The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)

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I have very much enjoyed sitting through this debate on health. I remember that when we had the equivalent debate last year, many speakers did not have the time they wanted to make their speeches. The fact that we have had longer today has enabled many right hon. and hon. Members to make valuable contributions on a number of subjects, focusing not only on health care issues in their constituencies and on important individual cases that highlight the need for changes in the system, but on the big challenges that face the NHS in tackling long-term medical conditions.

In the time available to me, I will do my best to answer the questions and points put across by Members on both sides of the House. My hon. Friend the Member for Stafford (Jeremy Lefroy) and I have met on a number of occasions, along with my hon. Friend the Member for Stone (Mr Cash), to talk through the challenges facing Mid Staffordshire trust. My hon. Friend the Member for Stafford has been a great advocate for, and a great support to, the patients and staff at that trust. I would like to put on record my thanks to him for all that he has done for all his constituents. His advocacy during his time in this House has been tremendous.

My hon. Friend the Member for Stafford raised some important issues. We know that it is desirable, not only because it makes good health care economics but, more importantly, because it is good patient care, to keep people well and looked after in their own communities and in their own homes. My hon. Friend threw up a legitimate challenge when he said that if we are to deliver good care in the community and in people’s homes, we need to find a way of moving from the current situation. At the moment we have a crisis management response by default, where people are rushed into A and E, and he is right to highlight the fact that some parts of the country do not have an adequate GP out-of-hours system to look after people around the clock. We need to ask how we go from a system set up around crisis management to one that is better placed to meet the future needs of preventive care and looking after people with long-term conditions such as diabetes, dementia and heart disease in their own homes and communities. The Government are taking steps to address this issue by making sure that GPs and local health care commissioners, through clinical commissioning groups at a local level, will hold a lot of the health care budget. That will ensure that the focus is on primary preventive care and on better looking after people with long-term conditions.

My hon. Friend is right to say that we need sufficient numbers of hospital beds, but as time passes there might less need for beds in some hospitals if local CCGs effectively meet the challenge of ensuring that that they invest in community and preventive care. In the interim, we need to support good commissioning of beds locally. We must have intermediate care beds available at community hospitals and in other care settings in the community for step-up care, step-down care and respite care.

On the other side of the River Thames, the clinical director of St Thomas’ hospital, Ian Abbs, is looking into year-of-care tariffs, which look after patients with long-term conditions such as diabetes and heart disease in a holistic way that enables them to be supported when they need a hospital bed and need to be looked after in the community. That has to be the right way forward. We in the Department’s ministerial team will work with clinicians, medical directors, trusts and commissioning boards to make sure that Eurocare tariffs are in place, so that we can shift the focus away from the community, but in a managed way that means that hospital beds will still be available as people require them.

The hon. Member for Easington (Grahame M. Morris) has been a strong advocate—he has raised his concerns many times—for constituents and others throughout his part of the country who are patients who need access to cancer care, cancer services, the cancer drugs fund and, indeed, high-quality radiotherapy. It is worth setting out some of the background—he outlined it himself in his speech—to the Government’s commitment to improving care for patients with cancer.

In 2011 the Government made a commitment to expand radiotherapy capacity by investing more than £150 million more over four years from 2011. As the hon. Gentleman knows, that was to increase the utilisation of existing equipment, support additional services and ensure that all high-priority patients with a need for proton beam therapy get access to it. In April 2012, the then Secretary of State announced that the Department had set aside up to £250 million of public capital, to be invested by the NHS in building proton beam therapy facilities at the Christie hospital in Manchester and the University college London hospital, to treat up to 1,500 patients each year. In October we announced a £15 million radiotherapy innovation fund for 2012-13, which brings this Government’s additional investment in radiotherapy over the spending review period to more than £165 million. The fund is designed to ensure that, from April 2013, radiotherapy centres will be ready to deliver intensity-modulated radiotherapy to all patients who need it.

The hon. Gentleman was right to say that, in spite of that increased investment, there are ongoing concerns about the variability of access to radiotherapy services in the NHS. I hope that it will reassure him that, in response to the requests of radiotherapy centres to the fund, we will go beyond the original commitment and will this week notify the centres of allocations totalling almost £23 million. We have taken on board the hon. Gentleman’s concerns and are making sure that we continue to invest in high-quality radiation in the years ahead. I know that he will hold the Government to that task in the coming years.

The right hon. Member for Wentworth and Dearne (John Healey) has rightly raised issues of principle arising from the Vinny Duggan case. I want to put on record my best wishes to the family concerned. I will deal with two issues: first, the issue that arose from the way in which the trust handled the complaints procedure, and secondly, the wider point about the Nursing and Midwifery Council.

First, as the right hon. Gentleman has highlighted, the trust clearly failed to acknowledge to any adequate degree that mistakes happened and that the quality of care was not of the standard that it should have been. That much was clear in this regrettable episode in the trust’s history. Two years is an unacceptable amount of time to wait for an apology or for an adequate explanation for what went wrong. The right hon. Gentleman is absolutely right to say that what patients want when things go wrong is a sincere apology and an explanation as to why things happened. We all know, no matter how good the care is in the NHS, that bad things will sometimes happen, but we need to know that that mistake has been recognised, that there has been an apology and that lessons have been learned for the future. We cannot rewrite history or always unpick mistakes, but we can learn lessons for the future and make sure that such bad things do not happen again. That is what good medicine is about. Clearly, in this case there were problems with the way in which the complaints were addressed.

Secondly, on the wider point raised by the right hon. Gentleman about the NMC and the disparity between how different professional regulators approach the complaints process, he is right that the NMC can review or reopen a case only when new evidence is available. If old evidence is reconsidered or if it changes, as in this case, it is very difficult to review it. There are differences between the medical and other professional regulators with regard to how such cases are handled, and the Law Commission has rightly highlighted those inconsistencies. There needs to be more consistency throughout all parts of the medical, nursing and allied health professional groups, in order to make sure that patients know that, when complaints are made and concerns are aired, they will be looked into and, where necessary, complaints can be reopened and reinvestigated.

The Law Commission proposals are expected to be introduced to the House in 2014. The right hon. Gentleman asked whether we could do anything sooner than that, but, as he will know, if we brought in a section 60 order, it would take about two years for it to get through the full parliamentary process. Given that the Law Commission proposals are holistic and apply to not just the NMC, but all health professions, we believe that the right approach is to consider those proposals in 2014. We hope that that will bring a lot more consistency, which I think we all feel is desirable, to future cases involving the professional conduct of all medical, nursing and other health care professionals.

I thank my constituency neighbour, my hon. Friend the Member for Suffolk Coastal (Dr Coffey), for her kind comments about the work that I, other Suffolk MPs and, indeed, the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), have done in relation to problems with the East of England ambulance service. People in more rural counties, particularly North Norfolk and parts of Suffolk, appear to be getting a service that is not of the standard that we would expect. We need more transparency with regard to response times, not just on a regional level, but on a county-wide level. My hon. Friend the Member for Suffolk Coastal asked whether there could be a breakdown by postcode. That is a little more challenging, because it is possible that, in any given month or response period, not enough people in a particular postcode will need an ambulance. There is a desire, however, for more transparency with regard to sub-geographical regions.

My hon. Friend the Member for Waveney (Peter Aldous) has also taken a keen interest in the issue and has recently been out with the ambulance service on a number of evenings.

Dr Poulter

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My hon. Friend is absolutely right and I pay tribute to him for taking the time to go out with the ambulance service and see first hand the problems that have been experienced in some parts of Suffolk and Norfolk. There have been problems with the handover time at some hospitals in the east of England and that is clearly unacceptable, because if the ambulance and hospital staff are engaged in lengthy handovers, it means that other patients are not being treated and seen in a timely manner. Those issues need to be addressed by some trusts in the east of England.

My hon. Friend the Member for Waveney has written to the ambulance service and his letter was made available to my noble Friend Earl Howe. In it, he highlighted the trust’s decision to publish more performance information online from February and stated that it was important that that was done by geographical area to ensure that there is greater transparency in the quality of response data in areas such as Beccles and Bungay, relative to more urban areas such as Ipswich. That is an important point. I urge him and my hon. Friend the Member for Suffolk Coastal to continue pushing for transparency in the ambulance service’s data, and to continue their fight for improved response times for more rural areas of Suffolk and Norfolk. I know that my noble Friend Earl Howe would be happy to meet hon. Members to discuss the matter further.

Let me turn to the issues that were raised by the other three Members. I will be brief, Mr Deputy Speaker, because I take your hint. My hon. Friend the Member for High Peak (Andrew Bingham) raised concerns about a number of ambulance stations, including one in Buxton. I know that my hon. Friend the Member for Staffordshire Moorlands (Karen Bradley), who lives in a nearby constituency, shares those concerns. A review is currently taking place. We all welcome reviews if they are going to improve the quality of care for patients and improve ambulance response times. However, there are local concerns that the review must take into account issues such as rurality and the difficulties that patients on high land or in harder-to-access areas have in accessing all types of health care services.

I note the concerns that the review is making proposals that do not necessarily take account of those factors. My hon. Friend the Member for High Peak has put those concerns on the record today. If that has happened, I echo his concerns, because it is important, in the review of any service, that issues such as rurality and difficult-to-access areas are taken fully into account. This is, of course, a local health care decision. If he wants to discuss the matter further with Ministers, we are happy to discuss it with him.

The hon. Member for Lewisham West and Penge (Jim Dowd) put across his strong advocacy for Lewisham hospital. I trained in south Thames and have colleagues who work at Lewisham hospital. We all know that Lewisham faces particular challenges. It has demographic challenges, given its difficult population groups with considerable health care needs, and great health care inequalities. It has a large migrant population, which brings particular health care challenges and means that people do not always have English as a first language. Such people need to be looked after properly. It is important that those issues are taken into account during the discussions.

I take on board the concerns of local staff that they are being drawn into the big financial concerns with South London Healthcare NHS Trust. However, we also have to recognise that no one hospital operates in a vacuum. We must ensure that hospital services and the care that is provided reflect the needs of the wider geographical area. My right hon. Friend the Secretary of State will be looking into these issues.