have been referred for sentencing reports, alongside the three people who pleaded guilty on 9 February. A further four people are due back in court after Easter.
The Care Quality Commission (CQC) has now completed their focused inspections of 150 services for people with learning disabilities. The reports from these inspections are being published in batches, and a further 19 reports are being published today. They can be found at: http://www.cqc.org.uk/LDReports?1atest—86 inspection reports have been published so far. These reports have found poor practice in some of the units and frequent areas of concerns include limited person-centred care, limited appropriate activities and a lack of monitoring and learning from incidents of restraint.
Where CQC has identified concerns, the provider is required to inform CQC when its improvement actions have been completed. CQC will follow up to check that the improvements have been made, including further inspections where necessary. Where CQC has issued warning notices it has been back to inspect and found the locations to be compliant.
In the original proposal for the learning disability review the plan was to undertake two phases. Phase one was the inspection of 150 locations. These inspections have now been undertaken. Phase two was the inspection of registered services for people with learning disabilities covering a wider range of services than those included in phase one, notably adult care providers.
However, CQC has taken the opportunity within phase one to inspect 33 adult social care locations. Following discussion at the CQC inspection programme advisory group, CQC decided not to proceed with phase two at this time but wait until the national report on the findings from the LD inspection programme had been published and then reassess the options.
A programme of thematic inspections is starting this April looking at domiciliary care agencies. This will test the tools for inspecting this type of service so they can be used for other care groups. This programme of inspection will focus on older people.
Once the criminal proceedings are completed, we expect the serious case review, chaired by Dr Margaret Flynn, to be published. The serious case review is looking at:
i. the effectiveness of the multi-agency response to concerns raised and events
within Winterbourne View hospital since January 2008;
ii. the role of commissioning organisations in initiating patient admissions and
the role of the regulator; and
iii. the operational policies and practice, including the governance
arrangements of Castlebeck Care (Teesdale) Ltd.
The review is considering information submitted by Castlebeck, NHS South Gloucestershire PCT, NHS South West, South Gloucestershire council and Avon and Somerset police.
These reports will feed into the wider departmental review of Winterbourne View together with evidence from other investigations and reports. The review team are actively engaging with people with learning disabilities or autism and family carers, as well as with commissioners, professionals and providers to explore the emerging issues and possible options.
The review is considering all the evidence carefully and assessing the implications for policy and practice across the system, including for commissioners, providers, professionals, regulators and Government. Everyone has a part to play in addressing these issues to help prevent abuse and to drive up standards for people with learning disabilities or autism and challenging behaviour.
While these reviews and inspections are ongoing, we are taking action to address emerging issues. For example:
CQC has amended its whistle blowing policy;
the whistle-blowing helpline for NHS staff has been extended to staff and employers in the social care sector from 1 January;
on 18 October, the Secretary of State announced that the NHS constitution is being updated to include:
an expectation that staff should raise concerns at the earliest opportunity;
a pledge that NHS organisations should support staff when raising concerns; and
clarity around the existing legal right for staff to raise concerns about safety, malpractice or other wrong doing without suffering any detriment;
we are working on legislation that will require stronger local action in relation to safeguarding adults; and
where issues for local management are highlighted in the NHS review, they will be developing actions plans to deal with this.
Ministers will report findings from the departmental review to Parliament and determine what further action is necessary.
I will continue to update the House as things develop.
Health and Social Care Bill
Paul Burstow Excerpts(12 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Minister of State, Department of Health (Paul Burstow)
I beg to move, That this House agrees with Lords amendment 63.
Madam Deputy Speaker (Dawn Primarolo)
With this it will be convenient to discuss the following:
Lords amendments 64 to 73 and 75 to 147.
Lords amendment 148, and amendments (a) and (b) thereto.
Lords amendments 149 to 167, 295 to 298 and 343 to 365.
Paul Burstow
The amendments cover Monitor, the regulation of NHS services and the governance of foundation trusts. Before I deal with them, I would like briefly to address some of the myths that have grown up around part 3 of the Bill. [Interruption.]
Madam Deputy Speaker
Order. I am sorry to interrupt the Minister, but I am having some difficulty hearing his response to these amendments. May I ask Members to leave the Chamber quietly, so that we can continue with this debate and hear his comments?
Paul Burstow
Thank you, Madam Deputy Speaker.
Part 3 is a key element of the Bill. As the Government have made clear, commissioners will decide whether, when and how to use competition to deliver services for patients. Where they decide to do so, part 3 will ensure that competition is regulated effectively and in the patient’s best interests. Under the Bill, Monitor will, in future, regulate all providers of NHS services, so that all patients are protected, irrespective of who supplies their treatment and care.
In the earlier debate, my hon. Friend the Member for Southport (John Pugh) asked about the applicability of competition law to the function of commissioning. I draw his attention to European case law, which makes it clear that commissioning is not subject to competition law. It is the function that matters when it comes to determining whether this is applicable—
Paul Burstow
I am responding to my hon. Friend and, if the hon. Gentleman does not mind, I am going to carry on doing so.
In addition, the Office of Fair Trading has published guidance that is consistent with the view that the Department has expressed on this matter. I will write to my hon. Friend with the detailed case law, so that I can quote the case reference for him.
Claims have also been made that part 3 does something else. Specifically, it has been suggested that it introduces competition and competition law into the NHS, as if that were the case for the first time. Part 3 does not do that, nor does anything else in the Bill. The NHS will, as a result of the Bill, be better insulated against the inappropriate application of competition law, particularly as it develops more integrated services, which are now embedded throughout this legislation. Without Part 3, the NHS would continue to be exposed to price competition and the preferential treatment of private providers introduced by the previous Labour Government. Indeed, Labour’s 2006 procurement regulations assume that public authorities will be securing services from a market—that will not always be appropriate in the NHS—and so, under the existing regulations from the 2006 legislation, commissioners are placed at greater risk of legal challenge whenever they decide to secure services without competition.
Karl Turner (Kingston upon Hull East) (Lab)
Will the Minister say whether Monitor will keep its role as an independent regulator of foundation trusts?
Paul Burstow
I am coming on to deal with a whole section of amendments that were made in the other House and which this Government have accepted, when I will address that very point. If the hon. Gentleman is patient, he will get an answer to his question.
Grahame M. Morris
I wish to seek a point of clarification on the Minister’s reference to what Earl Howe said about the Bill providing
“insulation against inappropriate application of competition law”.—[Official Report, House of Lords, 6 March 2012; Vol. 735, c. 1689-90.]
Concerns were raised in the Minister’s own party about American-style private health care interests being able to use these mechanisms to provide health care services. Will he give an example of how this “insulation” would protect an NHS trust from being taken over by a north American private health care company?
Paul Burstow
That shows a fundamental flaw in the hon. Gentleman’s argument and in his understanding of what the Bill actually does. I commend to him the contribution made by Earl Howe, the Minister in the other place, on 6 March 2012, when he set out in great detail—this can be found in column 1689—all the aspects relevant to how this Bill protects the NHS, creating insulation for it against the application of competition law under the current framework, as provided by the 2006 legislation, which does not offer those protections. It certainly does not give commissioners the ability to exercise their discretion over whether, when and if to use competition. In those circumstances, the measures give for the first time, because of the sector-specific regulator, the ability to decide which services will be exempt from competition altogether—something that does not exist as a result of Labour’s legislation. That is one reason why so many hon. Members in this House are concerned about the impact of competition—because they are seeing the NHS being exposed to competition under the 2006 Act. This Bill will sort those defects out.
Barbara Keeley (Worsley and Eccles South) (Lab)
Will the Minister give way?
Paul Burstow
No, I am going to make some progress and then I will be more than happy to give way. [Interruption.] I am sure there will be more opportunities and I will give way in a moment.
On how Monitor exercises its powers, the Government have supported amendments made in the House of Lords, which were tabled by my noble Friend Baroness Williams, providing that the Secretary of State can give Monitor guidance to help ensure it exercises its functions in a manner consistent with the Secretary of State’s duty to promote a comprehensive health service. The amendments also help to ensure that the Secretary of State can discharge effectively his responsibility for the health service in England and to ensure that Monitor carries out its functions to that end. I therefore commend the amendments to the House. Both this House and the Lords have stressed the need for Monitor to use its powers to support integrated services and co-operation between providers. The Government therefore tabled amendments in the other place to provide express powers for Monitor to set and enforce licence conditions that would enable integration and co-operation between providers.
On the detail of Monitor’s specific regulatory powers, Monitor would have powers to intervene proactively to support commissioners in ensuring continued access to NHS services if a provider became unsustainable. Amendments tabled by the Labour peer Lord Warner, which we agreed in the other place, provide that Monitor will have to identify and publish evidence where it identifies risk that it considers arises from unsustainable service configurations. Those amendments would require commissioners to act on that information where necessary. Hence, they make clear the expectation that commissioners will address problems proactively and ensure that patients continue to have sustainable access to the services they need. These are sensible provisions that had support from all parts of the House of Lords and I hope that this House will also agree to them.
I want to say a bit more about the powers and responsibilities of Monitor, which relate to further amendments made in the other place. The extent of the various matters that Monitor would have to take into account was the subject of considerable debate in this House and the other place. I want to be absolutely clear about where we are regarding the overarching duty that Monitor has to take into account. Monitor will have a single, unequivocal duty—to protect and promote the interests of patients by promoting provision of NHS services that is economic, efficient and effective and that maintains or improves the quality of services. Beyond that overarching duty there is no hierarchy. No preference is given to competition or integration because integration is clearly a responsibility that sits with commissioners and Monitor’s role is to support it.
Peers also raised concerns about proposals for the Competition Commission to undertake seven-yearly reviews of competition in the provision of NHS services. The Government were sympathetic to the arguments and were concerned that it might be taken to suggest that competition was being given a higher status than the interests of patients. In order to avoid that, we accepted an amendment tabled by my noble Friend Lord Clement-Jones that removed the provision in the Bill for Competition Commission reviews. We also supported other amendments tabled by my noble Friend Lord Clement-Jones requiring the Office of Fair Trading to seek advice from Monitor whenever it considers mergers or potential mergers involving foundation trusts. The amendments will help to ensure that benefits to patients are evaluated on an informed basis by a sector-specific regulator giving its expert advice to the OFT in the discharge of its responsibilities and as a paramount consideration.
Jim Shannon
Many hon. Members will probably have received correspondence from the Nuffield Trust saying that
“much of the behaviour of providers will in practice be shaped by detailed guidance and the work on pricing conducted by both Monitor and the NHS Commissioning Board. The two organisations have a major task ahead of them to ensure there is the necessary information, data exchange, contracting and payment tools to support patient choice, integrated care, efficiency and quality.”
How would the Minister respond to the Nuffield Trust on that question?
Paul Burstow
What I heard the hon. Gentleman set out was a rehearsal of the interrelationship that exists between the NHS Commissioning Board and Monitor, particularly in the area of setting NHS tariffs and prices. For the first time, as a result of this legislation, there will be greater transparency and requirements about consultation in the design of those tariffs. At the moment, that process is obscured within the bowels of the Department of Health without accountability or public scrutiny. For the first time, this Bill puts that on a footing that ensures that transparency. As a result, it will produce much better tariff design for the future.
On Monitor’s role as the regulator of foundation trusts, it is important to be clear about this important part of the legislation. Foundation trusts will remain the principal providers of NHS services. The Government do not expect that to change. Monitor must therefore be able to continue operating a compliance regime transparently to assess and manage the risks, intervening proactively to address problems where necessary. The Bill is designed to reflect this and for Monitor to protect patients’ interests by regulating foundation trusts so that they continue to be able to provide NHS services in line with their principal purpose. Where Monitor identifies significant risk to a foundation trust’s continued ability to provide NHS services, the Bill provides Monitor with powers to intervene proactively to ensure that the risk is addressed. The Government agreed amendments in the House of Lords to clarify that further. In particular, the amendments clarify that Monitor’s powers to direct foundation trusts to do, or not to do, things to maintain essential standards of governance, or to ensure their continued ability to provide NHS services, will not be transitional powers. We accept that that previously was not as clear as it needed to be and we have made it clear.
We think that the Bill has been improved as a result of the amendments that were made in the House of Lords in that regard. Under clause 94 in the latest version of the Bill, Monitor’s enduring powers will include the power to set and enforce requirements specifically on foundation trusts to ensure that they are well governed. Monitor does that now and those requirements will need to be differentiated for foundation trusts to reflect their unique role and legal status as public benefit corporations financed by the taxpayer with a principal purpose defined in statute as being
“to provide goods and services for the purposes”
of the NHS. Monitor will also have enduring powers to set and enforce requirements on foundation trusts to ensure that they remain financially viable and to protect NHS assets. These measures deal with one of the concerns that has often been rehearsed about the privatisation of the NHS. The Bill does not provide that opportunity, but it provides for the protection of NHS assets. Those are necessary conditions of a foundation trust’s continuing ability to provide NHS services; they are not transitional issues.
Grahame M. Morris
I would appreciate the Minister’s clarification about reports that have been made available as a result of freedom of information requests indicating that senior officials of Monitor have been meeting on a regular basis with representatives of the private health care consultancy, McKinsey. Is the Minister aware of the nature of those discussions and do they have any relevance to the assurances that have been given at the Dispatch Box that there is no conspiracy to privatise the health service?
Paul Burstow
Absolutely not; the reports to which the hon. Gentleman refers, which had a substantial exposé in The Mail on Sunday, really do not bear as close an examination as he would like of them. We know that the relationship that existed in terms of contracting McKinsey to provide services was one that the previous Government engaged in far more freely than the current Administration. The amounts that this Government have contracted and the nature of the relationships that this Government have are far smaller.
Barbara Keeley
I have asked the Secretary of State about McKinsey and Co. in this Chamber and through a written question, but neither he nor anybody in the Department seems able to confirm whether it has access to the risk register. It seems very strange to me that the Department is not able to answer the question of an hon. Member about what access that organisation has to those documents. It is a very strange set-up.
Paul Burstow
The hon. Lady says it is a strange set-up and refers to her endeavours to get an answer to the question. I have not seen details of her exchange with the Secretary of State, but I will look at that and write to her with an answer to the question.
Simon Hughes (Bermondsey and Old Southwark) (LD)
My hon. Friend is dealing with matters of great concern outside this place, and I am clear that all these amendments are a move in the right direction. Will he put it on the record that as a result of the Bill, first, it will not be possible in future for any hospital to move, as Hinchingbrooke did, from the public sector to the private sector, and, secondly, that the proportion of private sector business cannot be increased up to the 49% that has been mentioned and will be increased only if the hospital decides, according to the amendments, to increase it by the small percentage that the amendments now allow?
Paul Burstow
I am grateful to my right hon. Friend for his questions. Let me start with the issue of Hinchingbrooke, which is an important one. It is worth remembering that the vast majority of the process that led to that franchise arrangement was completed under the Labour Government, not by the current Administration, and was part of the arrangements put in place by the Labour Health Act 2006 and Health and Social Care Act 2008. The Bill makes sure that in future there can be no scope for sweetheart deals to incentivise new entrants into the NHS, it ensures that there cannot be price competition of the sort that was allowed under the 2006 Act, and it ensures a protection for commissioners to decide when and if it is appropriate to use competition. That is not a protection that they enjoy under the 2006 or the 2008 Acts.
Paul Burstow
I have answered the hon. Gentleman’s question. He should read Hansard later.
I was asked, finally, whether there is a cap of 49%. Let us go back to the deliberations in another place before Christmas, when the issue first came up. Our noble Friends were concerned to make sure that we put it beyond doubt that foundation trusts were protected from the full force of competition law and that those organisations would continue to have as their principal purpose their service of NHS patients. That is why we have further amendments, which I shall come to shortly, about how a 5% increase would trigger further consultations and votes by the governors.
Paul Burstow
No. I shall make some progress, if the hon. Lady does not mind.
In addition, Monitor could also, in exceptional circumstances, use the enduring powers that I was describing to direct a foundation trust to remove its directors or governors. In other words, a direct intervention power is preserved by the amendments and changes that we have made.
The Government’s ambition is that eventually foundation trusts should have more responsibility for their governance than they do under the current arrangements. This will depend, in particular, on strengthening the role of foundation trust governors in holding their boards to account. We have listened to the concerns about the pace of change. Hence, we have amended the Bill so that Monitor will also have, on a transitional basis, express powers to remove, suspend or replace directors or governors of a foundation trust directly, without the prospect of an appeal to the first-tier tribunal. We would expect Monitor to use these powers to address failure of governance, which puts the trust at risk of not meeting its licence conditions, such as the requirements that I have already described.
Karl Turner
Is it right that the only provision preventing privatisation is the requirement in clause 161 that foundation trusts must use the NHS more than they use private providers? Is that not, in effect, the 49% cap?
Paul Burstow
No, because the overarching duty is that the service remains free at the point of use. Also, there are protections—[Interruption.] The hon. Gentleman asks a question, but when I try to give him an answer, he shouts and screams at me. That does not help the debate. What I wanted to say was that when it comes to mergers and acquisitions, there are clear requirements to protect NHS assets from a transfer out of the NHS and out of the state sector. The powers that I was describing would be retained as long as Parliament considered necessary, and they could not be removed before 2016 at the earliest and would then be subject to criteria that Monitor determines, with the Secretary of State’s approval.
Barbara Keeley
I do not know whether I am alone in this—I do not think so—but the notion of foundation trust governors having to approve an increase in private patient income does not feel like much of a safeguard, especially as the governors are inclined to balance the books. It just means that the proportion of private patient income will slowly grow to 49%, rather than jump to it straight away. While we are thinking about this aspect of clause 163, I understand that the Department of Health still has an explicit target in the operating framework to increase the proportion of non-public sector provision purchased with NHS funding. There are so many pressures and drivers that the denial that it is privatisation and the influx of competition—[Interruption.] It is privatisation that will slowly grow to 49%.
Paul Burstow
Absolute nonsense. That is part of the rhetoric and fantasy that we have heard throughout the Bill’s passage. Let me deal directly with it by reference to examples of current practice. The Royal Marsden and the Royal Brompton and Harefield all earn very high levels of private income but are consistently rated highly as providers of NHS services. They use those resources to reinvest in NHS services.
Mark Simmonds (Boston and Skegness) (Con)
Will the Minister confirm that most of the foundation trusts that are interested in raising and removing the cap want to invest the money that they would generate from private income to improve services for NHS patients? [Interruption.]
Paul Burstow
That is exactly the point; those moneys have to be reinvested—[Interruption.]
Madam Deputy Speaker (Dawn Primarolo)
Order. Members will not keep shouting across the Chamber, from either Front Bench or elsewhere.
Paul Burstow
My hon. Friend’s point seems to have upset some hon. Members, but it was entirely—
Paul Burstow
Let me at least do my hon. Friend the courtesy of answering his point before taking another intervention.
It is absolutely right to make the point about the use of those resources. Indeed, that has been one of the benefits of the system, as we have seen in the performance that some of the trusts that have had historically high caps have delivered in NHS services. However, it is worth noting that it is not just in relation to foundation trusts that there have been concerns about caps, because NHS trusts have never had caps, and it has been entirely possible for NHS trusts to increase their income without any of the constraints or controls that foundation trusts have found themselves under. The Labour party, in crafting its manifesto, seemed to have understood that, but it has now decided to run away from that in order to paint a picture about privatisation that is not part of this legislation.
Paul Burstow
We have also clarified a foundation trust’s principal legal purpose to show that it must continue to earn the majority of its income from NHS activity and that that is its overriding priority. Revenue for treating NHS patients could absolutely not be used to cross-subsidise private care, and we would expect Monitor’s licensing regime to prohibit that categorically. The amendments provide important safeguards, so I urge the House to support them.
Finally, this group contains a number of minor and technical amendments, including those implementing recommendations from the Delegated Powers and Regulatory Reform Committee that provide for greater consultation and clarify various matters. I urge hon. Members to support the Lords amendments in this group and to reject the Opposition’s amendments to Lords amendment 148.
Andy Burnham
I am not going to debate that now. The right hon. Gentleman is going to have to defend himself on whether he has his facts right. I do not think that he has.
We need to put firmly on the record that there are real flaws in the Liberal Democrats’ proposal. They say that it is a safeguard to state, “The governors will decide and it is better done at a local level,” but the governors are going to be under pressure from the management of the hospital because of the pressure on the hospital’s finances. If they make a decision that is in the interests of that hospital, it does not mean that it is in the interests of everybody and of NHS patients.
Paul Burstow
The model that the right hon. Gentleman describes is one that he was only too happy to go through the Lobby and support during the introduction of foundation trusts in the first place. He has omitted to mention Monitor’s role in overseeing the situation through its powers of intervention to ensure the safeguarding of a comprehensive health service, and to mention the guidance that the Secretary of State will give Monitor in order to do just that.
Andy Burnham
I am afraid that I am not at all reassured by that, or in fact by anything the Minister says. The letter that we have from the Deputy Prime Minister spoke of insulating the NHS from European competition law, but I am still waiting to see the amendment that delivers that. As I understand it, one of the Minister’s noble Friends tabled an amendment and then withdrew it, because they did not have the courage to press it to a vote, and accepted a statement on the record instead. This is different from what the Minister keeps saying that we did in government, because he is envisaging a huge expansion of the role of any qualified provider and the putting out to tender of commissioning support units. He has overseen a situation in which three community services have been compulsorily tendered.
The truth is that the Clegg-Williams letter, with the amendments that followed, does not only fail to deliver but sells out the national health service, as does so much of what the Liberal Democrats have agreed to. Our amendments, particularly amendment (b), would provide a measure of systems regulation in the best interests of the NHS, and that is why we will seek to press amendment (b) to a vote.
Simon Hughes
I will give way to my hon. Friend and then to the shadow Secretary of State.
Paul Burstow
I am grateful to my right hon. Friend for setting out these issues again so clearly and for putting to rest the myths that are yet again being fanned by Opposition Members. I confirm that the Bill provides two further safeguards. First, Monitor will continue to have a direct oversight role in this regard. It will be able to intervene and use its licensing powers and other powers to deal with concerns if NHS services are put at risk by the decisions of a foundation trust. Secondly, there are the contractual relationships that commissioners have directly with these organisations.
Simon Hughes
I accept that. That is why the amendments tabled by the right hon. Member for Leigh (Andy Burnham) are not necessary. Monitor already has a control that it can exercise to ensure that what he calls strategic control or central control is retained, as well as local decision making.
I will end this point by saying that although, technically, there could be a vote of the governors of any hospital—in the right hon. Gentleman’s constituency or mine—every year to increase private income by more than 5%, that is not the real world. In the real world, the people of this country love their national health service, NHS staff love their national health service, and the governors of the hospitals that I represent love their national health service. Those people are not suddenly going to change their attitude after 60 years of the NHS.
In the post-war Parliament, when the Labour party, supported by the Liberal party, put through the plans drawn up by Beveridge, the Liberal, for the NHS, it accepted from the beginning that there would be some private sector activity. From the beginning, GPs and some dental services were in the private sector, and they have remained there.
I am clear that the Bill does not mean that there will suddenly be a market, a route or a tramway for privatisation. Others say I am wrong—I know that there is a lot of concern—so I am clear that when the Bill becomes an Act, we need to sit down with the health professionals who still have concerns—[Hon. Members: “Too late.”] No, it is not too late if people understand what is really in the Bill, rather than what some people say is in the Bill. It is not too late if people look at the wording of the legislation, and do not just listen to the arguments about it.
I say to the right hon. Member for Leigh, whom I respect in many ways, that he has often distorted what has happened in the past and what will happen now. He has ignored the facts that Labour forced privatisation on the health service in many parts of England and that Labour paid more to the private sector to carry out activities for the NHS. I am here to support these provisions in the Bill because I want to end the incentives for the private sector and to end the enforced privatisation of the health service. I will ensure that there is no chance of any hospital in my part of the world voting significantly to increase private sector activity, because the NHS wants to remain in the public sector and deserves to be supported by us to do so.
I refuse to be misrepresented by Labour colleagues who accuse us of doing something that we are not doing. We have a public national health service, paid for through our taxes. Everybody has an entitlement to the best care in the country. I will not do anything that undermines that. I hope that the right hon. Member for Leigh will not and that Ministers will not. I agree that we have some work to do to reassure people outside this place. I hope that, from today, the right hon. Gentleman will join me in telling the truth about the Bill and not tell untruths.
Lords amendment 63 agreed to.
Lords amendments 64 to 147 agreed to, with Commons financial privileges waived in respect of Lords amendments 132 to 141.
Clause 161
Goods and Services
Amendment (b) proposed to Lords amendment 148.—(Andy Burnham.)
Question put, That the amendment be made.
Mr Deputy Speaker (Mr Nigel Evans)
With this we will consider Lords amendments 12, 43 to 53, 61, 62, 168 to 241, 243 to 245, 247, 249 to 251, 253 to 286, 288 to 291, 327, 333, 334 and 366 to 374.
Paul Burstow
This group encompasses a number of Lords amendments relating to public health, public involvement, local government, the Health and Care Professions Council, the National Institute for Health and Clinical Excellence and the NHS Information Centre.
We believe that the Bill has been improved as a result of the amendments made in the House of Lords. For example, the Government have directly addressed the concerns raised in this House and elsewhere about the status and security of directors of public health within local authorities. We have also introduced safeguards to ensure that local healthwatch organisations and HealthWatch England can operate effectively within the Care Quality Commission, and that the CQC can have better links with, and transparency to, local healthwatch organisations.
Throughout the Bill, we have emphasised the importance of public health. In particular, local directors of public health will have a leading role within their local authorities in ensuring that public health is a consideration across the full range of local government activity, not just its health responsibilities. For example, they will use their participation in health and wellbeing boards, alongside directors of adult social services, directors of children’s services and clinical commissioning groups, to find innovative solutions to local health needs.
To further strengthen the status of public health in local authorities, amendments tabled by my noble friend Earl Howe establish directors of public health as statutory chief officers of their local authorities. They also give the Secretary of State the power to issue guidance on the role of directors and other public health staff, to which local authorities must have regard. Along with the guarantee of chief officer status and statutory guidance, that is equivalent to the situation that currently applies to directors of children’s services and of adult social services.
Other Lords amendments will enable us to give directors of public health a key new role in considering applications for the licensing of premises for the sale of alcohol, and enable the national child measurement programme to continue once it is transferred to local authorities.
Beyond the provisions of the Bill, we have stated clearly that Public Health England will have a board with an independent, non-executive majority and an independent chair, to provide the chief executive and the Secretary of State with frank and expert challenge. Public Health England’s ability to undertake research and bid for external funding for health protection research in the same way as the Health Protection Agency is also provided for in the Bill as now drafted. Finally on public health, we have announced our intention, subject to consultation, to require the registration of non-medical public health specialists with the Health Professions Council.
We introduced safeguards in the other place to ensure that HealthWatch England could operate effectively within the CQC and have better links with, and transparency to, local healthwatch organisations. That will help to ensure that issues arising between them can be addressed, and local authorities and local healthwatch organisations will have to have regard to similar guidance. HealthWatch England will also exercise additional functions to assist local authorities with the arrangements that they make for local healthwatch. HealthWatch England may make recommendations of a general nature to local authorities about the making of those arrangements. When it is of the opinion that local healthwatch activities are not being properly carried out, it can draw that to the attention of the local authority.
The Lords amendments will ensure that regulations are able to, and in some cases must, make adequate and appropriate provision about HealthWatch England’s membership. That will include specifying that the majority of members must not be members of the CQC board, and setting out the procedures for selecting members or proposing persons for appointment as members. We listened to the concerns on that issue and have now undertaken a public consultation on the proposed regulations. The results are currently being carefully analysed.
A number of the amendments in this group apply to local healthwatch organisations. They will strengthen the statutory powers of those organisations, enabling them to become a powerful champion of patients’ interests locally. As a result of the Bill, they will have stronger and more wide-ranging powers than local involvement networks do under the current arrangements. The Government are ardent proponents of localism and of local authorities being able to take account of local needs and be accountable to their local population for the decisions that they make.
Simon Hughes
One thing that has got lost in all the noise about the Bill is the fact that there will be more opportunity for local authorities and local people in England to be engaged. Will my hon. Friend put on record how an ordinary constituent of his in Sutton, mine in Southwark or anywhere else—not a professional such as a GP or a nurse—will be able to get involved? I think there will be a much better system in future than there has been.
Paul Burstow
My right hon. Friend is absolutely right. Hard-wired throughout the Bill are requirements on patient and public involvement in clinical commissioning groups and health and wellbeing boards. Local healthwatch will provide a vehicle for delivering much wider engagement. One criticism that has often been levelled at past attempts at public and patient engagement has been the absence of hard-to-reach groups, which are seldom heard from in our health system. As a result, their voices have not helped to shape commissioning decisions. We need to ensure that they do, so that CCGs commission effectively for their whole population. That is a key part of what the Bill provides for.
As the Bill makes its way on to the statute book, Members of all parties will need to look closely at the opportunities for far wider public involvement that will result from how it has been improved. We have listened closely to groups such as the Richmond group, which has been a powerful advocate on behalf of a wide range of patients’ groups. It has talked about the importance of involving patients far more in co-production and commissioning decisions. That is an essential component of how we intend the Bill to be given effect in the months to come.
In tabling our amendments in the House of Lords, we wanted to ensure that local authorities had greater flexibility in the organisational form that local healthwatch takes. Local authorities are best placed to make decisions about the right way to commission a local healthwatch service for their area, but they cannot decide not to have a local healthwatch organisation, and we would not allow them to do that. It is essential that the voice of patients and carers is heard loud and clear in the decision-making processes of our NHS and social care services.
Andrew George
I am grateful to my hon. Friend, particularly for his last remark. I know that he will come on to Lords amendment 181, but I could not find anything in the debate in the House of Lords justifying the rationale behind the provisions relating to the establishment of local healthwatch organisations as statutory bodies corporate. I am sure that he is just about to provide that rationale.
Paul Burstow
I am grateful to my hon. Friend for the opportunity to do just that. First and foremost, I want to be absolutely clear that local authorities are under a statutory duty to ensure that local healthwatch arrangements are put in place. The Lords amendments do not change that one iota, and they do not in any way weaken the statutory functions conferred upon local healthwatch organisations. Nor do they enable local authorities in some way to limit, restrict or censor what local healthwatch organisations can do. Indeed, we tabled amendments to ensure there are better safeguards in relation to how local authorities carry out their role. The Secretary of State will be able to publish guidance relating to potential conflicts of interest between a local authority and its local healthwatch organisation, to which both sides must have regard. We have provided for HealthWatch England to make recommendations in that respect, but to be absolutely clear, local healthwatch has a statutory basis. All that has changed is that we want to enable local decisions about whether it is a social enterprise, a voluntary organisation or another format.
Grahame M. Morris
Will the Minister clarify that point and the issue raised earlier by the right hon. Member for Bermondsey and Old Southwark (Simon Hughes)? One Lords amendment allows a local authority to commission a community interest company, charity or other form of social enterprise that meets the prescribed criteria to be the local healthwatch for its area, and allows local healthwatch to make arrangements with others to carry out its functions—it effectively allows local healthwatch to delegate its functions to a community interest company. How does that address the concerns raised by the right hon. Gentleman? How would an individual constituent have their interests represented through a local healthwatch if it is no longer a statutory body?
Paul Burstow
The point is that the body will discharge a number of statutory functions. The models that the hon. Gentleman describes—community interest companies and other forms of mutual or social enterprise—are exactly the sort of organisations that are likely to engage more effectively with community interests and bring in a wider range of them. That is why we want that flexibility in the organisational form, against a set of criteria to safeguard the interests of the public. The public can tailor those organisational forms to meet the needs of their local community. That corporate envelope does not guarantee anything; the legislation still provides a statutory basis.
Simon Hughes
One last time—I am grateful to the Minister. Will he put on the record what constituents all over England can do if, for example, they hear that their hospital might want to close a ward for the mentally ill, or close accident and emergency services, or if it realises that there is no day care for people with mental illness? What power do they have to stop or start something?
Paul Burstow
Despite the noises off, the fact is that there is considerable scope for that sort of public shaping.
Let me talk my right hon. Friend through some of those changes. We are establishing local health and wellbeing boards, which are made up of clinical commissioning groups, elected local authority members, the various directors to which I just referred, and, importantly, local healthwatch organisations. They have the statutory responsibility for identifying population need for their area and for then framing the strategy to meet those needs. The local commissioner must evidence that the strategies for delivering that—the local commissioning plans—reflect the commissioning strategy that has been produced by the health and wellbeing board. That is the first opportunity to intervene and to help shape the nature of services that are being commissioned for a local population. Indeed, we made amendments that make it clear that health and wellbeing boards must involve their population in that work.
The next stage when people can be involved is when the clinical commissioning group produces its commissioning intentions and plan. CCGs have obligations to consult on their plans and to involve the public in their formulation. That is a further opportunity, but beyond it there is a role in commissioning decisions, or decisions to change or reconfigure a service, for the local authority’s health and overview scrutiny committee, which we are retaining and enhancing, so that, for the first time, NHS providers in the public sector or private providers providing NHS-contracted services can be held accountable for their decisions. That is a change from the arrangements under the previous Administration.
Those are just a few of the steps, but ultimately we have retained the provisions for a reference by the local authority to the Secretary of State to make decisions regarding major reconfigurations. There are a number of steps. I hope that that reassures my right hon. Friend and gives the lie to those who suggest that the provisions have been watered down—the contrary is the case.
We have committed to use the Secretary of State’s powers to specify the criteria that local healthwatch organisations must satisfy when it comes to strong involvement by volunteers and lay members, including in their governance and leadership. We want to ensure that local healthwatch organisations break out of existing models and find ways of reaching and involving far wider and more representative populations than hitherto.
I can confirm that there are a number of amendments, the majority of which are technical in nature, relating to the Health and Care Professions Council, NICE, and the NHS Information Centre. Part 7 of the Bill relates to the regulation of health and social care workers. The Government have made a technical alteration to the provisions amending article 12 of the Health Professions Order 2001 to enable the Health Professions Council to recognise training undertaken in Wales, Scotland and Northern Ireland as sufficient for admission to its register as a social worker. The amendments also give the council the power to assess training or professional expertise and experience in social work gained outside England but within the UK.
Part 8 of the Bill establishes the National Institute for Health and Care Excellence—I emphasise the word “care”—and extends its remit to adults’ and children’s social care. NICE will play a central role in driving quality improvement through the production of robust, evidence-based quality standards and other guidance across the NHS, social care and public health. That is yet another measure in the Bill that supports and drives greater integration of health and social care than has existed in the past. The Government have made minor and technical amendments to part 8 to avoid the potential for misinterpretation and to ensure that NICE’s functions can be exercised effectively in practice.
It is important that patients continue to have access to NICE-approved drugs and treatments in line with the NHS constitution and accompanying handbook, whether those fall within the future responsibilities of the NHS or of local authorities. We have therefore amended the regulation-making power in clause 234 of part 8 so that the provision in regulations to replicate the effect of the current funding direction for NICE technology appraisal recommendations may also be applied to local authorities in respect of the drugs and treatments that they may prescribe for public health purposes, such as smoking cessation aids.
Part 9 establishes for the first time the NHS Information Centre in primary legislation, setting out its powers in relation to the collection, analysis, publication or dissemination of information. The Government have made a number of amendments—to clauses 255 and 257—and inserted new clauses after clauses 252 and 257 that further strengthen the protection of individuals’ confidential personal information while ensuring that the wider benefits of safely and securely sharing information, which include improvements in the quality of services and treatments, can be realised.
The amendments will, for example, restrict the people who can require the centre to collect confidential, personal, identifiable information; clarify the circumstances in which the centre may require others to provide it with confidential, personal, identifiable information; and require a code of practice to be published, setting out how confidential information must be handled. That provides an essential safe haven that can provide a powerful driver to support research and quality improvement in the NHS.
To support these amendments, we have made a number of minor and technical amendments to part 9 and to schedule 19. Finally, we made a minor and technical amendment in part 11 relating to the transfer scheme, which is set out in clause 294. That provision allows for flexibility in how the Secretary of State holds his shares in any property company. That is normal for company structures and is in a form already used by the Secretary of State with his other companies.
I urge hon. Members to support these amendments, including amendment 181.
Liz Kendall
I start by sharing with hon. Members a letter to the Prime Minister on 13 March from Malcolm Alexander, who is the chair of the National Association of LINks Members, the national body representing 150 statutory independent local involvement networks that promote the public and patient voice in health and social care. The letter is about the amendments to HealthWatch that were made in the other place and are before us now. He wrote to register his
“strong objections to the government’s major policy change on Healthwatch—specifically your decision to abandon plans to establish statutory Local Healthwatch bodies…Instead of creating independent statutory bodies led by local people who can monitor, influence, involve the public, hold the local authority and NHS to account; the government plan to create weak bodies that will not be independent, but will be funded by and accountable to the local authority they are monitoring. There will be no genuine accountability to the public.”
He then makes this rather perceptive comment:
“Plans for a statutory Healthwatch body were probably the only part of the Health and Social Care Bill that had any public support.”
He continues:
“Your government’s ambition”—
not your Government, Mr Deputy Speaker, but the Prime Minister’s—
“to establish independent, statutory Healthwatch organisations that would help achieve equity and empowerment in relation to access to NHS and social care services, has been diminished to such a degree, that Healthwatch will have little impact…The aspiration to achieve equity and excellence in public involvement in health and social care, especially for the most vulnerable people, has been replaced by a model that has lost its central purpose of building effective patient and user led bodies that can influence the planning of health and social care.”
Paul Burstow
Just to be absolutely clear, may I say that clinical commissioning groups cannot subcontract decision making about their commissioning functions—that is crucial to the effective delivery of this. On the issue of the local healthwatch organisations, the Bill makes it clear that local healthwatch has to exist in each locality, and that local authorities have to contract for it to exist and to provide the range of services that the Bill provides for it to undertake.
Simon Hughes
I absolutely understand both those points. I understand that commissioning groups cannot subcontract their decisions, but the point I am making to my hon. Friend and to other Ministers is that we have to ensure that the groups do not end up in the position where, although they retain the decision, they leave lots of the thinking about it to the people they employ to do the work. The decisions have to be made by the health professionals. In reply to the Labour amendment, the Minister rightly said that it is a safeguard that local authorities will have the decision on the local healthwatch. Where a local authority is concerned that it should remain in a particular format, it will be able to do so.
In conclusion, I am clear, as I have said to Labour’s Front-Bench team, to constituents and to my friends on the ministerial team, that our constituents still have a huge amount of concern about this Bill; I am clear that a lot of it has arisen because of misinformation and misrepresentation; and I am clear that this is not a privatisation Bill and not a “carve up the NHS” Bill. However, everyone, including Government Members, will need to continue to be vigilant and to continue to talk to the health professionals. I hope that the Government and the health professionals will start talking again very soon. We will also all need to make sure that we understand their concerns and pass them on. I know what my constituents want at the end of this debate; they do not actually want lots of conversations about structures of the health service.
NHS Quality Standards
Paul Burstow Excerpts(12 years, 9 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Minister of State, Department of Health (Paul Burstow)
Today we are referring new NHS quality standard topics, that supplement previous referrals, to the National Institute for Health and Clinical Excellence (NICE)
NICE quality standards are a set of specific, concise statements and associated measures. They set out aspirational, but achievable, markers of high-quality, cost-effective patient care, covering the treatment and prevention of different diseases and conditions.
Quality standards will underpin the commissioning process. Under the provisions set out in the Health and Social Care Bill, the Secretary of State and the NHS Commissiong Board will come under new duties to have regard to any quality standards produced by NICE.
This list of topics being referred today follows advice received by the National Quality Board (NQB). The NQB developed a proposed list of topics in partnership with the Academy of Medical Royal Colleges which was then the subject of an engagement exercise conducted between 15 August and 14 October 2011.
Responses to the engagement exercise were supportive of the overall quality standards programme and the diversity of topics put forward. Detailed comments were also received on what particular aspects of care should be addressed by specific quality standards and we have asked NICE to take these detailed comments into account when developing quality standards.
In addition to this referral of NHS topics, we are today referring three pilot topics for development into NHS facing quality standards on cross-cutting public health topics. These quality standards will focus on the action the NHS can take in these areas, and comes in response to the recent recommendations from the NHS Future Forum that NICE should develop quality standards setting out the evidence-based action that the NHS can take in relation to the main lifestyle risk factors.
The NQB will continue to keep the sequencing of quality standard topics under regular review as well as the case for referring additional topics, taking into account operational requirements, NICE’S capacity to produce quality standards and clinical guidelines, and the evidence that is available at the time.
A copy of today’s referral letter to NICE (including a list of topics) 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. Further information on quality standards can be found on NICE’s website: www.nice.org.uk.
Adult Social Care
Paul Burstow Excerpts(12 years, 9 months ago)
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The Minister of State, Department of Health (Paul Burstow)
I am very grateful for the opportunity to speak in this debate. I start by thanking the Backbench Business Committee for granting it and my hon. Friends the Members for Truro and Falmouth (Sarah Newton) and for Stourbridge (Margot James) for securing it and leading it so well.
I have chosen to speak early in the debate because I want to spend the majority of it listening to colleagues. I undertake to respond to their questions in writing if necessary to ensure that we have a clear record of the Government’s position on these issues.
I pay tribute to the Care and Support Alliance. The lobby that it organised this week was a truly powerful event, because of the testimony of individuals who made the journey to Westminster to lobby their MPs. I had the pleasure of spending an hour being cross-examined by a large number of people on that lobby, and I found it a really useful opportunity to talk about social care.
I have been a Member of Parliament for more than 15 years and raised the issue of social care reform throughout that time. For far too long, it has been left in the “too difficult to do” drawer, and it is now due attention from the House and the Government. We must not make the mistake of putting it back in that drawer, which would be dangerously short-sighted.
What does high-quality social care mean? It means helping people to stay healthy, independent and out of hospital. As the hon. Member for Worsley and Eccles South (Barbara Keeley) said, it means reducing pressure on the NHS, but above all it means helping people to live the lives that they want—long, safe and comfortable lives with the maximum possible independence. That is why the coalition Government are determined to tackle social care, and we have already set to work on doing just that. We established the Commission on the Funding of Care and Support, chaired by Andrew Dilnot, to make recommendations on how we could develop an affordable and sustainable funding system for social care. My hon. Friend the Member for Truro and Falmouth outlined those recommendations.
Kelvin Hopkins (Luton North) (Lab)
There is constant emphasis on the importance of independence and of people living their own lives, but many people who depend on care want company. Some would prefer to live in decent, appropriate care than to be left on their own in their home and not cared for appropriately. Is the Minister not aware of that?
Paul Burstow
I am most certainly aware of that. Social isolation is a huge burden on the individuals affected by it and has huge consequences for health care. That is why, when I talk about independence, I also mean interdependence—the recognition of the value of family support and carers, and of the fact that people need to be active in their community throughout their life. Social care has a role to play in enabling people to do just that, rather than become institutionalised in their own home or a care home. I absolutely agree with the hon. Gentleman about that.
The Dilnot commission made a number of recommendations on the development of a system such as I mentioned, and my hon. Friend the Member for Truro and Falmouth described them well. In the spending review, we allocated an additional £2 billion by 2014-15 —£7.2 billion over the spending review period as a whole. In November 2010, we also set out our vision for social care reform, including the roll-out of personal budgets and greater personalisation. I agree that we need to ensure that that is genuinely about how we enrich people’s lives, not just an opportunity to reduce the available resources to individuals. We are also investing £400 million over four years to help to give carers much needed breaks. We are ensuring that the NHS is held firmly to account for delivering the money in the coming year by making sure that it has to account directly to carers’ organisations locally, and agree with local authorities the plans to provide breaks, spell out how many there will be and the size of the budget for that purpose.
It is also important to dispel a myth about social care, which has been hanging around for far too long—that, in some way, it is just like the NHS and free. As my hon. Friend the Member for Truro and Falmouth said, it is not free and never has been. If people assume that the state will pick up the bill, they are unlikely to prepare themselves. If they do not prepare and they need help, the impact can be truly devastating for them and their families: life savings wiped out, family homes full of memories sold off, and thoughts of a comfortable retirement turned to dust.
We therefore recognise the problem, which is getting worse. Our population is ageing, and that should be a cause for celebration. Too often, debates about ageing in our media are couched in terms of demographic time bombs and the like. However, the current care and support system is not fit for purpose. I agree with the Care and Support Alliance about that. It is broken, and patching and mending it is no longer acceptable.
However, reforming social care will not be easy. As has been said, it will require bold thinking and difficult decisions. The Dilnot commission shed much needed light on the reality of social care funding. Soon, we will publish a White Paper and a progress report setting out our response to the recommendations.
Barbara Keeley
Perhaps the Minister will enlighten us on what is meant by “spring”. There is speculation that spring might extend to May, June or July. When I was in government, I spent a lot of time answering questions about what spring meant in relation to Government reports. Will he tell us what it means now?
Paul Burstow
On that basis, the hon. Lady knows the answer that I would give and I shall therefore not tire her by saying what she would have said if she were in my place. We are anxious to publish a White Paper as soon as we can in a way that ensures that we have successful dialogue with the Opposition on funding. Those two matters are interdependent.
We are considering not just funding reform, but the legal structure that governs social care, which must be updated. The Law Commission has done a sterling job of making recommendations for replacing the patchwork that has built up in the past 60 years with a legal framework fit for the 21st century. A new social care law will bring clarity where today there is a complicated and confusing system, facilitate personalisation and support staff, service users and carers.
Beyond that, we need high-quality, integrated care, which focuses on early intervention, prevention and the needs of the individual. Better care is about not just spending more money, but spending it much more wisely. The Health Committee made that point powerfully to us. Some councils do that well; others could do it better. That is why the Government are jointly funding with the Local Government Association work to support councils to release savings while improving the care and support they provide.
The Health and Social Care Bill will foster far greater integration between the NHS, social care and, importantly, other public services. Health and wellbeing boards will bring together democratically elected local councillors, directors of children’s services, adult social services and public health services, clinical commissioning groups, and, importantly, the public through Healthwatch, to improve services in our communities. They will identify local needs now and for the future and, importantly, be accountable for setting the strategy to meet those needs. The unprecedented transfer of money from the NHS to social care is creating new opportunities for joint working.
However, we have a long way to go to improve the quality of social care, especially for older people. Clinical audits on fractures or continence care; the parliamentary inquiry into the human rights of older people in health and social care; and damning reports by charities such as the Alzheimer’s Society and Age UK all point to the fact that health and social care in England is far from universally excellent. In too many cases, it is very far indeed from being excellent. There can be no excuses and no mitigating circumstances. Yes, there are excellent staff working in our services, but some staff need to be challenged, and some need to leave the profession because they do not do the right thing. We need to be honest. We need to applaud the good, but to shine a light where there is no good.
It is not a matter of not having enough staff. In some places—
Paul Burstow
I will in a moment, because I made a point in direct response to my hon. Friend.
In some places, full staffing complements perform badly, while places under considerable staffing pressure perform exceptionally well.
Paul Burstow
I will give way to my hon. Friend, who I know works hard on these matters.
Andrew George
I am very grateful to the Minister, whom I respect. Poor standards need to be rooted out wherever they exist, whether among the lowest-paid care workers or the highest-paid managers, but does he accept that the care system is based on workers who work antisocial hours, who are often untrained and unsupported, and whose salaries are appallingly low?
Paul Burstow
I accept that we have a largely untrained work force—or they are not as trained as they should be. This is the first Government to set down the need for training standards for health care assistants and care assistants. We have signed off the funding to allow Skills for Care and Skills for Health to do that essential work for the first time.
On transparency, we need to know what is happening within caring organisations. Transparency is vital to improving the quality of services on offer and to holding providers and commissioners to account. As is happening already in the NHS, we need more information and data to improve the quality of social care. Without those, how can local authorities, individuals or their families hold providers to account?
That is why we published the adult social care outcomes framework last April, which was developed in partnership with the Association of Directors of Adult Social Services, the Local Government Association and others. I thank all those involved in developing that new tool, which has the potential radically to improve the quality of social care in England. The outcomes framework will enable local authorities to hold providers to account, and in turn enable local people to compare and contrast performance on social care in one part of the country with performance in another, and to hold their councils to account.
In the past, the emphasis has been on patients and people who use services bending to the convenience of service organisations. That must change, and it must do so faster than ever before. By focusing on the individual and integrating services around them, we can begin to break down institutional barriers that for too long have held back the improvements in care that the country needs.
Many people’s lives could be so much better. We are right to celebrate the fact that our population is living longer, and often living longer better, but we can do much more to ensure that we add quality to the extra years that the success of our health and other systems have delivered. That is why the best social care means the difference between a life of dependency and life lived with independence and dignity—the difference between a life endured and a life enjoyed, or a life in which potential is not realised or unlocked and a life in which it is.
Social care is among the most pressing issues facing us today—I believed that when I first came into the House. I hope that, during this Parliament, this Government, working in partnership with others and the Opposition on funding, can reach a consensus that can be delivered, and that we can translate that into sustained action. That is how we can do something that has not been done for 60 years.
We have inherited laws that are out of date, which make it impossible for some people to navigate their way around our social care system. It is time to change. That is why the Government will publish our White Paper and set out our plans for legislation. I look forward to more debates on adult social care as time goes by, but today I look forward to listening to colleagues, and will respond to further questions.
Paul Burstow
The right hon. Gentleman made those remarks ahead of the spending review in 2010. The spending review also gave the Government the opportunity to make announcements about social care spending, and it is when we committed £7.2 billion extra for social care support. We have to challenge local authorities to use those resources wisely. Indeed, I hope that he will join me in challenging local authorities to commit to spend the resources that the Government have allocated for social care on social care.
Andy Burnham
Yes, I will. There is no difference between us on that, but there is a difference between us on the funding position that the Minister has set out. The King’s Fund and others have identified that there is a £1 billion funding gap in adult social care in England, not just because of the money but because of the demographic pressures, which we cannot get away from.
The Government’s commitment was to give more money to the health service, but we have produced figures showing a real-terms cut in outturn last year, and we also notice that transfers—indeed, recent transfers—have had to be made to the social care system, which implies that the Government have left it short, and that there is an emergency propping-up of the system, revealing the flaw in their position.
Kelvin Hopkins (Luton North) (Lab)
I apologise for being away from the debate for a short time, Mr Deputy Speaker. I was speaking in Westminster Hall on another subject. Being in two places at once, even for a Member of Parliament, is rather difficult.
I have long had an interest in this subject. I congratulate the hon. Member for Truro and Falmouth (Sarah Newton) on securing this important debate and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on her excellent speech. I also give full credit to the two Front-Bench spokesmen because I believe that they genuinely care about this matter and are not just speaking warm words. I appreciate that.
I will focus on residential care, but I believe that domiciliary care is also in a poor state. I know of many cases in my constituency of people not being looked after well under the new privatised, personalised approach to care. The contrast between that type of care and what people get from an NHS district nurse who goes around to tend to people is extreme. I have spent a day with one of my local district nurses—they are not called that any more, but Members know who I am talking about—and seen how a true professional, a public employee motivated by the public service ethos, treats their patients at home. That is how all sorts of care ought to be provided, rather than by private companies or private individuals who often have heavy work loads, are impatient and do not provide the care and sympathy that they should when they visit people in their homes.
The royal commission on long-term care for the elderly, which recommended that care ought to be free at the point of need on the same basis as the national health service, was absolutely right. The Government of the time rejected its recommendation, and went so far as to ensure that a couple of members of the commission voted against it so that it was a majority view, not a unanimous one. I personally think that was a terrible thing to do. I have raised it before in the Chamber and probably will again, because I think it was so wrong. Nevertheless, the royal commission recommended free long-term care for all, and I absolutely agreed.
I tabled an early-day motion in the 1997 to 2001 Parliament calling for the Government to adopt the royal commission’s recommendations. More than 120 Members signed it, most of them Labour Members, but other parties were represented as well. No notice was taken of it. The current Minister was one of the signatories. I tabled another early-day motion in the 2001-05 Parliament saying the same thing, and it got similar support. I hope I am not embarrassing him, but he tabled a similar motion when he was in opposition, which I supported. We were on the same side at that time, and I like to think that he is doing his best to push that agenda forward within the constraints of the coalition.
My position is absolutely clear: I believe that there should be free long-term care for all, provided by a professional care service of directly employed public service workers. That is how people would be served best, and it would be properly publicly accountable.
Paul Burstow
The hon. Gentleman is absolutely right that I signed early-day motions supportive of the royal commission, but I need to correct the record ever so slightly. He is giving the impression that the royal commission recommended that all aspects of long-term care should be free. I am sure he will want to acknowledge that accommodation and hotel costs were not intended to be covered by its proposal.
Kelvin Hopkins
I thank the Minister for his correction, and I think the situation is possibly similar in the health service.
I come to the problem of affordability. I remember that in the early days after 1997, the Government were trying to keep down public spending, and there was a crisis in the NHS because of under-spending. That crisis was inherited from the previous Government, but for the first two or three years after 1997 nothing happened. We got well behind in what we needed to do to fund the NHS.
During that Parliament, the standard rate of income tax was reduced by 1p, and nobody even noticed. I believe that at that time, 1p on income tax was the equivalent of about £3 billion, and that income was just lost. It could have been spent on long-term care or the health service, but the decision was taken to reduce tax. Later on, in the last Parliament, the then Chancellor decided to reduce the standard rate of tax by 2p. I am not suggesting that the standard rate of income tax is necessarily the way to pay for care, but it is not right to say that things are unaffordable when big tax cuts are being made. I believe that 1p on the rate would now raise about £4 billion or 2p about £8 billion—plenty to pay for free long-term care for all who need it.
Dr Sarah Wollaston (Totnes) (Con)
I have good news: people in their 40s and 50s are at the pinnacle of evolution, according to Dr Bainbridge writing in the New Scientist. I do not think my children would agree with that assessment, but they would agree that they feel rather outnumbered. This is a cause for celebration, however, and we should note it in this House: it is a good thing that we are all living longer—after all, the alternative is very unattractive indeed. A man who reaches the age of 65 can now expect on average to live a further 18 years, and a woman at 65 can expect to live even longer—to 85 and a half. We should welcome that on international women’s day. This is good news all round, therefore, but these extra years must be lived well. We should add to people’s years of life while also helping them live with independence and dignity.
I have the privilege of serving on the Health Committee, and I have also had the privilege of working for 24 years on the front line in the NHS. I have therefore met many carers, and also many people who, sadly, are suffering from dementia. Many Members have commented on that topic however, so I will not discuss it further now.
I want to focus on the Select Committee’s recommendations following our inquiry into social care. I acknowledge that, by 2014, an extra £2 billion a year will be spent on social care, and I welcome that investment. There is still an issue that needs to be addressed, however, and it transcends party politics.
As the King’s Fund and the Dilnot commission have made clear, demand is outstripping supply—by 9% over the past four years—and the Local Government Association and the Association of Directors of Adult Social Services have stated that this underfunding is a long-term problem. According to the King’s Fund, the funding gap could be as high as £1.2 billion by 2014. Also, about 890,000 older people in social care may have a need that is not being met. As the Select Committee heard, some councils are tightening their eligibility criteria, so that people who perhaps would have been classed as having “substantial” needs are now being classed as having “moderate” needs. Other councils are setting a different benchmark, so they are funding only “substantial” needs, rather than both, as they might have done in the past. Obviously, the problem goes beyond the total spend. Government Members are taking a realistic attitude to our national debt, knowing that there are no blank cheques. However, we need to continue to increase our social care funding slightly, so that we can achieve what we want to achieve for our older people: dignity and independence.
It will not matter how much we spend unless we change how we spend it. One thing the Dilnot commission examined well was how we divide our spending. We know that we spend £145 billion a year on older people in England, about half of which goes on benefits, such as pensions, housing-related benefits and pension credits. Some £50 billion is spent on the NHS but only £8 billion goes towards social care. That balance is not right. If we were designing the system from scratch, we would not set the funding in that way. That structural problem has been recognised for decades, but the White Paper and the changes in the Health and Social Care Bill give us an opportunity to address it. I therefore ask the Minister to rebalance things by examining the Select Committee’s key recommendation, which was to deliver integrated health and social care, with a single commissioner or a commissioning body, and to drive this joint working by also looking at pooling budgets.
Some wonderful examples of that approach are available, as we found when the Select Committee visited Blackburn with Darwen PCT and Torbay Care Trust. I am fortunate that the Torbay Care Trust covers much of my constituency, because it achieves real results: low average lengths of stay; rapid access to equipment, thus avoiding hospital admissions; and getting people out of hospital much quicker. The key to all that is recognising that keeping people independent in their own homes, rather than admitting them to expensive hospitals, saves money. As has been said, for every £1 we spend on integration, we save £2.65 for the health service—as is so often the case, the best care turns out to be the cheapest care.
I was disappointed to hear the Minister describe the care trust model as an experiment that never really got “out of the lab”. I urge him to get back into the laboratory with care trusts, because this is good practice. They bring a positive culture on joint working, pooled budgets and putting patients first. In Torbay, they have considered an imaginary patient, “Mrs Smith”, who has complex care needs and at every stage in the system they have designed everything around her, putting her needs first. That sometimes means sweeping away the silo working that we so often see. In many parts of the country, six different phone calls have to be made when dealing with a patient with complex care needs, and there are endless delays and frustrations, and repeated assessments, but Torbay has a care co-ordinator with a single number. We need to adopt that kind of working.
Paul Burstow
The hon. Lady is making an important set of contributions to this debate. That comment I made during the Health Committee’s evidence session was very much born out of frustration—it is frustration that my hon. Friend the Member for Southport (John Pugh) has echoed. How we spread best practice and get it adopted is one of the key challenges in delivering more integrated health and social care, and it is one of the things we are going to address in the White Paper. The Select Committee’s contribution to that process has been very helpful.
Dr Wollaston
I thank the Minister for that encouraging response. I am glad to hear him say that rolling out good practice is key to this. I ask him to consider the Select Committee’s recommendation that the way that we can best drive that is by having a single outcomes framework. We are currently going to have outcomes frameworks for housing, for social care and for elderly people in health. Bringing those together would drive proper integration. Having a single commissioner for all these services would bring people together. If we do not have that, we risk carrying on as we are. When budgets are stretched, as we all accept they are, there is more of a tendency for organisations to say, “This money is for social care”; where spending the money would perhaps improve only health outcomes, there is less of an incentive to spend it. We should consider pooling the budgets, and having a single commissioner and a single outcomes framework. I am not saying that we should be too rigid in imposing how that is done, but we should set out what we expect. In addition, we should recognise how important housing is in this area. We should not leave it out of the equation when we consider how we help older people to continue to live independently.
Winterbourne View
Paul Burstow Excerpts(12 years, 9 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Minister of State, Department of Health (Paul Burstow)
I promised to update the House about ongoing activity in relation to Winterbourne View private hospital and other services for people with learning disabilities.
The House will wish to note that 11 people employed at Winterbourne View appeared in Bristol Crown court on 9 February. Three people have pleaded guilty and have been referred for sentencing reports. A further eight people are due back in court on 16 March.
The Care Quality Commission (CQC) has now completed their focussed inspections of 150 services for people with learning disabilities. The reports from these inspections are being published in batches and a further 20 reports are being published today. They can be found at: www.cqc.org.uk/LDReports?latest.
67 inspection reports have been published so far. These reports have found poor practice in some of the units and some major concerns.
Where the CQC has identified concerns, the provider is required to inform CQC when its improvement actions have been completed. CQC will follow up to check that the improvements have been made, including further inspections where necessary.
We have written to NHS and local authority chief executives to ensure that they are continuing to take action required to address any concerns raised; and review their own commissioning, care planning and oversight arrangements to support improvements.
We will continue to look for ways to drive up standards across health and care for people with learning disabilities.
The results of the CQC inspections programme will feed into the wider departmental review of Winterbourne View, together with the reports from the serious case review and the NHS serious untoward incident review, and evidence from other investigations and reports.
The departmental review is continuing to engage with people with learning disabilities or autism and challenging behaviour and their families about how services can be improved. Ministers will report findings from the departmental review to Parliament and determine what further action is necessary.
I will continue to update the House as things develop.
Oral Answers to Questions
Paul Burstow Excerpts(12 years, 10 months ago)
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Jo Swinson (East Dunbartonshire) (LD)
7. What assessment he has made of the effectiveness of NHS allergy services.
The Minister of State, Department of Health (Paul Burstow)
A number of reports have highlighted variations in NHS allergy services and a lack of integration throughout primary, secondary and tertiary care. The Department has funded the NHS in north-west England to pilot an integrated model of care, and the results of that work have been widely disseminated. The Government expect NHS commissioners to commission services to meet the health needs of their local population and to deliver improving outcomes for patients.
Jo Swinson
I thank the Minister for that reply. He mentions the recent north-west allergy pilot, and its report contains a number of recommendations, including improved education for commissioners about the impact of allergy on primary care, and the allocation of additional specialist allergy training posts. How does he intend to act on those recommendations in order to improve services for millions of allergy sufferers?
Paul Burstow
I am grateful to my hon. Friend, who I know campaigns on these issues and has a parliamentary reception on them later this week. She is absolutely right that we need to ensure that there are improvements in the area, and that is why I can confirm today that discussions are under way with clinical leaders on the potential development of a tariff to cover allergy services and the steps necessary to make that possible. On training places, I can confirm also that the joint working group, on which the Department, strategic health authorities, NHS Employers, postgraduate medical deans and professional organisations sit, does look at those issues and make recommendations about additional places.
Derek Twigg (Halton) (Lab)
What services is the Secretary of State setting up for professionals who have become allergic to his Health and Social Care Bill and to him?
Paul Burstow
That was a pretty limp attempt. One of the most striking things about this Question Time is how many Opposition Members are yet again suffering from another health problem—memory lapses. When it comes to the Labour party’s record in government, £12 billion was wasted on a computer system that did not work, with which 60,000 nurses could have been recruited and employed for a decade.
Iain Stewart (Milton Keynes South) (Con)
8. What progress he has made in improving outcomes for NHS patients.
Dan Jarvis (Barnsley Central) (Lab)
10. What progress he has made on tackling inequalities in cancer care.
The Minister of State, Department of Health (Paul Burstow)
Through the national cancer equality initiative, we are working in partnership with patients, professionals, academics and the voluntary sector to take forward a range of projects, such as working with Macmillan Cancer Support and Age UK to tackle the under-treatment of older people, our launching of the “Cancer does not discriminate” campaign with black and minority ethnic groups and our funding of work to target lesbian and bisexual women with cervical screening.
Dan Jarvis
I am sure the Secretary of State and the Minister will acknowledge that cancer mortality rates are higher in my constituency than in his. Can he therefore justify to my constituents why Barnsley primary care trust is being forced to spend £17 million not on addressing issues surrounding the inequality of cancer care but on delivering an undemocratic, unwanted and unnecessary top-down reorganisation of our NHS?
Paul Burstow
I say two things to the hon. Gentleman: first, that the reforms will actually release resources from back-office costs and put them back into the front line, which I hope all hon. Members want to happen; and, secondly, that when it comes to our cancer strategy, we committed additional resources in the spending review to invest in cancer services. If he wants to raise specific issues with me, I will be only too happy to address them.
Mr John Baron (Basildon and Billericay) (Con)
The Minister will fully understand the importance of early diagnosis in cancer outcomes and tackling cancer inequalities. May I therefore urge the Government to include the one-year outcome measure in the commissioning outcome framework, so that we can measure the performance of clinical commissioning groups?
Paul Burstow
My hon. Friend, who chairs the all-party group on cancer, has been pursuing that issue vigorously. We certainly need to ensure that we use both proxy and other performance indicators on cancer outcomes, and I will want to continue examining whether that indicator is the most appropriate one to tell us what we need to know about improvements in cancer outcomes performance.
Liz Kendall (Leicester West) (Lab)
The hon. Member for Basildon and Billericay (Mr Baron) is right that early diagnosis is crucial for treating cancer, and it is often very worrying for people to wait for their test results. Under the current Government, waiting times for diagnostic tests have soared. Will the Minister confirm that the number of patients waiting more than six weeks for their test has more than doubled since May 2010, the number waiting more than 13 weeks has more than trebled and the average wait is up, too, by 28%? It is a simple question, so will he give us a simple answer—yes or no?
Paul Burstow
It was a somewhat longer question than that, so I hope the hon. Lady will let me go a little further than a yes or no. I tell her that at the end of December 2011 only 1.4% of patients were waiting six weeks or longer for one of the 15 key diagnostic tests, and that just five NHS trusts are responsible for about 30% of all waits of six weeks or longer. We are working specifically with those five trusts to bear down on those waits and ensure that people do not have to wait so long. Of course she is right to make her point about waits, which is why the Government are focused on the issue and have sent in the additional support needed to ensure that trusts deal with it.
Andrew George (St Ives) (LD)
11. If he will withdraw the Health and Social Care Bill.
Lorely Burt (Solihull) (LD)
12. What steps he is taking to improve the standard of dementia care in hospitals.
The Minister of State, Department of Health (Paul Burstow)
As many as four out of 10 people in hospital have dementia, and people with dementia stay longer in hospital. We know that there is much room for improvement. That is why we have set a new national goal for hospitals actively to identify people with dementia.
Lorely Burt
According to the Royal College of Psychiatrists’ report on dementia care in hospitals, only one in three staff said that they felt that their training and development in dementia was sufficient. What action is the Minister taking better to equip staff to be able to take care of dementia patients in future?
Paul Burstow
I am grateful to my hon. Friend. Training is certainly one of the issues highlighted by the audit. We are taking a number of steps. We are working with the Royal College of Nursing, which has developed an online dementia information resource; we have been working with Skills for Care and Skills for Health to provide a series of training workshops for staff; we have been working with Oxford Deanery to trial a new approach to dementia education and training for GPs; and we are funding another audit to make sure that we keep track of the improvements that we expect to see across the NHS.
Jim Shannon (Strangford) (DUP)
What discussions has the Minister had with universities such as Queen’s university in Belfast with regard to new treatments and medication for those suffering from dementia, and when will those advances filter through to patients?
Paul Burstow
I have not had such conversations with the university to which the hon. Gentleman refers. However, this Government, right from their first Budget, have indicated their commitment to prioritising research into dementia—both the basic research that gives us the targets for detailed research and the translational research. We have put in place all the building blocks that will allow this country not only to maintain its pre-eminence but to accelerate the pace of research.
Chris Skidmore (Kingswood) (Con)
14. What progress he has made on reducing the costs of PFI schemes in the NHS.
The Minister of State, Department of Health (Paul Burstow)
My hon. Friend is right about the need to invest in early intervention and prevention. In addition to the £7.2 billion that we will invest this Parliament, this January we announced an extra £120 million for the remainder of the year to support care services. Furthermore, we are funding, jointly with the Local Government Association, work to support councils in delivering improved productivity and sharing best practice to ensure that they deliver improvements to services, and not just cuts.
Andy Burnham (Leigh) (Lab)
The Secretary of State said that he would listen to doctors and nurses but yesterday shut the door of No. 10 Downing street in their faces. But now things take a sinister turn. Let me quote from a letter from an NHS director received last week by a respected clinician of many years’ standing:
“I understand that you are a signatory to a letter which highlights your personal concerns about the Health Bill. It is inappropriate for individuals to raise their personal concerns about the proposed Government reforms. You are therefore required to attend a meeting with the Chief Executive to explain and account for the actions you have recently taken.”
Will he confirm that it is now his policy to threaten NHS staff with disciplinary action if they speak out against his reorganisation?
Ben Gummer (Ipswich) (Con)
T6. Dentists in Ipswich are increasingly concerned about having to put right work done by dentists from outside the UK who have received temporary registration from the General Dental Council, causing yet more cost to the NHS and trouble for those receiving care. How will Ministers measure the quality of those receiving temporary registration?
Paul Burstow
The hon. Gentleman raises an important issue that we are discussing with the GDC. The council’s work on revalidation will ensure that the work of those supervising foreign dentists and, where appropriate, foreign dentists themselves is properly covered.
Mrs Mary Glindon (North Tyneside) (Lab)
T2. Given that managed clinical networks for neuromuscular conditions can help to reduce the number of unplanned hospital admissions for patients with life-shortening illnesses and save the NHS money, will the Secretary of State commit to establishing such networks with funding from the NHS Commissioning Board?
Simon Wright (Norwich South) (LD)
T9. I recently met Norwich and District Carers Forum to hear about the work that it is undertaking, together with GP surgeries in Norfolk, to help identify carers in the county. What recent steps have Ministers taken to help identify and support carers in Norwich and elsewhere?
Paul Burstow
I am grateful for my hon. Friend’s question, and I know that a lot of work is being done across the county of Norfolk between the NHS and social care. Nationally, the Government are working with the Royal College of General Practitioners, Carers UK, the Princess Royal Trust for Carers and Crossroads Care to recruit GP carers champions and volunteer carers ambassadors, and make them aware of the need not just to identify carers, but to ensure that they take the necessary action to assess and provide appropriate support, so that carers get a break from their caring responsibilities and have the opportunity both to stay in work, if that is what they want to do, and to have a life, not just a caring responsibility.
Mr David Winnick (Walsall North) (Lab)
If I was concerned only with the politics of the situation, I would be urging the Secretary of State to carry on with the Health and Social Care Bill, in view of the political fallout. However, does he realise that the strength of opposition throughout country—certainly among the medical profession, as well as the public—is based on the fact that they believe that the national health service will be seriously undermined if the measure goes through? Why is he not willing to listen to the voices of people who are so concerned that the institution—which we all believe is so necessary—will be threatened and damaged as a result of his measure?
Nicky Morgan (Loughborough) (Con)
Ministers will be aware of the Centre for Mental Health’s report last week, which showed that physical health outcomes are linked to mental health outcomes, and that both need to be treated at the same time. Can the Minister update the House on the Department’s progress on implementing its mental health strategy?
Paul Burstow
I can indeed. We will shortly be publishing a more detailed implementation plan showing the role that the NHS Commissioning Board, the clinical commissioning groups and others will play, alongside the voluntary sector, in delivering the strategy. More importantly, we are also doing work on long-term conditions that will begin, for the first time, to join up the way in which we commission physical and mental health services. We have to do that in order to deliver better outcomes for people.
Simon Danczuk (Rochdale) (Lab)
Every week in my surgery, I hear more and more residents complaining about having to wait too long for an operation, if they can get on to the waiting list at all. This top-down reorganisation is clearly exacerbating the problem. Why do not the Government just drop the Bill?