Gosport Independent Panel: Terms of Reference

Philip Dunne Excerpts

Thursday 3rd November 2016 Written Statements

[The Minister of State, Department of Health (Mr Philip Dunne)]

I wish to update the House about the investigation into Gosport War Memorial Hospital.

On 10 July 2014, the former Minister for Care Services (Norman Lamb), announced the establishment of the Gosport independent panel, chaired by Bishop James Jones, to review documentary evidence held across a range of organisations concerning the initial care of families’ relatives and subsequent investigations into Gosport War Memorial Hospital.

When the former Minister announced the terms of reference for the Gosport independent panel on 9 December 2014 the Government expected the panel to complete its work by December 2017 [HCWS78].

As a consequence of the greater number of families now in contact with the panel and the increase in the volume of material the panel is reviewing, the panel now expects to complete its work in spring 2018.

It is also available online at: http://www.parliament.uk/writtenstatements.

[HCWS233]

Community Pharmacies

Philip Dunne Excerpts

Wednesday 2nd November 2016 Commons Chamber

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a pleasure to follow the hon. Member for Burnley (Julie Cooper). I was interested to learn of her personal experience in the sector. She gave a well-informed speech that was in stark contrast to that of her boss, the hon. Member for Leicester South (Jonathan Ashworth). She was generous to contributions from Opposition Members, but it is only fair to say that Members on both sides of the House expressed considerable support for the work done by community pharmacies up and down the country. There is unanimity in the House on the importance of not only pharmacies’ current work, but their increasing role in supporting the NHS and providing services in future.

I am grateful for the contributions made today by 24 hon. Members, in addition to the Front-Bench speakers. I wish to start my remarks by referring to the impact that these proposals will actually have on the typical pharmacy, because I am sorry to say that there has been considerable confusion, mostly among Opposition Members, about what the proposals deliver. The average pharmacy will see a reduction in taxpayer subsidy of £16,000 a year. The largest element of that is a reduction in the establishment payment, which is a fixed payment of between £23,000 and £25,000 that most pharmacies receive just for being there. It will be reduced by 20% from 1 December, which equates to a reduction of just over £400 per month, or £100 a week. From April, it will decrease by a further £400 per month, to £200 a week. Those are not huge reductions for private businesses. This element is a 40% reduction in the only fixed taxpayer subsidy that I am aware of that is paid to private businesses up and down retail high streets in England.

Meanwhile, pharmacies will still receive £1.13 for every prescription item they dispense, with the average pharmacy dispensing 87,000 items a year, as was said by the hon. Member for Liverpool, Wavertree (Luciana Berger), who is, sadly, not in her place.

[Luciana Berger]

I am here.

[Mr Dunne]

Oh, she is—I apologise. We are also introducing a new quality payment scheme worth up to £6,400 a year, so that the amount of NHS funding community pharmacies will be receiving will remain very significant.

In addition to payments from the NHS, pharmacies can earn extra income from a range of sources other than dispensing fees. About half the clinical commissioning groups in England already commission minor ailment services from pharmacies. These services include: flu vaccinations, which are topical today; stop-smoking schemes, which were topical last month, in Stoptober; and emergency hormonal contraception. All of those provide an additional source of income for community pharmacies. I believe the right hon. Member for North Norfolk (Norman Lamb) referred to healthy living pharmacies, and they will now qualify for this new quality payment, whereas they have not in the past—I hope he will welcome that. The Local Government Association’s briefing ahead of this debate echoed that fact, saying that

“there are significant opportunities for councils to commission public health services from community pharmacies as a key element of their health improvement strategies.”

In addition to those two alternative sources from NHS and non-NHS public bodies, in many cases pharmacies get a whole section of private sector income from non-publicly funded elements. That has not been referred to at all, but it is a significant element in the profitability of many pharmacies.

The Government’s vision in these reforms is to bring pharmacy into the heart of the NHS. The Opposition spokesman, the hon. Member for Leicester South, gave what appears, from his early outings at the Dispatch Box, to be becoming a trademark speech in his new role, seeking to scare the public about the proposals without demonstrating a genuine understanding of how community pharmacies are funded or owned, or of what is proposed by the measures. Since 2005-06, there has been an 18% increase in the number of pharmacies, so that today some 1,800 more operate in England than did so 10 years ago. Next year, pharmacies in England will receive £2.6 billion in funding from the NHS. NHS England supports the developments that we are proposing. The suggestion is that we will decimate NHS services because we will push a large number of people out of community pharmacies to their GP, but that is not the belief of NHS England. This is not about pharmacy closures—the point made by almost every Opposition Member who spoke—but about securing better value from the funding that we provide, modernising the way in which we do it so that pharmacies are not the only sector in the country that receives direct taxpayer subsidy for opening premises on the high street, and encouraging them, through increasing payments in the future, to provide more services to help patients in every community.

Community pharmacies are already much more than the place to which we go to get our medicines. They are an essential front-line service, providing care direct to patients and increasingly advising on a wide range of public health issues, for which, as I have indicated, they are paid separately from their dispensing fees. In doing so, they can relieve, and are relieving, pressures on other parts of the NHS.

Our package of reforms are about advancing that agenda, by rewarding quality for the first time, and moving to an enhanced role for the community pharmacy network in providing value-added services, as well as dispensing prescriptions. Yes, it does include making efficiencies in the way that these pharmacies are funded—I am talking about a reduction of £200 a week from next April—but those savings can be made within community pharmacies without compromising the quality of services or the public’s access to them. A key element of our proposals is that we will protect those pharmacies on which communities depend the most through the pharmacy access scheme, which has been supported by many hon. Members. A review of eligibility will assess the impact on those pharmacies in 20% of the most deprived areas, close to the one-mile test. That review opened yesterday and lasts for six weeks.

The hon. Member for Sedgefield (Phil Wilson) referred to the pharmacy access scheme. He admitted that, by his calculation, 40% of the pharmacies in his constituency will benefit from the scheme. I can update him on that. Nine out of the 20 pharmacies—or 45%—in his constituency will benefit. Indeed, his constituency will be one of the biggest beneficiaries of this scheme.

In summary, the reforms are what the NHS needs and what patients and taxpayers expect. I am confident that we will see a community pharmacy sector that is more efficient and better integrated with the rest of the healthcare system and delivering better services for patients as a result. I urge colleagues to support the amendment to this motion.

Question put (Standing Order No. 31(2)), That the original words stand part of the Question.

Health Service Medical Supplies (Costs) Bill

Philip Dunne Excerpts

2nd reading: House of Commons & Programme motion: House of Commons
Monday 24th October 2016 Commons Chamber

[The Minister of State, Department of Health (Mr Philip Dunne)]

What a great pleasure it is, Mr Deputy Speaker, to stand before you after this important debate, with a little time in which to satisfy as many Members as I can, while recognising that the Committee stage will begin shortly and we shall then have an opportunity to discuss points with which I cannot deal today. I thank everyone who has taken part in the debate. We have heard a number of excellent contributions, some of which showed a surprising knowledge of the intricacies of pharmaceutical pricing but were none the less very welcome.

The Bill deals with a treasured national institution, our national health service, and with the need to secure the best possible value for the taxpayer. Medicines represent the second largest cost to the NHS, after staff, and it is important that we do not pay over the odds. The level of interest and the quality of the contributions that we have heard today have shown how important that is to all Members. I find it refreshing that a debate involving the NHS should feature the degree of consensus that has erupted across the House today. I am led to believe that—as has been pointed out by other Members—this is a relatively unusual occurrence, so I shall enjoy it for as long as I can.

The debate reinforces the principles of securing the best possible value for the NHS, making decisions on the basis of good-quality information, and supporting this country’s innovative pharmaceutical industry, to which several Members have referred. Those are principles on which we can all agree. However, the debate has raised a number of other issues, some of which I hope to clarify for the benefit of Members who have commented on them. In one of her closing comments, the hon. Member for Worsley and Eccles South (Barbara Keeley) sought to link last week’s announcements about community pharmacy funding with the Bill. I can reassure her that there is no link whatsoever between the Bill’s provisions on information collection and the announcement about decisions on community pharmacy funding. The funding changes will come into effect in December and are not reliant on any of the provisions in the Bill, and the provisions in the Bill will not change those decisions.

[Barbara Keeley]

Perhaps I was not clear enough, but I was not making that point. I was making the point that the cuts imposed by the Government will mean that some community pharmacies—the smaller ones; the independent ones—will not have the necessary staff. If the Government are imposing a new information-gathering requirement, who will carry out that task? As I said, there may be staff cuts amounting to between £60,000 and £80,000, and people will simply not be able to absorb a new requirement.

[Mr Dunne]

Just to reassure the hon. Lady, I can tell her that the establishment cost for each pharmacy is currently £25,000, and there will be a reduction in that cost rather than a much larger cost. She must be referring to companies that have several establishments, rather than to individual ones. I will touch on the points that she has raised about information gathering in a moment.

We have heard a number of allegations during the debate, starting with those made by the hon. Member for Ellesmere Port and Neston (Justin Madders), who I am sure will be joining us shortly, that the Conservative party appears to have broken out in a rash of Corbynism. I can assure the hon. Gentleman categorically that that is not the case. What we are seeking to do through the Bill is address points, which have been made by hon. Members on both sides of the House, about the potential for exploitative pricing, particularly of unbranded generics that are of low volume, in circumstances where there is no competition from an alternative supplier in the market. I believe that there is considerable agreement on that across the House.

I welcome the support for the Bill from the Labour Front Bench, from the Front Bench of the Scottish National party and from the Liberal Democrat spokesman, the right hon. Member for North Norfolk (Norman Lamb). They all support the principles behind the Bill. I look forward to what I hope will be a rapid conclusion to proceedings on this short Bill in Committee. Doubtless hon. Members will be raising important points in Committee, but I am sure that we will continue to have constructive contributions throughout.

The hon. Member for Ellesmere Port and Neston mentioned difficulties of access and funding for new medicines. These points were also raised by the hon. Member for Central Ayrshire (Dr Whitford). The NHS is investing in innovative medicine and, in the first year of the current voluntary scheme, medicines covered by the innovation scorecard saw an increase of more than 18% compared with growth of about 5% in medicines not on the scorecard. That illustrates that we are prepared to fund patients’ use of innovative medicines under the existing scheme. However, we recognise the need to continue to ensure patient access to new medicines. That is why my right hon. Friend the Secretary of State referred earlier to the accelerated access review, which was announced earlier today. That will accelerate the speed at which 21st-century innovation in medicine and medical technologies can be taken up by patients and their families through the NHS. That will present a real advantage—bringing forward innovations from pharmaceutical companies, not only in this country, and driving them through for use in the NHS.

A number of hon. Members have referred to the investigative work of The Times in helping to highlight the problems with unbranded generics. I would like to add our welcome to the investigation that was undertaken by those journalists, but gently to point out that the Government were already aware of some of the problems. Indeed, we published a consultation in December last year raising that issue, and I think it was partly in the light of that that The Times decided to do its work. I do not wish to decry that work in any way, however. It was clearly helpful.

We have referred cases to the Competitions and Markets Authority, as the hon. Member for Wolverhampton South West (Rob Marris) mentioned. The CMA has imposed fines in one case, as he said, and it is expecting to reach a final decision on another in the coming months. Two more cases were opened in March and April this year. We are looking to refer examples of bad practice to the relevant authorities when we come across them.

The hon. Member for Central Ayrshire asked how the data collection would work. That point was also raised by other hon. Members. We already collect significant data from the supply chain for medicines under the voluntary scheme and the statutory scheme. We collect data from manufacturers and wholesalers of generics, and from pharmacies themselves. As part of developing the regulations, and of the consultation that will take place before we introduce the scheme, we are looking to identify as many automated data collection solutions as possible, in order to minimise the burden to which the hon. Member for Worsley and Eccles South referred. In particular, we recognise that some of the medical products companies are small companies, and we want to make their burden as light as possible.

The hon. Member for Central Ayrshire referred to the devolved Administrations and how we will work with them. Our intention is that they would be able to access data not on a timing of our choosing, but as they require, and that, again, will be undertaken in a manner that we hope to capture in a memorandum of understanding so that there is clarity between each Administration and ourselves as to how that will work.

The right hon. Member for North Norfolk asked in particular about how we intend to control the medicines bill overall, and a number of Members have mentioned that. The cost of medicines across the NHS is rising quite rapidly. That is a concern, and it gets to the heart of why we have sought to introduce this legislation.

We are looking in the first place to align the statutory and the voluntary cost control schemes for the supply of medicine. At present, companies may decide to join either scheme depending on the other benefits they perceive in the schemes, but we believe that the financial benefit to the NHS of each scheme should be the same. Our proposals will put beyond doubt the Government’s powers to amend the statutory scheme to achieve this objective, which the impact assessment has indicated should save the taxpayer some £90 million a year. Draft regulations of these provisions will be available at the Committee stage.

The second element of the Bill strengthens the Government’s powers to set prices of medicines where companies charge unreasonably high prices for unbranded generic medicines. In most cases, competition works well to keep prices down. However, when it does not, and when companies are making excessive profits, the Government should be able to take action. This Bill closes a current loophole in the legislative framework. We are all agreed across the House that we cannot allow profiteering at the expense of the NHS.

Thirdly, the Bill will strengthen the Government’s powers to collect information on the costs of medicines, medical supplies and other related products from across the supply chain. Putting existing voluntary provision of information regarding medicines on a statutory footing will enable the Government to set more accurately and fairly the reimbursement arrangements for community pharmacies and dispensing GPs. In addition, the power will provide vital data to underpin the reformed statutory scheme for controlling medicine pricing, and will give us more evidence about whether companies are making excessive profits at the expense of the NHS.

I want to reiterate what my right hon. Friend the Secretary of State said in his opening remarks to assure the House about the impact of the information powers on the medical technologies industry. It may surprise Members, and in particular Opposition Members, that the powers to require information from suppliers already exists in section 260 of the National Health Service Act 2006—[Interruption.]—which the hon. Member for Wolverhampton South West says from a sedentary position he remembers bringing into effect, but we think that those enforcement powers are draconian and wish to make them more proportionate. The Government have never in fact used the powers under the 2006 Act, and we want to marry powers for information gathering with those we will have for medicines, so that there is no confusion in future about which information regime applies.

[Rob Marris]

First, may I say in passing that it does not sound very draconian if the powers have never been enforced? Section 260 of the 2006 Act refers to medical supplies and defines them, as I said earlier, as

“surgical, dental and optical materials and equipment”.

Will the Minister look at that definition, because it seems to me that it is not as wide as many people think, and therefore there is a way to get around it if certain technological companies wish to do so, such as the manufacturers of MRI scanners, which I do not think is the intention of the House. Will he look at that definition?

[Mr Dunne]

I think the hon. Gentleman may be making a pitch to the Committee of Selection and I would be delighted to see him committing his considerable intellect to this topic. I think we will spend much of our discussion refining the definitions of what information is appropriate and how it will be gathered.

The Government intend to table amendments to the Bill to reflect how the information-power provisions will apply in the devolved Administrations. The amendments will ensure that the Government can collect information that relates to devolved purposes and share it—with appropriate safeguards relating to confidentiality—with the devolved Administrations, enabling them to use the information for their own purposes. To avoid duplication, we have agreed with the devolved Administrations that the Government will collect information from manufacturers and wholesalers for the whole of the UK while each country will collect information from the pharmacies and GPs in their territories.

The degree of consensus and the support that we have received from across the House, for which my colleagues and I are extremely appreciative, has made this a remarkable debate. Medicines are a vital part of the treatments provided by our NHS. Robust cost control and data requirements are key tools to ensure that NHS spending on medicines across the UK continues to be affordable while delivering better value for taxpayers and freeing up resources, which supports access to services and treatments. The Bill will ensure a more level playing field for our medicine pricing schemes while ensuring that Government decisions are based on more accurate, robust information on medicine costs. This will be fairer for industry, for pharmacies and for the NHS, patients and the taxpayer. I am pleased to commend this Bill to the House.

Question put and agreed to.

Bill accordingly read a Second time.

Health Service Medical Supplies (COSTS) BILL (Programme)

Motion made, and Question put forthwith (Standing Order No. 83A(7)),

That the following provisions shall apply to the Health Service Medical Supplies (Costs) Bill:

Committal

(1) The Bill shall be committed to a Public Bill Committee.

Proceedings in Public Bill Committee

(2) Proceedings in the Public Bill Committee shall (so far as not previously concluded) be brought to a conclusion on Thursday 17 November 2016.

(3) The Public Bill Committee shall have leave to sit twice on the first day on which it meets.

Proceedings on Consideration and up to and including Third Reading

(4) Proceedings on Consideration and any proceedings in legislative grand committee shall (so far as not previously concluded) be brought to a conclusion one hour before the moment of interruption on the day on which proceedings on Consideration are commenced.

(5) Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at the moment of interruption on that day.

(6) Standing Order No. 83B (Programming committees) shall not apply to proceedings on Consideration and up to and including Third Reading.

Other proceedings

(7) Any other proceedings on the Bill (including any proceedings on consideration of Lords Amendments or on any further messages from the Lords) may be programmed.—(Andrew Griffiths.)

Question agreed to.

NHS Provision (Brighton and Hove)

Philip Dunne Excerpts

Monday 24th October 2016 Commons Chamber

[The Minister of State, Department of Health (Mr Philip Dunne)]

I congratulate the hon. Member for Brighton, Pavilion (Caroline Lucas) not just on securing this debate but on doing so on a day that enabled her to get through her entire speech and take interventions from the hon. Member for Hove (Peter Kyle) and my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton)—a considerable achievement.

The hon. Lady has a long-standing interest in health outcomes for her constituents, as we all do in the House. I would like to join her at the outset by highlighting the excellent work carried out every day by all those who work in the NHS, not just in her constituency but equally in my own and across the country. Before addressing the specific points that she made, I should like to give the House an overview of the NHS in her constituency. Brighton and Hove clinical commissioning group covers a geographical area of approximately 34 square miles, with a patient population of some 300,000. It commissions a wide range of healthcare services including from the main local acute trust, Brighton and Sussex University Hospitals NHS Trust, with a regional teaching hospital working across two sites in Brighton and Haywards Heath. I understand that the trust treats over three quarters of a million patients every year, and it recognises its growing role as a developing academic centre.

The hon. Lady has asked, not for the first time, for more funding to improve services and facilities in Brighton. I am pleased that she recognised the capital investment of more than half a billion pounds that is under way at the Royal Sussex County Hospital, replacing some very old buildings, as she said, and supporting the service quality improvements planned by the trust. I was a bit disappointed that, in his intervention, which came around the time that she referred to that capital investment, the hon. Member for Hove did not acknowledge that that is a significant investment in the facilities at the heart of health provision in Brighton.

The Government created the Care Quality Commission to shine a light on good and bad healthcare up and down the country. Its independent inspection teams provide a vital function on behalf of patients and everyone in England in challenging how hospitals, GP surgeries, care homes and all other healthcare providers are delivering to the standards we should all expect.

The CQC has identified that the local NHS in the hon. Lady’s constituency faces some challenges. I acknowledge that the confluence of inspection reports—they have come at around the same time to several of the different providers and commissioners in her area—is an unusual challenge to correct for the benefit of local residents. In stark contrast, as my hon. Friend the Member for East Worthing and Shoreham said, next door, there is the outstanding-rated Western Sussex Hospitals NHS Foundation Trust, which serves residents of West Sussex. As she pointed out, Brighton and Sussex University Hospitals NHS Trust was rated inadequate earlier this year by the CQC. To support its recovery, NHS Improvement placed the trust into special measures.

[Peter Kyle]

I am grateful to the Minister for giving way so early in his speech. He mentions that there has been an unusual confluence of reports. I would suggest that the unusual thing is that each of the reports indicates extreme failure in many different parts of our health system in Brighton and Hove, from the ambulance trust and six GP surgeries, as was brilliantly outlined by the hon. Member for Brighton, Pavilion (Caroline Lucas), right through to the hospital trust—all in special measures, and the hospital in financial special measures. That is the unusual thing. I suggest that the health economy in Brighton and Hove is now bankrupt.

I suggest to the Minister that he does not do his thinking on his feet now, but would he consider arranging for his Department to appoint someone to our city who can take an overview of what is right and what is wrong in our city, of the funding and of the relationship between the different health bodies and the local authority? Let us bring together all the health systems, figure out what is wrong and how we can bring them together to solve all the problems. The fractures have got too much.

[Mr Dunne]

I will not take up the hon. Gentleman’s invitation to think on my feet, but I will refer later to the sustainability and transformation plan, to which the hon. Lady referred, which is providing a forum for much closer collaboration across the NHS within an area. Clearly, it is a much larger area than Brighton itself, but it is going some way towards meeting the kind of analysis that he is looking for. I will also touch on the individual trust support that is being offered by wider NHS groups to provide additional qualified medical and managerial support to help to solve the problems.

[Caroline Lucas]

I want to put this on record. The Minister referred to the fact that up the road there is a more successful trust. Not only are we operating in a very old building, but we are trying to do that when the hospital is becoming a major trauma centre. That is a massive change in Brighton and Hove. I re-emphasise the points that my honourable colleague, the hon. Member for Hove (Peter Kyle), made. We need real finance and I do not think that the STP is going to do it. It needs some money.

[Mr Dunne]

I thank the hon. Lady for her intervention. I am going to move on, but I acknowledge her point. I hope that, in part, the STP will focus the attention of the wider area to support the new trauma centre that is being established. That is part of the purpose of the STP, although, like her, I have yet to see the full details.

I think we all recognise that patients deserve the highest quality care and we expect the trust to take action to ensure the root causes of the CQC concerns are addressed. NHS Improvement has confirmed that the trust has developed a recovery plan and as part of a package of support for the trust for being in special measures, NHS Improvement has appointed an improvement director and a board adviser.

We should also acknowledge along with the trust’s challenges the fact that there are good things going on in Brighton. We should praise the team that delivers services for children at the Royal Alexandra children’s hospital in Brighton as the CQC rated them as outstanding for being innovative and well led.

Emergency care services at the trust are not as we would expect, as the hon. Member for Brighton, Pavilion identified. With support from the national emergency care improvement programme, a clinically led initiative that offers intensive practical help to trusts looking to improve their emergency services, NHS Improvement is working closely with local clinicians to make a difference for the people of Brighton and Hove seeking emergency care. The trust is also developing plans to create capacity to support delivery of the planned care standards.

As the hon. Lady said, on Monday of last week NHS Improvement announced that the trust has entered financial special measures, a programme launched by the regulator that provides a rapid turnaround package for trusts and foundation trusts that have either not agreed savings targets with local commissioners or planned to make savings but deviated significantly from this plan in their quarterly returns. As part of financial special measures, the trust will agree a recovery plan with NHS Improvement. The trust will also get support from and is held accountable by a financial improvement director.

The hon. Lady also referred to the challenges faced by the ambulance services in her constituency and the area. In addition, South East Coast ambulance service was recommended for special measures by the CQC in its inspection report published last month. NHS Improvement acknowledges that there are wide-ranging problems across the trust, including in governance structures and processes, culture, performance and emerging financial issues. NHS Improvement has agreed a support package for the trust, which was formalised on 9 August this year, and includes a formal peer support relationship with a neighbouring ambulance trust that is rated good by the CQC.

As part of the support package, NHS Improvement has also appointed an interim chair and will appoint an improvement director in due course.

[Peter Kyle]

For the second time, I am extremely grateful to the Minister for giving way. We focus the onus for improvement on the delivery bodies in the Brighton and Hove area. NHS Improvement and the CQC have been outlining plans and their responsibility is to instigate this improvement, but does he accept that NHS Improvement is also under scrutiny in how it unfolds this improvement programme and that if improvements do not happen fast enough it will also be culpable? Some of the dates for improvement have already passed without the improvements being made.

[Mr Dunne]

The hon. Gentleman will recognise that NHS Improvement only came together in April of this year when the two previous regulators, Monitor and the NHS Trust Development Authority, were combined. It is to a degree finding its feet in working out how best to assist trusts that get into difficulty. It has introduced a number of different schemes for different types of challenge, and we have touched on the care challenge and the financial special measures challenge. It is also undertaking a five-point A&E improvement plan to focus particularly on challenges in emergency care. It is fair to say that it is early days in seeing how NHS Improvement undertakes its functions, but we have every confidence that it will be able to assist trusts in dealing with these challenges.

Finally on the South East Coast ambulance service, NHS Improvement is also undertaking a capability and capacity review and will provide the trust with support with its finances. The hon. Lady mentioned the problems with the non-urgent patient transport service provider. This has clearly been a very difficult time for its staff and for some patients, as she has highlighted. My understanding is that the High Weald Lewes Havens CCG has overseen the implementation of plans to ensure continuity of service, and has recently appointed a specialist transport adviser to look into the resilience of the contract and to explore options to strengthen this further.

The provision of the services is, quite rightly, a matter for the local NHS. The hon. Lady asked who is responsible for monitoring contracts. The reality is that the CCG is the statutory NHS body with responsibility for the integrity of the procurement, as well as for managing the contract. It has powers within the standard NHS contract to intervene where a contractor’s performance falls below what is expected.

[Caroline Lucas]

Will the Minister give way?

[Mr Dunne]

I will give way for the last time.

[Caroline Lucas]

The Minister says that the CCG has such a power, but the CCG told me that it could not see the contract between Coperforma and its subcontractors, because that was not for the CCG to see. It therefore cannot have such a degree of oversight.

If this is the last time the Minister gives way, will he say if he will step in on the issue about whether the Docklands phoenix company is properly licensed to provide the service it is providing? Right now, we do not know whether it is, and our patients may be at risk.

--- Later in debate ---

[Mr Dunne]

On the first point, it is down to the CCG to undertake a contract that gives it visibility on subcontracts. If that failing has emerged, the CCG needs to be able to get to see them in subsequent contracts, and I am sure it will learn from that message. On the regulation of the provider, that is a matter for the CQC to look at. I undertake to inquire of the CQC what the status is of the current provider to ensure that it is properly regulated.

For much of her speech, the hon. Lady talked in rather familiar terms about her understanding of the impact of the so-called privatisation of the NHS. I gently remind her that the Health and Social Care Act 2012 did not introduce competition into the NHS. Previous Governments have used patient choice and competition as part of their reform programme. Independent sector providers have provided care and services to NHS patients under successive Governments ever since the NHS was founded. In particular, in the area of non-emergency patient transport, that has happened across many areas of the country. In the last year for which financial data are available, NHS commissioners purchased 7.6% of total healthcare from the independent sector. In 2010, that was about 5%. The rate of growth in the use of private providers under this Government is lower than it was under the previous Labour Government.

[Tim Loughton]

Will the Minister give way?

[Mr Dunne]

I will give way, for the final time, to my hon. Friend.

[Tim Loughton]

This is the first time I have intervened on the Minister, and we do have about an hour left in which to carry on this debate.

--- Later in debate ---

[Mr Dunne]

My hon. Friend makes a very powerful case. As I have already undertaken to do for the hon. Member for Brighton, Pavilion, I will take up the issue with the CQC and ask it to give me some reassurance about both the regulation of the entity and, to the extent that it is relevant to the CQC, the procurement. I accept that we should look at the due diligence for such activities.

I will close, without taking any further interventions, by saying a brief word more, as I promised to earlier, on the sustainability and transformation plans. These were submitted to NHS England by 44 regions across the country during the course and by the end of last week—by last Friday. As I said earlier, the intention is that the plans build on the work already undertaken to strengthen care. They will help deliver the NHS’s own plans for its future, set out in the five-year forward view, by encouraging providers and commissioners within an area to work more collaboratively—without the barriers of stovepiping that in the past have led to conflict between them—and co-operate to try to come up with the best plan for patients; that must take into account the increasing integration with social care providers in the area, which the hon. Member for Brighton, Pavilion has mentioned, so local authorities are also integral to the plans.

[Caroline Lucas]

Will the Minister take one final intervention?

[Mr Dunne]

I am afraid I really do not think that I can.

We expect most areas to undertake public engagement from now until the end of the year, building on the engagement they have already done to shape thinking. But we are clear that we do not expect changes to the services that people currently receive without proper, full local engagement and, where appropriate, public consultation. There are long-standing processes in place to make sure that happens.

[Caroline Lucas]

Will the Minister give way? This is on a serious point.

[Mr Dunne]

I have been very generous and have spoken for substantially longer than I normally would in winding up an Adjournment debate.

In closing, I emphasise that it is the responsibility of local NHS organisations to determine how local services are delivered. They are best placed to understand the needs of the people they serve, and we must ensure that changes are led locally, in some cases with improved local management where there have been management shortcomings. Changes need to be focused on the needs of the local population and not driven by central Government. This Government recognise the importance of ensuring that the NHS is held to the highest standards of care, in the hon. Lady’s constituency and across the UK, and we will continue to work to ensure that services are high-quality, safe, appropriate and affordable.

Question put and agreed to.

Kettering General Hospital

Philip Dunne Excerpts

Friday 21st October 2016 Commons Chamber

[The Minister of State, Department of Health (Mr Philip Dunne)]

What a pleasure it is to join you this afternoon to participate in this debate on Kettering hospital, Madam Deputy Speaker. I congratulate my hon. Friend the Member for Kettering (Mr Hollobone), not just on securing this debate, but on his persistence in keeping Kettering hospital at the forefront of the national debate on what is happening to our health service. He has taken an assiduous interest in promoting it at almost every opportunity, as he suggested today. Indeed, he raised the matter at my first Health questions earlier this month and was on his feet raising it again with the Prime Minister the following day. He is a worthy champion of the cause, and I am therefore fully aware of his interest in local health matters affecting his constituents.

I wish to join my hon. Friend in recognising at the outset the great work done by all our staff in the NHS right across the country, but particularly the staff who work in and around Kettering and the other hospitals we have heard of today from my hon. Friends the Members for Corby (Tom Pursglove) and for Wellingborough (Mr Bone). I was invited by two of the three Members who have spoken to attend their local hospitals—

[Tom Pursglove]

You are very welcome to Corby, too.

[Mr Dunne]

My hon. Friend, from a sedentary position, extends an invitation, too. I am grateful to all three hon. Friends. I am relatively newly in post, and the demands at present are to visit hospitals that are in greater difficulty than any of these cases, but I will endeavour to see what I can do during next year possibly to visit Kettering.

[Mr Hollobone]

One visit to all three of us would kill three birds with one stone.

[Mr Dunne]

I have responsibility for the acute sector, not the community sector, so initially my visit would be focused on Kettering hospital. I will certainly do what I can, but I think that it will have to be some time next year. My hon. Friend has previously met my predecessors to discuss health services in his constituency. He has raised a number of issues today, and I will attempt to address most, if not all, of them in the time that I have.

I wish to start with my hon. Friend’s concerns about the underfunding of his local clinical commissioning groups. That was a point also raised by my hon. Friend the Member for Wellingborough. NHS England is working to move CCGs towards their target fair share of funding, but this has to take place at a pace that maintains stability in the system across the country at a time of significant financial challenge. I feel that quite acutely as a local Member of Parliament representing a rural constituency that has been consistently underfunded. We are taking steps, as I mentioned to the House in a debate earlier this week, to look at introducing a fairer share of funding for rural areas and addressing other issues such as social deprivation. A consequence of that has been to try to bring those CCG areas that are recognised to be underfunded closer to the target.

The point was made that Nene and Corby CCGs have been beyond 5% of the target. I am pleased to confirm the figures that were mentioned earlier by my hon. Friend the Member for Kettering: Nene and Corby CCGs received cash increases of 5.2% and 9.4% respectively in the current year. Those increases are significantly above the average for English CCGs and bring them both within 5% of their target allocation in this year. I think that 9.4% is one of the highest increases in allocation that we have seen this year across the country, so I hope that he recognises that we are moving to right that historic challenge. This year, more than £757 million will go into my hon. Friend’s local area, and allocations over the next few years should bring both Nene and Corby CCGs even closer to their funding target.

I will take a moment to touch on the national pressures that are affecting the NHS. The NHS is very busy, but hospitals are generally performing well. The latest figures for August 2016 show that more than nine out of 10 people were seen in A&E within four hours. During 2015-16, nearly 2,500 more people were seen in A&E each day within four hours compared with 2009-10.

Paramedics respond to the majority of life-threatening cases in under eight minutes. More than 567,000 emergency calls received a face-to-face response from the ambulance services across England in August 2016 alone—an average of 18,300 a day. Ambulance services are busy, which is why we are increasing paramedic training places by more than 60% in this year alone, on top of the 2,300 extra paramedics who have joined the NHS since 2010. That allows more than 200 additional ambulances to be deployed by the NHS compared with 2010.

[Mr Bone]

The Minister is making a very good point. Does he not accept that if an ambulance were to take a patient to the Isebrook hospital, it is 10 minutes’ transport, but if it has to go to Kettering, it is 45 minutes’ transport? Is that not the sort of thing that we should look at as an efficiency saving, which is worth the investment in Isebrook?

[Mr Dunne]

I would agree with my hon. Friend in the event that the hospital in Wellingborough were able to cope with the condition, but many of the most serious conditions need to go to the best place to deliver the service, even if it takes a bit longer to get there. The quality of treatment in our ambulances now, with the skills of the paramedics who are on board in almost all cases, is such that very few people die while in transit. They are kept stable, and they need to go to the best place for treatment.

Going back to the national picture, the NHS last year treated, on average, 21,000 more outpatients a day and performed more than 4,400 operations a day compared with 2010. There is substantially more activity across the NHS, which is one reason why we have recruited so many more clinicians to help cope with this activity. We now have over 8,500 more doctors and over 2,700 more nurses, paid for in part by having nearly 7,000 fewer managers. Ultimately, we want to reduce pressure on services by reforming the urgent care system and caring for people better in the community, and that is where I think some of the things being done and being planned for the Kettering area are so interesting. It is clear that the NHS in the constituency understands the scale of the challenge and is taking action to address it.

[Mr Hollobone]

We understand the scale of the challenge. The problem is that the urgent care hub proposals, which are really exciting and could be rolled out across the country, are now with NHS Improvement, and its say-so is required to go to the consultancy phase.

[Mr Dunne]

Indeed, and our plans for improvement and integration among collaborative NHS areas across the country, including the Kettering area, through the sustainability and transformation plans are being delivered for each area today. NHS England will review those plans and decide to prioritise those that meet the national objectives and are best thought out.

In the past three years, including the current year, the Department has provided just over £37 million of interim revenue support and over £15 million of emergency capital to the trust. Since May 2010, capital expenditure on the hospital has amounted to £68.7 million, so it is receiving quite substantial support from the Department. The intention of the transformation work is to move to a position where the ability to cope with the remaining additional pressures on A&E and across the patient flow in the hospital is built in.

My hon. Friend the Member for Kettering said that the trust’s emergency department was too small and too limited in scope, and he touched on the new construction completed this year to extend the scope of the A&E department. It was originally built 20 years ago for 40,000 attendances a year, but is now dealing with more than 82,000. But the trust has had some success in reducing A&E attendances; there are more than 3,000 fewer than six years ago. The measures to integrate with the surrounding area are therefore having an effect on reducing attendances, despite the growing demand overall.

The trust has recruited and trained additional medical staff. Since 2010, the trust has increased its doctors by 77, or 24%, to 394. That is one of the most significant increases I have seen thus far. Some of this has come from the recruitment of staff through the certificate of eligibility for specialist registration scheme, involving doctors who have, for example, completed their specialist training overseas and chosen to practice in this country.

My hon. Friend and my hon. Friend the Member for Corby referred to proposals to develop the urgent care hub at the hospital. The aim is to develop a one-stop shop, which will enable patients to use primary care facilities, rather than A&E, by having these services co-located on the Kettering general hospital site. These services would enable rapid assessment, diagnosis and treatment by appropriate health and social care professionals. Patients would be streamed into appropriate treatment areas to minimise delays and reduce the need for admissions. This is an example of best practice across the NHS; it is what we are trying to introduce to relieve pressure on clinicians in the A&E department.

My hon. Friend the Member for Kettering raised the possibility of capital investment to develop this hub. The Department’s position has not changed. We are looking to the trust to take responsibility for developing and taking forward its own capital investment proposals. Foundation trusts, such as Kettering, can apply to the Department’s independent trust financing facility for a capital investment loan. They need to work closely with local planning authorities to ensure that developer infrastructure contributions can be taken into account as a source of funding.

I hope that these plans will be successful as they emerge through the STP, and as I have said, I hope that I will find an opportunity to visit Kettering on one of my visits north if I am allowed to do so on a suitable day when not required here in the Chamber.

Question put and agreed to.

Glenfield Hospital Children’s Heart Surgery Unit

Philip Dunne Excerpts

Wednesday 19th October 2016 Westminster Hall

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a great pleasure to serve under your chairmanship, Mrs Gillan. I congratulate the hon. Member for Leicester West (Liz Kendall) on securing the debate and on speaking with such evident passion and knowledge on the subject. I think she has impressed us all with her grasp of the issues. I also congratulate all other hon. Members, from both sides of the House, who managed to secure an intervention during her speech. They made their points clear, with some personal testimony from constituents who have used these facilities, and also made clear how important it is to the region of the whole, in their eyes, that the facility continues.

The future of congenital heart disease services at Glenfield hospital is an important subject, not just regionally but as part of the national plan to ensure that we have world-class heart facilities for infants and children in this country. It is a matter that has been around for some time, and I understand the point the hon. Lady and others made about how unsettling the uncertainty around the future of services is for the dedicated staff who work in those units. It is appropriate that we try to bring these discussions to a head in an orderly, thoughtful and timely way, so that that is not prolonged.

It is worth emphasising that NHS England’s review is about ensuring that CHD services are delivered with high quality and that they are consistent and sustainable for the future. The common standards, which have been agreed by clinicians, other experts and patients, are the driving force to make sure every patient benefits from the same excellent care. It is worth reminding hon. Members present that the proposals for changes to adult and children’s congenital heart services at Glenfield and the other centres across the country are at present just that: proposals. They are not final decisions. NHS England will be consulting on the proposals in the coming months, so it is not appropriate for me to respond in detail to all the concerns raised here today.

The hon. Member for Leicester West asked some specific questions, some of which I will be able to address but most of which, I regret to say, I will not. Those will be drawn out when we come to the consultation, so that the points she made about the current performance of the hospital can be brought to attention through the consultation process.

[Liz Kendall]

I am soon to meet the Minister at the Department of Health. If he is not able to answer the specific questions I have raised, perhaps he can come back to me on those issues at that meeting next month.

[Mr Dunne]

The hon. Lady has put her points on the record. I will be able to respond to some next month, but some will be part of the consultation, which we anticipate will get under way in the new year.

I am trying to put this in context, particularly in relation to the amount of time that we have been considering how to create excellent centres of congenital heart surgery for children across the country, which has been the subject of concern for more than 20 years. Clinical experts and national parent groups have repeatedly called for change, and there has long been an overwhelming feeling that change is needed. Added to that is the fact that children’s heart surgery has become ever more complex and technically demanding. Surgeons now operate on babies who may be only hours old, which demands a highly-skilled and technical team of doctors and nurses who maintain those skills through regular practice. That is why standards are being progressively raised for each surgeon over time, as the hon. Lady referred to.

As I am sure everyone involved in the Glenfield debate is aware, the process of consultation began quite a long time ago. A Safe and Sustainable review was launched in 2008 by the Department of Health under the previous Labour Administration—of which the hon. Lady was a member—to start addressing these issues. The decisions that came out of that review were challenged in court, via referral to the Secretary of State and subsequently to the independent reconfiguration panel. As a result of those challenges, the Safe and Sustainable review was halted. Responsibility for reviewing children’s CHD services was then handed to NHS England, which decided that its new review of those services would also encompass services for adults.

NHS England’s review team consulted extensively with patients and their families, clinicians and other experts before publishing the new standards for CHD services, which only came into effect in April this year. Hospital trusts providing CHD services were then asked to assess themselves against those standards and report back on their plans to meet the standards within the set timeframes. In July this year, following those assessments and further verification with providers, NHS England announced its proposals for change.

In the case of Glenfield, NHS England is minded to work with University Hospitals of Leicester to safely transfer CHD surgical and interventional cardiology services from there to appropriate alternative hospitals. The rationale for that is that NHS England is currently of the view that Glenfield does not meet the standards to be a centre for surgery and interventional cardiology, and is unlikely to do so in the future. The hon. Lady eloquently expressed her belief, presumably based on conversations with the hospitals and with clinicians, that they are on track to meet those standards. That will be important evidence to make available to the consultation, and I am sure that she and other hon. and right hon. Members will do so over the months of the consultation. NHS England’s assessment is based on information provided by the trust itself about surgical numbers, surgeons and their expertise, and which specialist services are located together. It has not come from the centre; it has come from the trust itself.

There is no plan to close Glenfield as a provider of CHD services, other than in relation to surgery. NHS England is instead proposing to continue to commission specialist medical services that make up much of the pre and post-surgical care required by people with congenital heart disease. Closing the medical services for CHD at the hospital is not mentioned under any of the proposals. That has understandably prompted much concern, including about the impact that such a transfer might have on issues such as children’s extracorporeal membrane oxygenation—ECMO—services and paediatric intensive care services, as the hon. Member for Leicester West identified. As I understand it, when the review was undertaken in 2008, Glenfield was not only the first hospital in the country providing ECMO services but was the leading hospital. There were not many others. Today there are five centres offering ECMO services, so Glenfield is not in quite as strong a position as it was a few years ago.

The hon. Lady referred to the petition on Glenfield and the many hundreds of thousands of people who have signed it, which demonstrates the strength of public support for maintaining the service. It shows how passionately people feel about these issues and their strong desire to defend their local services. At this stage I reiterate to those people that no final decisions have been made. We need to wait and see what comes from the next stage of the process, and I am sure the petitioners will make their views known during that. I appreciate that hon. Members may be frustrated that I cannot answer all their questions at this stage. The hon. Member for Leicester West has referred to the meeting we will have in the coming weeks. I look forward to that and to attempting to answer some of her questions.

I remind hon. Members that this is not about cutting costs—that allegation has not been made by anyone during the debate, which I appreciate. It is about trying to improve the standard of service for some of the most sick infants and children in the country, and to ensure that we have a robust, sustainable pattern of expertise in a slightly smaller number of hospitals. Precisely where we get to in deciding which hospitals should provide those services in future will come through the consultation that will take place. The intent is for a formal, three-month public consultation that will conclude in the spring, with decisions being made next summer. I am sure all hon. and right hon. Members present will participate in that debate and I look forward to hearing their contributions.

Question put and agreed to.

Healthcare (Devon)

Philip Dunne Excerpts

Tuesday 18th October 2016 Westminster Hall

[Peter Heaton-Jones (North Devon) (Con)]

It is a pleasure to serve under your chairmanship, Mrs Main. May I congratulate my right hon. Friend the Member for East Devon (Sir Hugo Swire) on securing this debate on a topic that is vital for all us, right across Devon?

It will not be a surprise to anyone that I intend to focus mercilessly on North Devon and to fight our corner very hard indeed against the threat to our acute services at the North Devon district hospital in Barnstaple. Before I go into that in any detail, I want to make a couple of points. First, I would like to thank the Minister, who has on a number of occasions met myself and other colleagues in Devon to address this issue. I know he understands the particular significance of the North Devon district hospital, because I have discussed it with him, as I have with a whole slew—I am not sure what the collective noun is—of managers in the Northern Devon Healthcare NHS Trust and other directors and managers within NHS England, who by now are well aware of the strength of feeling in North Devon. I want to put it on record that the Minister has been very proactive in arranging such meetings.

My right hon. Friend the Member for East Devon talked about community hospital beds. I do not want the impression to be given that that is not a serious issue also in North Devon, although I will not be majoring on it. In North Devon, there is a bit of history. We did the heavy lifting with the loss of many of our community hospital beds about 18 months ago under a different process from the one now being undertaken in the rest of the county. I agree with what my right hon. Friend said about the need to look very carefully at the provision of social care before community hospital beds are removed.

I do not think NHS England has done this in the right order. Community hospital beds have been removed in North Devon, specifically from the Tyrrell hospital in Ilfracombe, and there is a great amount of concern among the local community about what is replacing that provision. Is there integrated and fully functioning health and social care provision in North Devon to replace those beds? My view is that the answer is no. That is also the view of the community in Ilfracombe. Last Friday I met the League of Friends of the Tyrrell Hospital, and that is strongly their view. That is not my major point today, but I want it on record that that remains a concern in North Devon, as it will become in other parts of the county.

My focus today is on acute services in North Devon. The community is extremely concerned. Many constituents have contacted me and shown their strength of feeling through protests on the street, campaign marches and letters to me, as the local MP, and to my hon. and learned Friend the Member for Torridge and West Devon (Mr Cox), whose constituents also use the North Devon district hospital in Barnstaple.

My point is absolutely clear and I will make it up front: there must be no cuts to acute services at North Devon district hospital in Barnstaple. I cannot see any clinical argument to justify even consideration of any such a reduction in services, let alone its implementation. Let me provide some background.

Healthcare in Devon is currently subject to not one but two separate review processes. We have the success regime, and the Northern, Eastern and Western Devon clinical commissioning group area was given this special treatment with only two other areas in the country—one in Essex and one in Cumbria. Because of the need to ensure that we do not fall into a future funding black hole, the success regime was implemented. I fully support that because we need this special treatment.

On top of the success regime we have a sustainability and transformation plan, which, as hon. Members will know, is being implemented in all NHS regions in England. We have this two-tier process and my understanding from conversations with NHS England is that the success regime will probably be folded into the sustainability and transformation plan, so North Devon will find itself subject to a target that we are at least more easily able to identify. The difficulty is that the ideas that are starting to emerge from the two, soon to be one, reviews are simply unpalatable for North Devon.

I put it on the record that I am fully aware that these are not firm proposals or ideas and no public consultation has been launched. None the less, what has started to emerge has, reasonably and understandably, created serious concern in the North Devon community because, looking across the piece at the various documents that have emerged from both the success regime and the sustainability and transformation plan, we see a picture that puts under threat some of the services at North Devon district hospital, which my constituents rely on most keenly and have done for generations. They include vital services such as accident and emergency, stroke and one that I want to focus on now, maternity.

I have here one of the latest documents to emerge, which hon. Members may remember. Unfortunately, NHS England decided not to make this series of documents public. I say gently to the Minister that that has not been helpful. I know it was not his direction, but it has given rise to the belief that stuff is being done in private behind closed doors and that leads to suspicions, rightly, among my constituents and the public in general. That latest document, which is about five weeks old, starts by talking about

“a two-site option for maternity”

and states that the

“Royal Devon and Exeter Hospital would most probably be the second site”—

after Derriford in Plymouth—

“rather than North Devon District Hospital”.

That is a clear indication that consideration is being given to closing the maternity unit at North Devon district hospital. That is not acceptable to my constituents and we will fight any such proposals if they come forward. We will do that forcefully for a couple of reasons.

North Devon is a special case, not least because of our geography. I have said many times in this Chamber, in the House and elsewhere that Devon has been historically underfunded, and North Devon even more so. We are and have been for too long the poor relation in public funding. Let me be clear. This is not something that has happened in the last 18 months or the last six and a half years. It has been an issue under Governments of all colours for many years, if not decades. It is something up with which we will no longer put.

Part of the difficulty of singling out North Devon and Barnstaple as a place that can apparently sustain further reductions in services is that we start from a lower base of funding than in many other regions. That feeds perfectly into the point that my right hon. Friend the Member for East Devon raised about rurality. North Devon is a largely rural constituency, and for many years a series of funding formulae have dealt unfairly with North Devon because of its rurality. There seems to have been a belief that, because we are a rural area with a sparse population, we can somehow do with less funding. In fact, the opposite is true, and I am delighted that this Government are starting to recognise that. Across the piece of funding for local government, the police, education and health services, we are starting to right that wrong and equalise that funding gap, but the history is still there and that is why North Devon is the last place where we should be looking for further cuts.

[The Minister of State, Department of Health (Mr Philip Dunne)]

I am grateful to my hon. Friend for allowing me to intervene during his limited time in this debate, but I would like to respond specifically to his point about funding and allocations.

In the 2016-17 funding round, the allocation formulae have been looked at again and we have, for the first time in several years, introduced three differentials that are relevant to rural areas and that I think will affect my hon. Friends here. They include looking at the combination of rurality, remoteness and sparsity of population to improve the ambulance emergency cost adjustment, to reflect the greater distances travelled in rural areas; an adjustment to support continued provision by hospitals with 24/7 A&E services that are remote from the wider hospital network—my hon. Friend’s North Devon district hospital will be one of those’and an adjustment to remove from the formula supply-induced demand in urban areas where people live close to hospitals. Those three measures have led to a change and I gently suggest that my hon. Friend may care to look at the CCG allocations table which sets that out. For Northern, Eastern and Western Devon CCG, the per capita allocation for 2016-17 is £1,250, which is slightly above the average for England of £1,221 per head.

[Peter Heaton-Jones]

I thank the Minister for his intervention and I welcome it, but I say gently to him and NHS England, which I am sure is monitoring this, that all that good work will be entirely undone if we then lose our acute services at North Devon district hospital. This is not about figures on a spreadsheet; it is about the services and healthcare provision that my constituents will receive in Barnstable.

I am aware of the time, Mrs Main, but I want to raise a second issue, which is important and recognisable to us in North Devon, but perhaps not to those beyond: our unique geography and the distances. An Australian historian once referred to the tyranny of distance, and I think we suffer from that in North Devon. If one looks at a map, it is all too easy to think that there is a decent road network between Barnstaple and Exeter. I can give several reasons why that would be a wrong assumption. First, vast numbers of people live in isolated regions far north of Barnstaple. Secondly, the road network is not all it is cracked up to be—although that is a subject for another day and one on which I am fighting heavily.

My main point is that what no map or distance table shows is that in North Devon we have pockets of serious deprivation. In Ilfracombe, I have two of the most deprived wards in the south-west and by some metrics the most deprived in south England. In those areas car ownership is less than 80%. Put another way, one in five households do not have access to their own private transport and, because of the demographics, some of those who do are elderly and perhaps have their own vehicle but simply would not feel comfortable or up to going long distances to Exeter or Plymouth. Those two reasons alone are sufficient to argue strongly that the last place where we should be looking to make cuts to acute services is at North Devon district hospital.

I am aware of the time, Mrs Main, so I will conclude. I welcome the fact that the Government are looking at the funding. I welcome the repeated assurances that local clinicians will make the final decisions. However, I want it to be in no doubt whatever—the community of North Devon are very clear about this—that North Devon is a special case and needs to be treated as such. In that regard, I make no apologies whatever for fighting for North Devon and for appealing for there to be common sense and no cuts at North Devon district hospital.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Philip Dunne)]

I am grateful to you for taking the Chair this afternoon, Mrs Main, and for encouraging me to leave some time for my right hon. Friend the Member for East Devon (Sir Hugo Swire) to respond, which I will endeavour to do. I congratulate him not only on securing this debate, which has been very well supported by his colleagues from across the county, but if I may—this is the first opportunity for me to do so publicly—on the recognition that he received of his time in Government from the previous Prime Minister.

I start by highlighting some of the excellent work carried out every day by all those who work in the NHS, not only in my right hon. Friend’s constituency but in mine and those of all the others who have spoken today. I will attempt to address some of the specific points that have been raised, particularly by my right hon. Friend, but I shall first provide the House with a little context and background regarding health services in Devon.

Devon is a leader in many areas of the health service—perhaps to the surprise of some hon. Members who have spoken—relative to other parts of the country. Not least, the Torbay and South Devon NHS Foundation Trust was the first trust in England to join up hospital and community care with social care. A plea to do that was made by my right hon. Friend and it is already happening in South Devon. The trust operates as a single organisation, working with partners to improve the way it delivers safe, high-quality health and social care. The trust is showcasing exactly the kind of joined-up, patient-centred care that we want the NHS to provide to meet the needs of the ageing population.

I also pay tribute to the staff at the Royal Devon and Exeter NHS Foundation Trust, who last month celebrated their fifth anniversary since the last incident of hospital- acquired MRSA. That remarkable accomplishment comes as the result of continuous improvements at the trust over the last 10 years. The trust is now considered a national leader in infection control, being the only general hospital in the whole of England to have avoided any MRSA infections in the last five years.

However, I absolutely recognise that the region is facing difficulties. NHS staff across the region are working hard to provide good care to patients, but services are not keeping pace with the changing needs of local people. It is becoming increasingly difficult to make sure that local people have access to consistently high-quality care that is affordable and sustainable.

As my right hon. Friend said, in June 2015, NHS England announced that north, east and west Devon would be one of the three areas in the country to take part in a success regime. That is designed to improve health and care services for patients in local health and care systems that are struggling with financial or quality problems. Following intense diagnostic work, the north, east and west Devon success regime published, in February this year, the “Case for Change” report, which was referred to earlier. The report sets out the underlying challenges facing the area and the opportunities to improve access to services and ensure clinical and financial stability. The work concluded that if nothing was done, Northern, Eastern and Western Devon would have a system deficit of £398 million by 2020/21, as has been referenced by a couple of hon. Members, including the hon. Member for Burnley (Julie Cooper).

As well as the financial challenge, the work identified significant health inequalities and some clinical services that will be unsustainable in their current form. There are good reasons for that. As we have heard from hon. Members, people in north, east and west Devon are living longer successfully, particularly in areas of the constituency of my right hon. Friend the Member for East Devon and in Torbay.

People are living with increasingly complex care needs and require more support from health and social care services. More than one in five people in north, east and west Devon are over the age of 65, and that figure will be almost one in four by 2021. Some 40% of local people use almost 80% of health and social care services. There are 280,000 local people, including 13,000 children, living with one or more long-term conditions such as asthma, diabetes, hypertension, cancer and mental illness.

Although Devon is regarded from the outside as generally affluent, we are all aware—hon. Members have explained this—that there are areas of significant deprivation. There are big differences in health outcomes between some areas, particularly in Plymouth. There are also spending disparities between different parts of the county.

More than 10% less for each person is spent on healthcare in west Devon compared with north and east Devon, even when age and deprivation is taken into account, as my hon. Friend the Member for North Devon (Peter Heaton-Jones) emphasised. Somebody living in Ilfracombe Central is statistically likely to die almost 15 years earlier than a person living a two-hour drive away in Newton Poppleford.

Inequalities need to be reduced, and the spread of health and social care across north, east and west Devon needs to be made more equal. I am sure that my right hon. Friend the Member for East Devon agrees that his constituents should have access to the same high-quality healthcare services as those in the rest of Devon, let alone the rest of the country. He referred to the success regime consultation as being at fault. I gently remind him that it was only published on 7 October. I am sure that comments made today about the lack of available paper copies of the consultation will be taken into account by the organisers, and that we can respond to that.

[Neil Parish]

I want to press the Minister on the success regime’s consultation. Is it right for a hospital to have its beds taken away as part of that consultation? Surely a consultation should be for people to have a say on a public decision.

[Mr Dunne]

I heard my hon. Friend mention the lack of reference to Okehampton and Honiton. I gently draw attention to the fact that the option to retain community beds in both those hospitals was considered as part of the 15 options in the document. The option was rejected as one of the four recommended for consultation, but that does not prevent him, his constituents or local representatives in those areas from putting those alternative options forward.

My right hon. Friend the Member for East Devon asked whether there was a “none of the above” option. I think he may have been referring to page 42 of the consultation document, on which the organisers say that they

“welcome all views and will carefully consider all responses and analyse these against the decision making criteria. That will include options which are not currently in the consultation document”.

They are open for proposals to be made by others, but those need to be looked at in the context of the criteria.

[Sir Hugo Swire]

I am grateful for that clarification. Presumably, that does not alter the fact that Tiverton—that rather expensive private finance initiative that we have inherited—stays part of any outcome.

--- Later in debate ---

[Mr Dunne]

My right hon. Friend would not expect me to be drawn on any of the specific options. I would not want to be seen to be influencing the consultation prematurely or, indeed, at all until we see the recommendations that come out of it.

It has come out of the investigations leading up to the consultation that every day more than 500 people in north, east and west Devon are being cared for in a hospital bed who do not need to be there. That is at the heart of the challenge that we face not just in Devon but across the country, as the hon. Member for Burnley mentioned.

The system is keeping people in community beds or acute beds longer than they need to be because of discharge challenges. That gets back to the initial remarks of my right hon. Friend the Member for East Devon about whether we are integrating the consultation properly with improvements to social care. It is important, when we come to look at the recommendations arising from the consultation, that we take into account the capacity that will need to be created in social care to provide alternative models of care if the number of beds is reduced.

The formal consultation concludes on 6 January. As I have said, I will not comment on specifics while that is under way, but I strongly encourage my right hon. Friend, all other hon. Members who have spoken in the debate, and those who were not able to because they are elsewhere in the House today to ensure that their views are taken into account. The next phase of the success regime will look at how services are provided in acute hospital settings, as my hon. Friend the Member for North Devon highlighted, as did my hon. and learned Friend the Member for Torridge and West Devon (Mr Cox) in his characteristically robust contribution. I am sure that they will make their views known in the consultation that we anticipate will follow next summer, and the clinicians involved with the acute services will be preparing their recommendations.

My right hon. Friend the Member for East Devon is aware that the success regime plans are part of a broader sustainability and transformation plan that covers the whole of Devon. That creates the opportunity for health and local authorities—not just NHS bodies but local authorities with responsibility for social care—to work together to try to formulate plans that give care packages the kind of integration and coherence that hon. Members have sought for Devon. It will build on the work that has been done by north, east and west Devon’s success regime and on the “Case for Change” published by South Devon and Torbay CCG in September. The latest iteration of the plan is due to be submitted to NHS England this Friday.

Before I conclude, I can confirm that I will write to my right hon. Friend on the Exmouth out-of-hours service. I understand that he has a meeting with the Minister responsible for NHS property services later this month, so he will be able to take up his concerns then. On other challenges that were mentioned, we recognise that there is pressure on recruitment and retention of clinicians in rural areas. Hon. Members will be aware of the announcement made by my right hon. Friend the Secretary of State to try to recruit 25% more doctors over the next few years; of our plans to recruit up to 10,000 more nurses over this Parliament; and of the announcement, last week, that we will be introducing a new category of nursing associate to provide more capability. We are acutely aware of those needs.

It is the responsibility of local NHS organisations to determine how local services are delivered. Hon. Members have made some important points, and I urge them to do so as part of the consultation. I hope that we will have another opportunity to discuss the forthcoming recommendations.

Ambulance Waiting Times

Philip Dunne Excerpts

Monday 17th October 2016 Commons Chamber

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a pleasure, Madam Deputy Speaker, to join you a little earlier than anticipated and to have you in your place presiding over this important debate.

I congratulate my hon. Friend the Member for South Dorset (Richard Drax) on securing the debate. I am grateful for this opportunity to discuss ambulance response times and to put on the record, as he did, my thanks to all those who work in ambulance services across the country, not just in the south-west. Ambulance services are a vital part of the healthcare system and provide rapid assistance to people in urgent need of help. We are all united in expressing our gratitude to them for the professional work that they do.

I acknowledge that the NHS is busier than ever. That is why we are backing the NHS’s future plan with an extra £10 billion by 2020-21, providing some of the funding that my hon. Friend concluded his remarks by calling for. The ambulance service is experiencing unprecedented demand in all parts of the United Kingdom, including, as we heard from the hon. Member for Strangford (Jim Shannon), in Northern Ireland. It is delivering over 3,400 more emergency journeys every day in England than in 2010. In the past year, calls to ambulance services in England rose by 400,000, from 9 million in 2014-15 to 9.4 million in the year ending in April. Including calls transferred from NHS 111, ambulance services deal with more than 10 million 999 calls every year.

The demands currently being placed on ambulance trusts mean that performance targets have been, and continue to be, under pressure. South Western Ambulance Service NHS Foundation Trust has seen a particularly sharp increase in demand for its services. In the year to date, there have been 11% more calls in the south-west than at the same time last year. These calls have led to over 1,800 face-to-face responses by the service, on average, each and every day. In June this year, the Care Quality Commission inspected the service, and recently published the report of its findings. Overall, the trust has been awarded a rating of “requires improvement”. Within this rating, there were some positive findings. In particular, the trust was rated as outstanding for being a caring service, and the majority of feedback from patients about their individual experiences was favourable. However, it was also deemed to require improvement for its emergency operations centres, emergency and urgent care, and patient transport services, on which my hon. Friend focused.

I am sure my hon. Friend will be pleased to know that we are undertaking a range of initiatives to meet these challenges. Sir Bruce Keogh’s review of the NHS urgent and emergency care system is tackling the root causes of demand. Under that review, ambulance services will be transformed into mobile treatment centres. As a result of significant advances in technology in recent years, an ambulance presenting at a patient’s home, or to wherever it is called to treat them, is in a far better position to provide more care without, in many cases, the need to transfer them to hospital. There is greater use at the front end of “hear and treat”, which closes calls with advice over the phone, and “see and treat”, which treats patients on the scene without onward conveyance. This is all happening as a result of the greater integration with the rest of the health system that my hon. Friend called for. The CQC recognised the trust as one of the highest performing in England on “hear and treat”, which enables clinicians to assess and triage patients over the telephone and close the call without the need to send an ambulance.

As part of the wider review, under the ambulance response programme that my hon. Friend mentioned, NHS England is exploring ways in which to change responses to 999 calls by the ambulance service to help improve patient outcomes and help ambulance services better to manage demand. The first element of the ARP is “dispatch on disposition”, which was first piloted in London and in my hon. Friend’s local trust area in the south-west. “Dispatch on disposition” gives call handlers more time to make a clinical assessment of 999 calls that are not immediately life threatening, ensuring that the most appropriate response, based on clinical need, is sent to each incident first time. Early analysis shows benefits for patients from “dispatch on disposition”, and I have recently accepted advice from NHS England to extend this pilot to all trusts to help inform the independent evaluation.

My hon. Friend focused much of his speech on his, I think, personal aversion to targets, and on some of the perverse consequences that can arise. Under the second phase of the programme, we are piloting new clinical codes in ambulance services in Yorkshire, the west midlands and the south-west. The codes are used by ambulance services to determine the appropriate response for each emergency call they receive. The trial seeks to ensure clinically appropriate responses to each presenting condition while making the best use of our ambulance resources.

The programme has clinical leadership at its heart and will be independently evaluated by the School of Health and Related Research at the University of Sheffield, which my hon. Friend acknowledged. The evaluation report will be laid before Parliament once the Secretary of State has made a decision on whether any changes are needed to the ambulance standards. The most seriously ill patients will continue to receive an eight-minute response under the programme, and a pre-triage system is being used to ensure that life-threatening cases are identified quickly and efficiently. Good progress continues to be made with the programme and NHS England will make recommendations to Ministers in due course.

[Richard Drax]

My hon. Friend is very generous in giving way, especially after I had so much time. I have just one question. Yes, my natural instinct is against targets; I do not like them, but I understand why we have to have them. When ambulance trusts or hospitals are fined for not meeting targets, would it not be more logical to look into the reason why and ask the executives, whoever they may be, to sort it out? If they cannot do so, can we then sack them? If the conclusion is that it is a matter of giving more money to help towards achieving the target, obviously it should be given.

[Mr Dunne]

My hon. Friend will be aware that the clinical commissioning groups around the country commission services from ambulance trusts. I am sure he will have looked into the experience of the CCG in his constituency to see whether it believes it is getting the service that his constituents and its patients require. I can speak for my area, where a change to the disposition of response vehicles, particularly ambulances, was proposed by the ambulance service. A trial period took place, and the CCG was persuaded that it needed to provide more money to the ambulance service to fund additional crews to improve coverage. It is specific to individual areas, but CCGs need to work with ambulance trusts to ensure that the relevant standards are achieved.

The South Western Ambulance Service established an action plan in response to the CQC report to identify activities to improve its performance and demonstrate the benefits of the ARP, including addressing staffing and fleet requirements, and working with A&E departments in hospitals to which it conveys.

My hon. Friend made some startling observations about the challenges and consequences of extended handover times, and his examples were instructive. It is clearly a problem when ambulance crews are unable to discharge their patients into emergency departments as efficiently as they would like. NHS Improvement is working with local commissioners and trusts to tackle those problems, including handover delays, when they present a continuing problem. The amount of time lost to handover delays at hospitals is a significant concern in the south-west service, as he indicated. He mentioned an aggregate figure. The figure I have is that, on average, 60 hours per day were lost to handover delays in August 2016. In July, a regional workshop was run by NHS England and the Emergency Care Improvement Programme, attended by the South Western Ambulance Service, acute providers and commissioners. A set of actions to address handover delays were agreed upon and a plan to implement them is being developed. Hopefully he will see the benefit of that shortly.

We recognise that there is currently a shortage of paramedics nationally. As my hon. Friend mentioned, the south-west area is no exception. A number of initiatives are being implemented to address that, from recruitment campaigns for ambulance staff and paramedics, to training schemes to upskill the existing workforce. In the CQC report, it found that South Western Ambulance Service has an appropriate mix of skills to provide a safe service, and that, where staff numbers are below planned levels, the trust is making good efforts to recruit new staff.

At the end of September, there were 1,568 ambulance paramedics at the South Western Ambulance Service, almost double the number of ambulance paramedics there in 2010. That is an impressive achievement, but there remains a vacancy rate at the trust of just over 3%, equivalent to 134 members of full-time staff. Health Education England is working with the College of Paramedics and has invested more than £2 million in a two-year paramedic pre-degree pilot, through which potential paramedic students are recruited into roles providing structured care in urgent and emergency care settings. Health Education England is also providing funding to ambulance services to invest in their existing workforce, train ambulance technicians to become paramedics, and upskill paramedics to advanced or specialist paramedic level.

In the south-west, Health Education England has provided £350,000 in funding to help retain staff so that they stay longer than my hon. Friend indicated they have in the past, and to improve engagement and provide the opportunity to train with the very latest equipment. I am pleased to note that 100% of the trust’s rapid response vehicles and dual-crew ambulances are funded to have a paramedic on board. In the six months to May 2016 there was, on average, a paramedic on almost 92% of all A&E conveying vehicles. The service is approaching the level for which it is funded, and I hope those initiatives ensure that there are sufficient paramedics to hit that 100% target.

In addition, to help to reduce system pressures, NHS England is undertaking a public information campaign about urgent care services. My hon. Friend urged us to do that to encourage the public to present at the right place and do the right thing. In particular, he referred to the use of NHS 111 as a front door to the integrated urgent care system to help improve its credibility as the place to get initial advice, rather than people dialling 999.

To conclude, I again emphasise that ambulance services are vital to emergency care and the NHS as a whole. We all want to be sure that, where loved ones suffer heart attacks or are involved in a serious accident, they will not be left waiting for medical help to arrive. The initiatives being taken in response to the record demand facing the urgent and emergency care system will ensure that patients continue to receive the quality care that they need.

My hon. Friend concluded his remarks by asking for a new approach to the integration of NHS services, to which I would add the integration of NHS services with social care services. He could have been describing the sustainability and transformation plans that are currently being finalised by health areas across the country for presentation to NHS England by the end of this week. They are bottom-up plans prepared by clinicians and senior management within NHS organisations alongside local authority organisations responsible for social care, which is precisely what my hon. Friend called for. I am pleased to say that, under this Government, that is being delivered.

Question put and agreed to.

Baby Loss

Philip Dunne Excerpts

Thursday 13th October 2016 Commons Chamber

[Victoria Prentis]

I thank my hon. Friend for his helpful intervention.

We in the all-party group welcome the MOJ’s consultation and the subsequent response, which was published just before the summer. It seems that we are—I really hope we are—on the cusp of making some very important changes in this area. I ask that we push for these changes to happen speedily, because they are really important.

[The Minister of State, Department of Health (Mr Philip Dunne)]

I am very grateful to my hon. Friend for letting me intervene during her impressive and important speech. On the back of that comment, I want to inform the House that my colleague the Under-Secretary of State for Justice, my hon. Friend the Member for Bracknell (Dr Lee), announced last month the formation of a national cremation working group. It is now working with all interested parties, and it intends to take evidence from Members of the House. I strongly encourage all hon. Members with such an interest to participate.

[Victoria Prentis]

I very much thank the Minister for that intervention. We in the all-party group were thrilled about the formation of that group.

In that contest, may I give the House a few more examples from the response of the MOJ that we feel are particularly important to take forward speedily? We hope that the MOJ will provide a statutory definition of ashes to make it clear that everything cremated with a baby, including personal items and clothing, must be recovered. We hope that the MOJ will amend cremation application forms to make explicit the applicant’s wishes in relation to ashes that are recovered. Crucially—I know this point is very important for many Members in the Chamber—we hope that the cremation of foetuses of fewer than 24 weeks’ gestation can be brought within the scope of the regulation, where parents wish that to happen. There is some positive news in this very sensitive area.

Moving on to the future of maternity services more generally, my overriding constituency concern at the moment is the future of the Horton general hospital. In fact, if I am honest, it occupies most of my waking moments, and my children complained during our summer holiday in August that I cannot formulate a sentence without the word “Horton” in it, which I fear is true. This summer, I found the lid repeatedly lifted on my own experiences, as we have real safety concerns about the downgrading of our obstetrics unit at the Horton general hospital.

Since last week, a midwife-led unit remains at the Horton general hospital, but all mothers who might—might, not necessarily will—need obstetric care, which is of course the majority of them, have to go under their own steam or be transferred as an emergency to the John Radcliffe hospital in Oxford. In a blue-light ambulance, that journey of between 22 and 27 miles, depending on the route taken, takes about 45 minutes. If my labouring mothers travel in their own car—of course, not all of them have one—the journey can easily take up to an hour and a half, depending on where they live and on the state of the Oxford traffic. The decision to downgrade the service was taken on safety grounds, as the trust had failed to recruit enough obstetricians, but I must say that I have severe safety concerns for the mothers and babies in our area. In 2008, an Independent Reconfiguration Panel report concluded that the distance was too far for our unit to be downgraded. As I see it, nothing has changed except that the Oxford traffic has worsened. I am keen, generally, that we start to be kinder to mothers during pregnancy and birth, and in my view, that does not mean encouraging them to labour in the back of the car on the A34.

We know that personal care leads to better outcomes. We need to take very careful note of Baroness Cumberlege’s recommendations in her “Better Births” report. She said that births should

“become safer, more personalised, kinder, professional and more family friendly”.

We must use the impetus of events such as this week to drive through her major recommendations.

Chief among these recommendations must be the recommendation for continuity not of care but of the carer, which has been shown to reduce premature deaths by 24%. Professor Lesley Regan, recently elected the first woman president of the Royal College of Obstetricians and Gynaecologists for 64 years, has done a plethora of well-evidenced research on miscarriage, demonstrating again and again that a system of reassurance and continuity, with weekly scans and meetings with a midwife, has reduced the rate of recurrent miscarriage by 80%. That figure of 80% is for women who have miscarried three or four times.

My hon. Friend the Member for Eddisbury mentioned the excellent work being done at Queen Charlotte’s as well. In this context, I am troubled that the sustainability and transformation plans might push us towards larger and larger units with less personal care. I may be wrong— I hope I am—and perhaps it is safer for such giant units to deliver the majority of babies, but I worry that in our case in Banbury decisions are being taken about my constituents without their views being considered and without real evidence of the risks involved.

Everyone in the House today is clearly committed to reducing baby loss, and I have never heard such emotion in a debate. We have evidenced-based research to show us how, in part, to do that. I refer the Minister very firmly to Baroness Cumberlege’s report. Yes, better bereavement care is important. Sadly, some babies will always die, as mine did, but let us really now make a commitment to reduce miscarriages and deaths from prematurity.

I need to be able to tell my constituents that they will not have to suffer as I did.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Philip Dunne)]

I am humbled to be responding to this debate. It is undoubtedly the most moving debate that I have participated in during the 11 and a half years I have been in the House and I pay an enormous tribute to all those who have spoken, particularly those who spoke of their own personal experiences. I shall touch on that further in a few moments. I want to start by congratulating my hon. Friends the Members for Eddisbury (Antoinette Sandbach) and for Colchester (Will Quince) on initiating this debate during baby loss awareness week. I also commend them on the remarkable progress they have made in launching the all-party parliamentary group on baby loss and on securing cross-party support for it. The group has had an unusually large impact compared with the plethora of other groups, and it has managed to achieve a Commons Chamber debate within a few months of being set up. That is an unusual and impressive achievement by them and the other officers of the group on both sides of the House.

Yesterday, hon. Members from across the House showed tremendous support for the work of the group. This was evidenced by the support from Mr Speaker in hosting a reception in his state rooms which was attended by many of the 21 pregnancy and baby loss charities that are dedicated to arranging support and care for families that go through this terrible experience. Events such as those that have taken place throughout the week here in the House—and indeed on Twitter, as the hon. Member for Ellesmere Port and Neston (Justin Madders) mentioned earlier—help to raise awareness for the families who suffer this loss, often in silence. One of the things that has struck me most about this debate is the determination of those who have experienced such loss, either directly or through their families or constituents, not to allow the issue to remain in the closet.

I would like to address some of the comments that have been made and to applaud the contributions and interventions that we have had today from the more than 30 hon. Members who have spoken of their own personal experiences and those of their constituents. Interestingly, although we have had contributions from 17 Back-Bench women, we have also had contributions from 13 Back-Bench men, some of whom have had personal direct experience as well. Particularly moving have been the contributions from Members who have not raised their experience of this issue in public in this place before. They included the hon. Members for Lewisham, Deptford (Vicky Foxcroft) and for North Ayrshire and Arran (Patricia Gibson), my hon. Friend the Member for Banbury (Victoria Prentis)—she might have mentioned it before, but she made another moving contribution today—my hon. Friend the Member for Gower (Byron Davies) and the hon. Member for Glasgow North West (Carol Monaghan). Such personal testimony obviously touches the heartstrings of everyone who hears it, and there was barely a dry eye in the House when they were speaking. I pay tribute to their courage in making so clear the pain that they went through, either recently or some years ago. Foremost among those Members are my hon. Friends the Members for Eddisbury and for Colchester, who brought this matter so vividly to our attention with their speeches nearly 12 months ago.

I shall not go through every contribution that has been made today, but I shall try to refer to many of them in my remarks. In particular, I should like to pay tribute to the hon. Member for Ellesmere Port and Neston for his very thoughtful contribution and for the spirit in which he made it. I shall try to address most of his questions as I continue. Before I forget, I should like to address the question put by my right hon. Friend the Member for Crawley—

[Sir Nicholas Soames]

Mid Sussex.

[Mr Dunne]

I am sorry. Have I got it wrong again?

My right hon. Friend the Member for Mid Sussex (Sir Nicholas Soames) asked about progress on screening for group B streptococcus, and I can reassure him that the UK national screening committee is reviewing its recommendation on antenatal screening for GBS carriage as part of its three-yearly review cycle. It will be taking new published evidence into account. We are anticipating that a public consultation will be held on this topic shortly, and I am sure that my right hon. Friend will want to participate in it. Once it has been concluded, we will review the recommendations that emerge.

The loss of a baby is clearly devastating for its parents and the family, regardless of when or how the death occurs. Those experiencing the heartbreak of miscarriage, stillbirth, the death of an infant or the decision to terminate a much-wanted pregnancy need our support and kindness, and the acknowledgement that their child was here for a short time and was loved. I have been deeply struck by the comments about the lack of sensitivity that can occur when such a loss takes place, and it is absolutely right that the Department of Health should encourage best practice across the NHS in order to minimise the distress caused by insensitive conduct on the part of those involved in supporting families at this time.

Such feelings of loss are real, but as has been said, in particular by my hon. Friend the Member for Gower, who explained this dispassionately and clearly, the issues are often not discussed. Many of us do not realise that on an average day in England around 32 women will be diagnosed with an ectopic pregnancy, 15 babies will be stillborn and eight babies born on that day will die before their first birthday. Most of those infants will probably be less than a month old. It is therefore important that we in Parliament discuss the issues around baby loss and the care for those families experiencing such tragedies.

I want to talk about the steps we are taking with the NHS to reduce stillbirths and other adverse maternity outcomes. I also want to talk about what we are doing to support families who experience this loss. England is a very safe country in which to have a baby, and it is encouraging that the stillbirth rate in England has fallen from 5.2 per 1,000 births in 2011 to 4.4 in 2015. In 2014, the neonatal mortality rate was 2.5 deaths per 1,000 births, and the rate of deaths in babies aged 28 days to one year was 1.1 per 1,000 births. Those rates have been steadily declining and are now at their lowest levels since 1986. There is, however, as we have clearly heard from every contribution today, more that we can do, and, as a Government, we are determined to do so.

It is important that we do not accept all miscarriages, stillbirths, pregnancy terminations or neonatal deaths as inevitable, or simply nature taking its course, as has been touched on by a couple of contributions today, because many of them might have been prevented.

When compared with similar countries, our stillbirth rates remain unacceptable. In the stillbirth series of The Lancet, which was published earlier this year, the UK was ranked 24th out of 49 high-income countries. The same publication showed that the UK’s rate of progress in reducing stillbirths has been slower than that of most other high-income countries. The annual rate of stillbirth reduction in the UK was 1.4% compared with 6.8% in the Netherlands. That places us, as we heard from my hon. Friend the Member for Eddisbury, in the bottom third of the table, in 114th place out of 164 countries around the world, for progress on stillbirths.

We also know that the rates of death in some higher risk groups are not coming down. Again, that was referred to by my hon. Friend the Member for Colchester. According to the Twins and Multiple Births Association, stillbirth rates for pregnancies involving twins, triplets or more increased by 13.6% between 2013 and 2014. Multiple births make up 1.5% of pregnancies in the UK—around 12,000 pregnancies each year—but a disproportionate 7% of stillbirths and 14% of neonatal deaths.

We want NHS maternity services to be an exemplar of the kinds of results we can achieve when we focus on improving safety. With a concerted effort, we can make England one of the safest places in the world in which to have a baby. That was why, last November, the Secretary of State launched a national ambition to halve the rates of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or soon after birth by 2030, with a shorter-term aim of achieving a 20% reduction in each of these rates by 2020. I am glad that that was recognised by my hon. Friend the Member for Eddisbury and pleased that she will be keeping an eye on the progress that we make each year to achieve those targets.

To support the NHS in achieving this stretching ambition, the Government have announced plans for investment. There will be a £2.24 million fund to support trusts to buy monitoring or training equipment to improve safety. More than 90 trusts have been successful in receiving a share of the fund, enabling them to buy equipment such as training mannequins, and foetal or maternal monitoring equipment such as carbon monoxide monitors and portable ultrasound equipment.

As my hon. Friend the Member for Colchester acknowledged, we are also investing in the roll out of training programmes to support midwives, obstetricians and entire maternity teams to develop the skills and confidence they need together to deliver world-leading safe care. We hope to be able to say more about how maternity services can apply for this funding soon.

We are also providing funding via the Healthcare Quality Improvement Partnership for developing the new system—the standardised perinatal mortality review tool—which, once complete, should be used consistently across the NHS in Great Britain to enable maternity services to review and learn from every stillbirth and neonatal death. That was an important element of the APPG’s vision for the future. We need to develop proper learning and understanding from what goes wrong, and then the lessons learned should be spread to maternity services across the country. As my hon. Friend the Member for Grantham and Stamford (Nick Boles) emphasised, many reports have highlighted that we do not effectively learn from our mistakes. Indeed, the guidelines of the Royal College of Obstetricians and Gynaecologists state that all stillbirths should be reviewed in a multi-professional meeting using a standardised approach on analysis for substandard care and future prevention. That is something that we would like to see taken up.

We must view individual failings as important and recognise the need for accountability, but balance that with a need to establish standard processes that can prevent avoidable mistakes from happening again. In April we established a new independent healthcare safety investigation branch to carry out investigations and share findings. The HSIB will operate independently of Government and the healthcare system to support continuous improvement by using the very best investigative techniques from around the world, as well as fostering learning from staff, patients and other stakeholders.

An important improvement in maternity care is care that is more collaborative and responsive to the needs of women. Several Members referenced the investigations by Sands, the stillbirth and neonatal death charity, which has revealed that 45% of women who raised a concern with a health professional during pregnancy were not listened to and then went on to have a stillbirth. Clearly, that is not acceptable. All women should receive safe, personalised maternity care that is responsive to their individual needs and choices.

The hon. Member for Ellesmere Port and Neston asked where we are on supporting those with mental health conditions through pregnancy. I draw his attention to the announcement in January in which the Government set out that an additional £290 million will be made available over the next five years to 2020-21 to invest in perinatal mental health services. That is funded from within the Department of Health’s overall spending review settlement, and it will go a long way to providing support for women who are pregnant and need mental health counselling both before and after birth.

Last November we asked the national patient safety campaign Sign up to Safety, which was launched by the Government in 2014, to support all NHS trusts with maternity services to develop plans to improve safety and share best practice. In March this year we launched “Spotlight on Maternity”, with guidance for maternity services to improve maternity outcomes. This set out five high-level themes that are known to make maternity care safer that services could focus on: building strong clinical leadership; building capability and skills for all staff; sharing progress and lessons learned across the system; improving data capture and knowledge; and improving care for women with perinatal mental health problems.

In February this year, “Better Births”, the report of the independent national maternity review that was chaired by Baroness Cumberlege, was published, and hon. Members have touched on it today. It sets out that the vision is for maternity services across England to become safer, more personalised, kinder, more professional and more family-friendly. The Department of Health is leading the promoting good practice for safer care workstream of the maternity transformation programme that was launched last July to deliver the vision set out by the national maternity review, and we will set out our action plans shortly.

As my hon. Friend the Member for Eddisbury highlighted, it is vital that we support research into the causes of stillbirths and neonatal deaths so that we can better understand how to identify babies at risk and improve services. In recent years, the Government have invested in research, looking at important questions regarding stillbirths and neonatal deaths. From 2012, the National Institute for Health Research biomedical research centres at Cambridge and Imperial College will have invested £6 million over five years in research on women’s health, including research to increase understanding of the causes of still births and neonatal deaths. We continue to encourage research bids for new studies that will help us to identify babies at risk.

The evidence shows that this stretching ambition cannot be achieved through improvements to NHS maternity services alone. The public health contribution will be crucial. As The Lancet stillbirth series concluded, some 90% of stillbirths in high-income countries occur antenatally and not during labour.

We heard from a number of hon. Members about the need to do more to highlight risks during pregnancy so that women are aware of what they can do while they are pregnant to minimise the risks. When starting pregnancy, not all women will have the same risk of something going wrong, and women’s health before and during pregnancy is one of the factors that influence rates of stillbirths, neonatal deaths and maternal deaths. We know that a BMI of over 40 doubles the risk of stillbirth, that a quarter of stillbirths are associated with smoking, and that alcohol consumption is associated with an estimated 40% increase to stillbirth risk. In addition, the MBRRACE—Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries—report published in June last year showed that women living in poverty had a 57% higher risk, babies from BME groups have a 50% higher risk, and teenage mothers and mothers over 40 have a 39% higher risk.

[Tim Loughton]

I sense that the Minister is coming to the end of his speech—if you have anything to do with it, Madam Deputy Speaker. Will he give me a guarantee that he will look into the registration of stillbirths? He has not mentioned that yet.

[Mr Dunne]

I will come back to my hon. Friend’s point just as I conclude.

These striking facts are why the Department of Health will continue to work closely with Public Health England and voluntary sector organisations to help women to have a healthy pregnancy and families to have the best start in life. A new information campaign will be launched shortly, and I encourage all hon. Members to support it during the launch period.

I would like to say a few words before I conclude about the importance of delivering good bereavement care for those families who have experienced baby loss, which was a topic raised by many hon. Members. Having not gone through the experience myself, I can scarcely comprehend how devastating it must be for parents to lose a baby. It is important that parents receive appropriate care and support as sensitively as possible when that occurs. The MBRRACE report that I referenced stated that 60% of parents currently receive a high standard of bereavement care, but that clearly leaves 40% who do not, which is not good enough.

Since 2010, we have invested £35 million in the NHS to improve birthing environments, including better bereavement suites and family rooms at some 40 hospitals, to support bereaved families. I have seen some of those rooms, including the superb suite opened last month in the Medway Maritime hospital, which I think was one of those that indicated that it did not have such a suite when my hon. Friend the Member for Eddisbury undertook her research. We have heard from my right hon. Friend the Member for Broxtowe (Anna Soubry) about the recent improvement in Nottingham.

We have been working with Sands, the Miscarriage Association, the Lullaby Trust and others to understand the challenges that maternity services face and to highlight areas of good practice. I am pleased that the all-party group’s report, which was published this week, recognises the work that we are supporting to develop an overarching bereavement care pathway to help to reduce the variation in the quality of bereavement care provided across the NHS.

In response to the comments made by my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) in his intervention and elsewhere during the debate, I should like to say that I have been impressed by comments made about the distress caused by the registration of post-24 week baby loss, often in the same place where mothers with young babies are registering births. I can well imagine that that compounds the sense of grief. It is appropriate that we look at best practice and the common-sense delivery of registration to see whether it could be spread more widely, so I will ask officials to look at that, but I am not promising legislation.

I again thank again all hon. Members for participating in the debate and their deeply moving contributions. In particular, I thank those who secured the debate for their work in driving the all-party group and raising awareness across the nation. It is important that we as a Government try to drive an improvement in outcomes, and I reassure hon. Members that the Government are fully committed to reducing the number of babies who die during pregnancy or in the neonatal period, and to supporting those families who are bereaved. Although the Baby Loss Awareness Week events here in Westminster culminate with today’s important debate, other events are continuing to take place throughout the United Kingdom and internationally. I should like to encourage everyone to join in the global wave of light, which we heard about earlier this afternoon, by lighting a candle at 7 o’clock this Saturday 15 October and letting it burn for one hour in remembrance of all the babies who have died during pregnancy or at, during or after birth.

Oral Answers to Questions

Philip Dunne Excerpts

Tuesday 11th October 2016 Commons Chamber

[Rob Marris (Wolverhampton South West) (Lab)]

4. What estimate he has made of the value of assets funded by PFI health projects which will remain in private ownership after the contracts for those projects have concluded.

[The Minister of State, Department of Health (Mr Philip Dunne)]

Between 1997 and 2010, 103 NHS hospital PFI schemes reached financial close, creating liabilities for the NHS of £77 billion. Three legacy PFI schemes have been signed since 2010 on stricter terms, with liabilities of £1.7 billion, and one scheme has been signed under the new PF2 model, worth £340 million. In nearly all cases, except for a few of the early schemes, ownership of the hospital reverts to the NHS at the end of the PFI contract. But even in those schemes, the NHS always has the first option on whether to end or continue with the contract.

[Rob Marris]

Effectively, those figures will mean even more debt for the next generation. Will the Minister commit the Government to abandoning all PFI? It always was an idiotic scheme. No more PFI, no more PF2, etc—just abandon it, Minister.

[Mr Dunne]

The hon. Gentleman has a consistent track record in opposing PFI, even when the vast majority of the schemes were put under contract by the Government of which he was a member—so I will not take any lectures from him about how to deal with PFI. We will continue to use the new stricter terms as and when appropriate.

[Norman Lamb (North Norfolk) (LD)]

The National Audit Office concluded that the PFI contract for the Norfolk and Norwich hospital was a bad deal for the taxpayer and for the NHS, yet last year Octagon Healthcare made a record profit as the Norfolk and Norwich’s finances sank ever further into the red. Will the Minister consider making a formal approach to Octagon Healthcare to ask it to forgo part of its profit to help confront the enormous financial black hole that the trust faces?

[Mr Dunne]

We have provided access for seven of the worst affected trusts with obligations under PFI to a support fund of some £1.5 billion to help them with those obligations. I am not sure whether Norfolk is one of them; I suspect that it is not. I would be happy to talk to the right hon. Gentleman about this, but rather than raising his hopes inappropriately I have to say to him that many of the schemes are too costly to divert resource to pay them off completely.

[Mr Steve Baker (Wycombe) (Con)]

5. If he will take steps to ensure that clinical commissioning groups publish their proposals for implementing the NHS “Five Year Forward View”.

--- Later in debate ---

[Andrew Bridgen (North West Leicestershire) (Con)]

7. What steps his Department is taking to improve NHS procurement.

[The Minister of State, Department of Health (Mr Philip Dunne)]

I agree with my hon. Friend that this is an important area. In his report earlier this year, Lord Carter identified potential annual savings of £700 million from reducing the variation in procurement performance between providers. We have announced a first tranche of 12 standardised products for all NHS providers to use; this will boost procurement volumes and bring about economies of scale, securing lower prices. These initial products, including commodity items such as gloves and needles, cover £100 million of trust spending. We expect this to result in savings of up to 25%.

[Andrew Bridgen]

Innovative private sector suppliers have successfully partnered with the NHS since its inception, and it is quite right to say that for that relationship to be sustainable, those suppliers must make a profit. However, does the Minister agree that rogue companies that exploit the NHS’s lack of commercial expertise could be named and shamed, because they are making a lot of money at taxpayers’ expense?

[Mr Dunne]

We believe that the right approach to securing procurement savings is to take advantage of the immense amount of data available across the NHS. That is why we have set up the purchasing price index benchmarking tool. Data on more than £8 billion of expenditure, covering over 30 million separate procurement transactions, has been collated and will be analysed. We will use that information judiciously to save the taxpayer money. We think that that is the right way to start, rather than naming and shaming.

[Chris Leslie (Nottingham East) (Lab/Co-op)]

I urge the Minister, when thinking about national procurement and national commissioning, to look at the national strategies that can underpin them—for example, at why we need to renew the national stroke strategy. Some 100,000 people a year suffer a stroke, and nearly 1 million people in this country have had a stroke. They care very much about rehabilitation and other services.

[Mr Speaker]

The Minister’s challenge is to relate that very important matter to the equally important issue that happens to be the subject of the question: procurement.

[Mr Dunne]

I am grateful to you, Mr Speaker, for drawing the hon. Gentleman’s attention to the fact that the topic is procurement. The hon. Gentleman is right to highlight the fact that we have looked at an acute heart treatment strategy. We are creating centres of excellence across the country to ensure that if people suffer from an acute heart incident or a stroke, they are treated by the specialists who will give them the best prospects for recovery.

[Sir Henry Bellingham (North West Norfolk) (Con)]

8. What progress his Department is making on turning around hospitals in special measures.

--- Later in debate ---

[Imran Hussain (Bradford East) (Lab)]

9. What steps he plans to take to address shortfalls in staff recruitment and retention in the NHS.

[The Minister of State, Department of Health (Mr Philip Dunne)]

I join the Secretary of State in welcoming the dedication and commitment of everyone who works in the NHS. We are taking active steps to encourage more people to become doctors, nurses and support staff. Only last week, my right hon. Friend announced a commitment to recruit an additional 25% of doctors to train in the NHS, which is 1,500 more doctors on top of the 6,000 currently trained every year.

[Imran Hussain]

Net temporary and agency staff expenditure has risen by 40% since 2013. It accounted for 8% of total staff expenditure in 2015-16, which equates to £4.13 billion. Does the Minister agree that rising agency costs point to a recruitment crisis, and will he make a statement to the House outlining his plans to address that crisis?

[Mr Dunne]

We recognise, absolutely, that bills for agency staff have become unsustainable, which is why we have taken deliberate action, including by introducing price caps on hourly rates last November, which has had a significant impact on reducing agency costs. In the year to date, agency costs are some £550 million less than they were last year.

[Jeremy Lefroy (Stafford) (Con)]

I welcome last week’s announcement about the increase in the number of medical school places. What plans does the Department have to ensure that there are sufficient clinical training places for those medical students?

[Mr Dunne]

I can reassure my hon. Friend that there is considerable excess demand from UK-based students to train to become a clinician in this country—only half of those who apply to train in medical school are accepted at present—so we are confident that there will be plenty of take-up for those extra places. With regard to clinical placements, we are in discussions with universities, colleges and teaching hospitals to ensure that there are adequate numbers of places.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I welcome the 25% expansion in medical student places, but I reject tying that to the elimination of 25% of overseas doctors who currently work in our NHS. With 10% of posts unfilled and ever-rising patient demand, the Secretary of State must know that we will always need international graduates in the future. Does he not recognise that he is creating unrealistic expectations and conflict with this idea of a British-only medical service?

[Mr Dunne]

I am grateful to the hon. Lady for giving me the opportunity to set the record straight and stop this scaremongering, which is undoubtedly unsettling many of the very valuable doctors, nurses and other foreign nationals who are currently providing vital services to the NHS. Last week’s announcement was about adding more doctors to be trained who are UK-based. We are not changing any of the present arrangements for international students being trained here, or doctors and nurses working here.

[Dr Whitford]

The Government might not be changing their position right now, but with one in 10 posts currently unfilled, and given the rhetoric used last week, how does the Minister expect us even to retain foreign doctors, let alone attract them to fill those posts?

[Mr Dunne]

There was no rhetoric used. In making that announcement, my right hon. Friend the Prime Minister used no rhetoric whatsoever regarding the very valuable contribution of foreign clinicians to our health service, and that remains the case.

[Nick Boles (Grantham and Stamford) (Con)]

Staff shortages this summer led United Lincolnshire Hospitals NHS Trust to introduce a temporary closure of Grantham A&E, causing huge concern to my constituents. Will the Secretary of State agree to meet me and Jody Clark, the founder of a local campaign group, to discuss how we can resolve this unacceptable situation?

[Mr Dunne]

I am well aware, from representations made by my hon. Friend and other neighbouring MPs, of the concerns that that has caused locally. The Secretary of State has already indicated to me that he does intend to meet my hon. Friend and campaigners in due course.

[Jonathan Ashworth (Leicester South) (Lab)]

The Minister says that no rhetoric or scaremongering was used last week. Can he explain to the House what the Prime Minister meant when she said:

“there will be staff here from overseas in the interim period until the further numbers of British doctors are trained and come on board in terms of being able to work in our hospitals”?

What did that mean? What should we expect next—ambulances plastered with “Go home” slogans?

[Mr Dunne]

That is exactly the kind of ill-judged remark I have been talking about, and I am surprised that the hon. Gentleman has used it in his first appearance in his new post. By the way, I congratulate him on that new post, but I very much hope that he will use more measured language in the future, rather than spreading that kind of inappropriate rumour. The interim period referred to is the period during which doctors will be trained. We will not get new doctors coming in under the increased allocation until 2023, and during that time we will clearly need to use all measures to ensure that we fill the spaces that I acknowledge we have across several of our hospitals.

[Jonathan Ashworth]

I appreciate the Minister’s warm welcome, and I can tell him that I am very much looking forward to shadowing the Secretary of State, but his comments on ill-judged remarks should be directed at the Prime Minister, not me. We have seen 8,000 fewer nurses, student nurse bursaries are set to be cut, there is a reliance on agency staff and a failure to train enough doctors, and now, after six years in office, the Government are talking about self-sufficiency. Given the concerns that these plans do not go far enough, will the Minister tell us what steps he will take to ensure that no staff from the EU lose their jobs, and will the NHS still be able to recruit from the EU if necessary post Brexit?

[Mr Dunne]

Health Ministers have been very clear about reassuring all the 53,000 EU citizens working in our NHS that their roles are secure. Regarding clinicians, I remind the hon. Gentleman that, although we have some vacancy rates, which are acknowledged, we now have 7,800 more consultants employed in the NHS than in May 2010, 8,500 more doctors than in May 2010, and over 10,500 more nurses working on our wards. We have gone through a very consistent policy of recruiting more people to work in the NHS under this Government.

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

10. What steps his Department is taking to model the potential cost savings to the NHS budget of earlier diagnosis of cancers.

--- Later in debate ---

[Sir Simon Burns (Chelmsford) (Con)]

11. What estimate his Department has made of the amount accrued to the public purse from efficiency savings in the NHS since May 2010.

[The Minister of State, Department of Health (Mr Philip Dunne)]

In 2010 a target was set by NHS leaders to make £20 billion of efficiency savings by 2015 in order to make more funds available for treating patients and to allow the NHS to respond to changing demand and new technology. Under my right hon. Friend’s inspirational leadership as a Health Minister, the NHS broadly delivered on this original challenge, reporting savings of £19.4 billion over this period. All these savings have been reinvested into front-line NHS services.

[Sir Simon Burns]

As Members would imagine, I warmly welcome that answer from the Minister. Would he confirm that those savings were achieved through greater efficiency and effectiveness in the delivery of care and by cutting waste in the NHS that occurred between 2002 and 2007? Can he confirm that the benefit of that achievement to the NHS is that not a single penny of those savings goes to the Treasury, but is reinvested in the NHS and front-line services?

[Mr Dunne]

My right hon. Friend managed to include several questions in his impressive supplementary. I can confirm that much of the waste that took place in the years he cited—2002 to 2007—related to projects of the previous Labour Government that they themselves then cancelled, such as the IT project. I can also confirm that savings generated in the NHS are kept in the NHS. Lord Carter, whose report I referred to earlier, has identified £5 billion of efficiency savings, which we hope to deliver during this Parliament.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

There is a distinction to be drawn between realistic efficiency targets and systematic underfunding. Only last month, Simon Stevens told the Public Accounts Committee that for three of the next five years

“we did not get what we originally asked for”.

Chris Hopson, chief executive of NHS Providers, also said last month that

“we’ve got a huge gap coming… it’s the chairs and chief executives on the front line…who are saying they cannot make this add up any longer.”

On funding, the Government keep saying that the NHS is getting all that it has asked for; those actually running the NHS say something quite different. Who is right?

[Mr Dunne]

The hon. Gentleman stood on a manifesto 18 months ago in which his party was not prepared to commit the funding that our party was prepared to commit. Labour committed £5.5 billion to the NHS; we committed £8 billion, and we have delivered £10 billion.

[Colleen Fletcher (Coventry North East) (Lab)]

13. What steps his Department is taking to reduce the number of men who take their own life.

--- Later in debate ---

[Dr Tania Mathias (Twickenham) (Con)]

T4. What will the Government do to scrutinise and assist the London ambulance service, which has had an appalling and consistently poor record on call-out times for category A emergencies?

[The Minister of State, Department of Health (Mr Philip Dunne)]

My hon. Friend is right to highlight the fact that the London ambulance service is in special measures and has been for some time. I visited it this summer and am pleased to confirm that some £63 million of additional funding has been provided to the ambulance service since April 2015. The service is starting to make significant inroads in increasing the number of paramedics who are available on call, with some 250 more being added over the last couple of years.

[Paula Sherriff (Dewsbury) (Lab)]

T2. Last October, the then Health Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), confirmed that my constituency fell far below the national average in terms of NHS dental provision. In fact, it is one of the worst in the country. Unfortunately, nothing has changed since then. Does the Secretary of State believe it is acceptable that my constituents, including many children, are unable to get an NHS dentist?

--- Later in debate ---

[Wendy Morton (Aldridge-Brownhills) (Con)]

T8. As Ministers will be aware, this week is baby loss awareness week. Access to neonatal cots and neonatal transport services are vital parts of the care of premature and sick babies. What assurances will my right hon. Friend give that his Department is continuing to review the findings of the Bliss report, and when can we expect to hear more?

[Mr Dunne]

I am grateful to my hon. Friend for raising baby loss awareness week. I am sure that, along with other hon. Members, she will be participating in the Backbench Business debate on that later this week. In February the independent maternity review, Better Births, made a number of recommendations, including on neonatal critical care. We are studying those recommendations and are due to report initial findings from our work in December.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I listened very closely to the Secretary of State’s comments earlier on mental health. On 9 December he stood at that Dispatch Box and said that

“CCGs are committed to increasing the proportion of their funding that goes into mental health.”—[Official Report, 9 December 2015; Vol. 603, c. 1012.]

However, my research shows that 57% of clinical commissioning groups are reducing the proportion they spend on mental health—yet another broken promise. When will we have real equality from this Government for mental health?

--- Later in debate ---

[Seema Kennedy (South Ribble) (Con)]

I welcomed last week’s NHS Improvement report which states that there are now sufficient staff for Chorley and South Ribble hospital’s A&E department to reopen, but I am dismayed that the trust is delaying the reopening until January next year. Will the Minister reassure me that he will work with me and other stakeholders to oblige the trust to open as soon as possible?

[Mr Dunne]

My hon. Friend has been a doughty champion of Chorley, in combination with another Member of the House and local campaigners, who visited the Houses of Parliament yesterday to meet local MPs. While welcoming the reopening of the A&E from January, I am happy to continue to work with my hon. Friend to see whether it can be brought forward.

[Mr Speaker]

The other doughty champion of the hospital is of course the right hon. Member for Chorley (Mr Hoyle), who regularly deputises for me in this Chair. I am sure the House will want to acknowledge that important fact.

--- Later in debate ---

[Kevin Foster (Torbay) (Con)]

The Secretary of State will be aware of the concern in my constituency about the future of Paignton hospital, which prompted hundreds to turn up to a recent meeting. Does he agree with me that it is vital the clinical commissioning group, in publishing its plans, does not just publish what it will remove but the details of what it will replace them with?

[Mr Dunne]

Considerable efforts are going into sorting out some of the historical challenges in the provision of both acute and community care in Devon. I hosted a meeting for a number of colleagues who are concerned about this and I am happy to continue to engage with colleagues across the county.

[Lilian Greenwood (Nottingham South) (Lab)]

Two years ago, Nottingham University Hospitals NHS trust privatised support services, including cleaning, handing them over to Carillion in an effort to save money. Since then there have been shortages of equipment, shortages of staff and an appalling decline in standards of cleanliness. Will the Secretary of State condemn Carillion for putting patients at risk? When will he ensure that hospital services in Nottingham are properly funded?