Human Fertilisation and Embryology Act 2008: Remedial Order

Philip Dunne Excerpts

Wednesday 29th November 2017 Written Statements

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

We are today laying a non-urgent remedial order to allow a single person to apply for a parental order, which transfers legal parenthood after a surrogacy arrangement.

Surrogacy has an important role to play in our society, helping to create much-wanted families where that might not otherwise be possible. It enables relatives and friends to provide an altruistic gift to people who are not able to have a child themselves, and can help people to have their own genetically-related children. The UK Government recognise the value of this in the 21st century where family structures, attitudes and life styles are much more diverse.

Provisions in the Human Fertilisation and Embryology Act 1990 allowed, where a child was born under a surrogacy arrangement, for the transfer of legal parenthood from the birth mother to the intended parents by means of a parental order.

These provisions were updated by the Human Fertilisation and Embryology Act 2008, which introduced new provisions to extend eligibility to same-sex civil partners and all couples in long-term relationships, where the relevant criteria were satisfied. This was further amended in 2013 and 2014 to include same-sex married couples.

The Government will now introduce legislation to reflect an equal approach for a single person and couples in obtaining legal parenthood after a surrogacy arrangement. Following a legal challenge to the 2008 Act in 2016, the family court made a declaration that the provision in the Human Fertilisation and Embryology Act 2008 which enables couples, but not a single person, to obtain a parental order following surrogacy is incompatible with article 14 of the European convention on human rights. Article 14 prohibits discrimination in the enjoyment of convention rights on the grounds of a person’s status, and it was accepted that this could include a single person in this context.

Following consideration of possible legislative options, the Government consider that there are compelling reasons to amend the 2008 Act by order made under the power in section 10 of the Human Rights Act 1998 to take remedial action where there is an incompatibility with the Human Rights Act 1998. The Government also propose to remake the parental order regulations in 2018 to reflect all technical amendments to secondary legislation arising from the remedial order.

The Government welcome the opportunity to lay this remedial order to allow a single person the same rights to gain legal parenthood as couples. The order will allow a six-month period where an existing single parent through surrogacy can retrospectively apply for a parental order.

It will be for the Joint Committee on Human Rights to scrutinise the order, take views from parliamentarians and stakeholders and advise the Government and Parliament on the appropriateness of the order. The Committee will have 60 sitting days to undertake these considerations before the Government must review and respond. The Committee will then have a further 60 sitting days to consider and make recommendations to Parliament, before debates in both Houses.

[HCWS282]

Drug Addiction

Philip Dunne Excerpts

Wednesday 22nd November 2017 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Gapes. Thank you for protecting my 10 minutes at the end of the debate. I congratulate my hon. Friend the Member for South Thanet (Craig Mackinlay) on securing the debate.

It has been noticeable that there is complete consensus among those who have contributed today about the horror and damage that drug abuse causes for individuals and wider society. Nobody, quite properly, has stood up here to say anything other than that. However, there is a noticeable difference in approach as to how to deal with some of these challenges. It is impressive that we had a consistent line from the right hon. Member for North Norfolk (Norman Lamb), my hon. Friend the Member for Reigate (Crispin Blunt) and the hon. Member for Inverclyde (Ronnie Cowan). They all called for a particular approach that the Government do not support. I shall focus most of my remarks on what the Government are actually doing.

The hon. Member for Washington and Sunderland West (Mrs Hodgson), who speaks for the Opposition, was quick to criticise the support provided to drug abusers and she called for more action, but she did not come up with a single example that I could detect of what more could be done—[Interruption]—to provide any greater action, in response to the drug strategy that we published in July. I appreciate that she expressed some welcome for that strategy, but she did not indicate anything else that she said was missing that we should introduce.

[Mrs Hodgson]

We could always take over in government.

--- Later in debate ---

[Mr Dunne]

As I said, the Government published what we regard as an ambitious new drug strategy in July. As my right hon. Friend the Home Secretary compellingly set out in her foreword, the harms caused by drug misuse are far-reaching and affect lives at every level. I welcome the support of my hon. Friend the Member for South Thanet for the strategy. My hon. Friend the Member for Henley (John Howell) also made a powerful contribution to the debate, focusing on differentiating enforcement action between the different categories of drug users. Although, of course, some of that is already in force in the sanctions available to our criminal justice system, the point that he makes in relation to identifying those who use criminality to fund their addiction is important.

Crime committed to fuel drug dependence is one of the biggest challenges that society has to contend with as a result of drug abuse. That extends into organised criminality in this country and internationally. From the perspective of the individual, the physical and mental health harms suffered by those who misuse drugs and the irreparable damage and loss to the families and individuals whose lives they destroy were eloquently expressed by the hon. Member for Glasgow East (David Linden), who speaks for the Scottish National party. The constituent’s story that he told was harrowing. I think that we all share those concerns.

The drug strategy highlights the huge financial cost to society from illicit drugs. Each year, drugs cost the UK £10.7 billion in policing, healthcare and crime, with drug-fuelled theft alone costing £6 billion a year.

[Norman Lamb]

Will the Minister give way?

[Mr Dunne]

I am afraid not, because I have limited time.

As my hon. Friend the Member for South Thanet pointed out, research shows that for every £1 spent on treatment, an estimated £2.50 is saved. It remains essential for us to offer those with a drug dependency the optimal chance of recovery. Since the 2010 strategy was published, we have made significant progress, despite the comments from the hon. Member for Washington and Sunderland West. She did acknowledge that drug use in England and Wales is lower now than it was a decade ago. In 2016-17, 8.5% of adults had used a drug in the previous year, compared with 10.1% of adults back in 2006-07. More adults are leaving treatment successfully now than in 2009-10, and the average waiting time to access treatment is now two days.

The new strategy aims to reduce illicit drug use and to increase the rate at which people recover from their dependence. Action is being taken in four areas: reducing demand to prevent drug use and its escalation; restricting the supply of illegal drugs; building recovery; and a new strand focused on global action. At the centre of the strategy is a core message: no one organisation or group can tackle drug misuse alone. As my hon. Friend pointed out, a partnership approach is required across Government and involving the treatment system, education, employment, housing, mental and physical health and the criminal justice system.

To drive forward the partnership approach, we are setting up a new board, chaired by the Home Secretary, which is due to meet for the first time next month. My right hon. Friend the Secretary of State for Health will attend, along with Ministers from across Government and wider partners, including Public Health England. The aim is to hold all parts of the system to account on specific commitments in the strategy. We are also appointing a new “recovery champion”, who will have a national leadership role with a remit to advise the Home Secretary and the board. That individual will drive collaboration across sectors and give people with drug dependency a voice to address the stigma that can prevent them from accessing the support that they need.

We will also take forward the drug strategy’s approach to prevention, because we know that we stand the best chance of preventing young people from misusing drugs by building their resilience and helping them to make good choices about their lives and their health. To achieve that, we will take forward evidence-based prevention measures, including developing the “Frank” drugs information service, to which my hon. Friend referred, so that it remains a credible and trusted source of information for young people. I note that the young people in the straw poll he did in his constituency had not heard of that service. I will ask officials to look at how we can raise awareness of that tool, but I point out gently to him that it is designed to be an information tool rather than a prevention tool in and of itself.

Other measures are promoting the online resilience-building resource, Rise Above, which helps teenagers to make positive choices for their health, and expanding the alcohol and drug education and prevention information service to give schools the tools and resources that they need to help to prevent drug misuse among teenagers.

The hon. Member for Washington and Sunderland West mentioned funding. Funding decisions on drug and alcohol treatment budgets have been devolved to local authorities, which are best placed to understand the support and treatment needs of their populations because they differ across the country, as we have heard today. We know that there are concerns about funding, and that local authorities are making difficult choices about their spending; we are not shying away from that. That is why we are extending the ring-fenced public health grant until April 2019 and retaining the specific criteria to improve drug and alcohol treatment uptake and outcomes. Although the intention remains to give local authorities more control over the money that they raise—like with business rates—we are actively considering the options for 2019 onwards. We remain committed to protecting and improving the outcomes from core services, including in respect of substance misuse, and will involve stakeholders in discussions about how we achieve that.

We know that drug misuse is both a cause and a result of wider social issues. That is why we are testing ways to improve employment support for people in recovery. We have accepted Dame Carol Black’s recommendation that we trial an “individual placement and support” approach to help people in drug and alcohol treatment to prepare for, find and maintain employment. In that context, I would like to give a quick plug to an outstanding charity in my constituency called Willowdene Farm, which provides very successful residential rehabilitation and training centres, historically for adult men with a history of substance addiction; it has just opened a residential facility for adult women as well. It is leading the way in encouraging those who have been through its programme into employment. Public Health England announced yesterday that the trial will go live in April 2018 in seven areas: Birmingham, Blackpool, Brighton and Hove, Derbyshire, Haringey, Sheffield and Staffordshire.

I shall briefly go through some of the emerging challenges. Since 2012, we have seen sharp increases in drug misuse deaths linked to an ageing group of older heroin users with multiple and complex needs. In response to drug-related deaths, Public Health England is looking at how we protect people from dying of overdoses. It has published updated guidance for mental health and substance misuse treatment services, to help them to work better with people who have co-existing mental health, alcohol and drug problems.

In addition, local authorities must ensure that treatment services respond to the changing patterns of drug use. Treatment has been demonstrated to have a significant protective effect, without which the recent rise in drug-related deaths is likely to have been higher. Drug treatment can also cut crime. Recent analysis by the Ministry of Justice and Public Health England showed that 44% of people in treatment had not offended again two years after starting treatment. In recent months, as we heard from my hon. Friend the Member for South Thanet, there have been deaths linked to fentanyl-contaminated heroin in parts of the UK. He gave us a graphic illustration of the impact in certain parts of the United States. I agree that that is extremely worrying. It underlines the importance of vigilance and strong enforcement action by the police and the National Crime Agency, as well as accessible treatment and the availability of life-saving interventions such as naloxone.

The use of synthetic cannabinoids, often called Spice, among the homeless and prison populations is a real concern for the Government. That was raised by a number of hon. Members. The Government have already taken action to classify third-generation synthetic cannabinoids, such as Spice, as class B drugs under the Misuse of Drugs Act 1971, giving the police the powers that they need to take action, making possession illegal and delivering longer sentences for dealers.

Health

Philip Dunne Excerpts

Tuesday 21st November 2017 Ministerial Corrections

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

20. What recent assessment his Department has made of the effect of the UK leaving the EU on the health and social care sector.

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

We are fully engaged with the highest level of Government work on Brexit. My right hon. Friend the Secretary of State is a member of the Cabinet Committee on Brexit, and he is engaged on all areas where Brexit may impact the health and social care sector.

[Official Report, 14 November 2017, Vol. 631, c. 139.]



Letter of correction from Mr Dunne.



An error has been identified in the answer I gave to the hon. Members for Glasgow South West (Chris Stephens) and for Linlithgow and East Falkirk (Martyn Day).



The correct answer should have been:

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

We are fully engaged with the highest level of Government work on Brexit. My right hon. Friend the Secretary of State is invited to attend the Cabinet Committee on Brexit, and he is engaged on all areas where Brexit may impact the health and social care sector.

[Chris Stephens]

Is the Minister aware of the latest figures released this month by the Nursing & Midwifery Council? The figures confirm a clear trend: an 11% increase in the number of UK-trained nurses and midwives leaving the register, alongside an 89% drop in those coming to work in the UK from Europe. Does the Minister agree with the chief executive of the Royal College of Nursing that

“These dramatic figures should set alarm bells ringing in Whitehall and every UK health department”?

[Mr Dunne]

It is the case that we have been reliant for much of the increase in clinicians in this country on doctors and nurses coming from the EU, so a reduction in that increase is something we are watching carefully. I gently say to the hon. Gentleman that the last figures we have show that, as of the end of June, there were 3,193 more clinicians working in the NHS in England than there were in June 2016.

[Official Report, 14 November 2017, Vol. 631, c. 139.]

Letter of correction from Mr Dunne.

An error has been identified in the answer I gave to the supplementary question asked by the hon. Member for Glasgow South West (Chris Stephens).

The correct answer should have been:

[Mr Dunne]

…I gently say to the hon. Gentleman that the last figures we have show that, as of the end of June, there were 3,193 more clinicians from the EU working in the NHS in England than there were in June 2016.

Oral Answers to Questions

Philip Dunne Excerpts

Tuesday 14th November 2017 Commons Chamber

[John Grogan (Keighley) (Lab)]

1. How many subsidiary companies have been set up by NHS trusts.

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

Local NHS organisations are responsible for deciding the most appropriate structures they need to deliver services to their patients within available resources. Commissioners and regulators are responsible for ensuring that NHS providers act in the best interests of patients and taxpayers. A theme of the 2015 review of performance variability across NHS hospitals, undertaken by the noble Lord Carter of Coles, sought to drive efficiency through sharing administrative functions across NHS bodies in an area. A number of trusts are creating the right structures to do so. NHS Improvement is aware of 39 subsidiaries consolidated within the accounts of foundation trusts as of 31 March 2017.

[John Grogan]

Does the Minister share my concern that NHS trusts in Yorkshire are now lining up to follow the example of Airedale NHS Foundation Trust, which recently, behind closed doors and as part of a VAT scam, set up a subsidiary company to run many of its activities, which will not only cost the Treasury in lost tax receipts, but mean that new staff, such as hospital porters, will no longer be on NHS terms and conditions?

[Mr Dunne]

I can reassure the hon. Gentleman that we have no interest in allowing NHS trusts to avoid their tax responsibilities. Guidance was sent to all trusts in September to ensure that any TUPE transfers of staff would remain subject to NHS pension rules and should not be done for tax avoidance purposes.

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

What role does the Minister see for the private and voluntary sectors in the provision of NHS services and delivery in the future?

[Mr Dunne]

There has been a continuing involvement of private provision of health services since the very origins of the NHS, when GP partnerships came in, as private businesses, to provide their services. Of course, competitive tendering was introduced to NHS contracts by the last Labour Government, and the rate of private provision under that Government grew faster than it has under this Government. According to the last figures, 7.7% of services were provided by the independent sector.

[Karin Smyth (Bristol South) (Lab)]

Where a foundation trust or other NHS provider sets up a wholly owned subsidiary within the public sector, would the Minister expect to see all those papers in the public domain?

[Mr Dunne]

As I said to the hon. Member for Keighley (John Grogan), the trust, which would consolidate subsidiaries in its accounts, would publish the accounts of subsidiaries as part of its consolidated accounts each year.

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

On Sunday, the Secretary of State said that

“good public services are the moral purpose of a strong capitalist economy”,

yet trusts are so strapped for cash that they are creating private companies to get around VAT laws. Not only does this take money away from the Exchequer, meaning that other parts of the NHS are effectively subsidising these trusts, but it also removes vital protections for staff, who will find that they no longer work for our national health service. Be in no doubt: this is another step down the road of privatisation. Will the Minister set out, therefore, what protections are in place to prevent any of these companies from being sold off in the future to the highest bidder?

[Mr Dunne]

I am afraid that the hon. Gentleman, for whom I have considerable respect, is trying, yet again, the tired old approach of weaponising the NHS by alleging privatisation—seeing privatisation fairies where there are not any. This is about responding to the review of Lord Carter—one of his hon. Friends in the other place, I remind him—of driving efficiency through the NHS, which I know he supports, and about finding the right structures to allow, for example, the back offices of different NHS bodies in an area to be combined. That requires a structure, and a number of foundation trusts are setting up subsidiaries to provide those services to each other.

[David Warburton (Somerton and Frome) (Con)]

2. What steps he is taking to ensure adequate medical provision in areas where there is a shortage of doctors.

--- Later in debate ---

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

20. What recent assessment his Department has made of the effect of the UK leaving the EU on the health and social care sector.

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

We are fully engaged with the highest level of Government work on Brexit. My right hon. Friend the Secretary of State is a member of the Cabinet Committee on Brexit, and he is engaged on all areas where Brexit may impact the health and social care sector. We are actively considering the Brexit implications for the UK on workforce, medicine and equipment regulation, reciprocal healthcare, life sciences, public health, research, trade and data.[Official Report, 21 November 2017, Vol. 631, c. 5MC .]

[Chris Stephens]

Is the Minister aware of the latest figures released this month by the Nursing & Midwifery Council? The figures confirm a clear trend: an 11% increase in the number of UK-trained nurses and midwives leaving the register, alongside an 89% drop in those coming to work in the UK from Europe. Does the Minister agree with the chief executive of the Royal College of Nursing that

“These dramatic figures should set alarm bells ringing in Whitehall and every UK health department”?

[Mr Dunne]

It is the case that we have been reliant for much of the increase in clinicians in this country on doctors and nurses coming from the EU, so a reduction in that increase is something we are watching carefully. I gently say to the hon. Gentleman that the last figures we have show that, as of the end of June, there were 3,193 more clinicians working in the NHS in England than there were in June 2016.[Official Report, 21 November 2017, Vol. 631, c. 6MC.]

[Martyn Day]

Brexit may well result in a loss of both rights and funding for people with disabilities, so when will this Government release their full impact assessment of the medical and social care sector?

[Mr Dunne]

The hon. Gentleman is looking for answers about social care. The Under-Secretary of State for Health, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who has responsibility for social care, has made it clear that a paper will be published in due course. I am afraid that the hon. Gentleman will just have to be a bit more patient.

[Jeremy Lefroy (Stafford) (Con)]

Earlier, my right hon. Friend the Secretary of State made a welcome statement about the contribution of EU citizens to the health and social care sector. Will the Minister kindly advise us on what is being done at a trust level to support overseas workers, both from the EU and elsewhere, to ensure that they feel welcome and are encouraged to stay here as long as possible?

[Mr Dunne]

I am grateful to my hon. Friend for giving me the opportunity to reaffirm the commitment of the NHS, from the centre through to every organisation for which EU citizens are working, that these people are welcome here. My right hon. Friend the Secretary of State for Exiting the European Union yesterday made it very clear that we are looking to have a simple, straightforward and cheap means for those who are here at the point of departure to be able to register to stay here. We want to encourage all those who are working for our NHS, wherever they come from, to continue doing so.

[Mr Philip Hollobone (Kettering) (Con)]

During his visit to the hospital in April, the Minister will have seen that Kettering General has a long and proud record of recruiting medical staff from outside the EU, and in numbers. Is it not the case that the NHS has always recruited from outside the EU and will continue to do so after Brexit?

[Mr Dunne]

My hon. Friend is right to say that there has been a long-standing tradition of this country welcoming professionals from outside, through various waves of migration that go back several decades. It is important to point out to him that the Secretary of State announced a year ago a 25% increase in the number of doctors in training in this country and earlier this autumn a 25% increase in the number of nurses to be trained in this country, so that we become less reliant on overseas clinicians at a time of a shortage of some 2 million worldwide.

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

Being a member of the European Medicines Agency has allowed UK patients early access to new drugs, and it also plays a crucial role in quality control and safety monitoring, so what solution has the Department come up with to ensure not only timely access to new drugs after Brexit, but that any complications are spotted early?

[Mr Dunne]

As I indicated in response to the hon. Member for Glasgow South West (Chris Stephens), finding an appropriate relationship with the EMA post-Brexit is one of the core strands of work the Department is doing. As the hon. Lady will be aware, next Monday the other EU nations will vote to decide which country will host the new EMA. It is our intent, as we have made clear to the EU negotiators, to seek mutual recognition.

[Dr Whitford]

With the World Trade Organisation not having updated its drug list since 2010, all new drugs developed in the past seven years could incur tariffs. What contingency plans have been made to avoid shortages and increased costs in the event of a no-deal Brexit?

[Mr Dunne]

As the hon. Lady will be aware, we are looking for a relationship with the EU to ensure that we have tariff-free access to the single market, including for drugs and medicines, because the life sciences industry is such a critical element of our economy. Contingency plans are being put in place for a no deal. She will have to wait, as will the rest of us, to see whether or not that eventuality happens. Of course we do not want it to occur—it is not our intent.

[Bob Blackman (Harrow East) (Con)]

8. What steps he is taking to reduce smoking rates.

--- Later in debate ---

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

There is no fixed timetable for sustainability and transformation partnerships to become accountable care systems. Evolution from an STP into one or more ACSs is dependent on an STP demonstrating that it is working in a locally integrated health system. Both commissioners and providers, in partnership with local authorities, will need to choose to assume collective responsibility for resource and public health, and the criteria for that were set out in NHS England’s next steps in the “Five Year Forward View”.

[Clive Lewis]

Last week, NHS doctors took out a judicial review against the Secretary of State’s plans to use secondary legislation to enable private companies to run big parts of the accountable care organisations. I think the Government understand that doctors, nurses, patients and the public want an NHS that is run for the public by the public using public funds. Ultimately, will the Minister ensure that we have time in this place for Members to discuss and scrutinise the ACOs, because they are a drastic change to our NHS?

[Mr Dunne]

I can honestly say that the best thing the hon. Gentleman can do to understand what STPs are really all about is talk to the recently appointed chair of the Norfolk and Waveney STP, which covers his local area. He will find that the former Labour Secretary of State, Patricia Hewitt, can give him very good advice.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

14. What steps he is taking to tackle inequalities in the provision of dental health services.

--- Later in debate ---

[Robert Jenrick (Newark) (Con)]

T9. Rural communities, and towns such as Newark without an A&E, desperately need a high-performing ambulance service, yet East Midlands ambulance service, and services across the country, are generally missing their targets. This is not a new problem—it began with Labour’s disastrous regionalisation of ambulance services—but it needs to end, and improvement is required. What strategy do the Government have to improve response times for ambulance services in the east midlands and across the country?

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

I am aware that the performance of the East Midlands ambulance service is not what local residents or we would like at present. The strategy that is being adopted is to introduce a new ambulance response programme, and EMAS has an ongoing consultation with staff on introducing new working models to bring that into effect.

[Diana Johnson (Kingston upon Hull North) (Lab)]

The Minister has just said that pharmacies are a critical part of our primary care infrastructure. Does he therefore share my concern that Lloyds Pharmacy has announced 190 branch closures across England due to funding cuts exacerbated by rising drug costs and cash-flow problems? At least two of those are in Hull. Why can 30% of pharmacies in the Health Secretary’s constituency get remedial help under the pharmacy access scheme but only 1.3% of pharmacies in Hull get that help?

--- Later in debate ---

[Tim Farron (Westmorland and Lonsdale) (LD)]

The south Cumbria area is one of the few places in England where patients who need even the least complex radiotherapy treatment must travel for longer than the maximum 45 minutes recommended by the National Radiotherapy Advisory Group. In NHS England’s consultation, which will close on 18 December, will the Secretary of State make sure that access to radiotherapy within 45 minutes is a key criterion in allocating resources so that Westmorland general can be given its much-needed satellite radiotherapy unit?

[Mr Dunne]

I am grateful to the hon. Gentleman for raising that point. We are absolutely aware of the need to have more radiographers and sonographers available to support facilities around the country, and we have currently some 200 radiographers in training. I would like him to write to me so that we can follow up the specific point he makes about south Cumbria.

[Helen Whately (Faversham and Mid Kent) (Con)]

Local A&Es serving my constituents in Kent now have 24/7 mental health services, thanks to this Government’s determination to improve mental healthcare. Can my right hon. Friend assure me that the Government will fulfil their commitment to increase mental health spending by at least £1 billion by 2020?

--- Later in debate ---

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

The NHS sustainability and transformation plan review in my region recently recommended that all acute services be maintained at North Devon District Hospital. That was a very welcome decision and a victory for the community. Will the Minister work with me and local NHS managers to ensure that the clinical need that has been identified can be fully met?

[Mr Dunne]

I share my hon. Friend’s ambition. I greatly enjoyed visiting his hospital in Barnstaple during the summer, and I have been impressed by the way in which the four trusts in Devon that provide acute services have decided to come together and provide a collaborative pool of, in particular, emergency department staff to ensure that each hospital is adequately covered and there is continuity of service. I think that is a model that we can adopt elsewhere.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

The Health Committee heard that to obtain a diagnosis of autistic spectrum disorder, many struggling children and families face a postcode lottery. Will the Department seek to publish baseline data so that we know where trained clinicians are positioned across NHS England, to ensure that workforce planning is undertaken appropriately?

Charing Cross Hospital

Philip Dunne Excerpts

Wednesday 1st November 2017 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Rosindell, and to have been left sufficient time to address, I hope, some of the concerns expressed by the hon. Member for Hammersmith (Andy Slaughter). I am grateful to him for engaging with my office in advance to indicate his line of questioning. He has made his points with characteristic skill and calm composure, which is much appreciated.

I will set the issue of Charing Cross within the context of the wider north-west London sustainability and transformation partnership to which he referred briefly. That is how the NHS is looking at the future of healthcare provision for populations throughout the country. Charing Cross, within the Imperial trust, sits firmly in the north-west London STP, the footprint for which has funding of some £3.7 billion. Between 2015-16 and 2020-21, that funding is expected to rise by more than £600 million—an increase of some 17%.

The Government’s position, as the hon. Gentleman is aware, is that any potential service change affecting Charing Cross is a matter for the local NHS. It will be determined primarily through the prism of the STP and the leadership of that wider NHS group. In our view it is right that decisions on service configuration are led by local clinicians, who understand better than the national NHS the healthcare needs of their local population, and that those decisions are made in consultation with local people, which was one of his challenges to the process. All proposed service changes will be based on clear evidence that they will deliver better outcomes for patients.

[Dr Huq]

Is the Minister familiar with the King’s Fund analysis of the STP plans from February this year, which concluded that, despite all the warm words about the new models of care, they are driven more by financial imperatives than by clinicians?

[Mr Dunne]

I do not agree with that. The analysis at the time was of course of the preliminary drafts of the STP plans, before any assessment by NHS England or the Department of Health. The plans are evolving and becoming partnerships, and they will move at differing speeds in different parts of the country, depending on the quality of the work and the extent to which they meet the four tests for service change, namely that they should have support from GP commissioners; be based on clinical evidence; demonstrate public and patient engagement; and consider patient choice.

In addition, NHS England introduced a new test from 1 April this year on the future use of beds, which is pertinent to the Charing Cross case. It requires commissioners to assure NHS England that any proposed reduction in the number of acute hospital beds is sustainable over the longer term and that key risks, such as staff levels, have been addressed.

The north-west London STP plan was published in November 2016. It confirmed that the “Shaping a healthier future” programme, to which the hon. Member for Hammersmith rightly referred and which was published in 2012, had set out the right plans to reshape health services across north-west London to respond to rapidly changing health and care needs. “Shaping a healthier future” forms a core part of the STP plan and I understand that the STP leadership intends to take that forward. There was a full public consultation in 2012 on the plans for a more integrated approach to care, whereby specialist services would be consolidated on fewer sites across north-west London to improve quality and efficiency, and routine and chronic care would be expanded to improve access, particularly in the community. It was proposed that Charing Cross would become a growing hub for integrated care in that services network. Following feedback from the public consultation, the proposals were refined to retain a wider range of services than was initially proposed on the Charing Cross site.

In October 2013, the Secretary of State for Health clearly set out, following the full public consultation, that both Charing Cross and Ealing Hospitals would retain A&E services, even if in a “different shape or size” from current arrangements, and that proposal remains. No final decisions have been made about the exact nature of services that are planned to continue at Charing Cross Hospital. It is certain that, even if changes are made, there will still be a thriving Charing Cross Hospital. There will be engagement with the public in due course on the detailed design and implementation of services on the site, which will include cancer, outpatients, diagnostics and 24/7 local A&E services.

As the hon. Member for Hammersmith quite rightly said, the STP is initially focusing on developing new models of care to reduce demand on acute services. I am grateful to him for welcoming the improvement of services in the community, so that it can be established that those services work before acute reconfiguration takes place through the proposal.

[Dr Huq]

The Minister is being generous in giving way. He pointed out that no final decisions have been taken, but can he not appreciate that that uncertainty creates a lack of morale among the staff? I had to visit Charing Cross very regularly for my late mother, who we lost during the election campaign, as her specialist Dr Perry was there. Staff morale is sapped: they are demoralised because they do not know what is going on.

[Mr Dunne]

I am very sorry to hear about the hon. Lady’s mother; she has my considerable sympathy and condolences. I will come to the issue of staff morale, which she is right to raise.

It is important that, whichever side we are on in this debate, we do what we can to ensure that the staff of all our NHS facilities—in this case Charing Cross Hospital— have confidence and clarity that they have good career prospects at that hospital. However we describe the challenges in our local NHS, we should not try to undermine the importance of those facilities to our local residents and, therefore, the importance of encouraging staff to continue to work there.

[Andy Slaughter]

The Minister is being generous in giving way. What I said was that I applaud the aims of improving community services. My CCG faces having to make £17 million of further savings—that creates great difficulty for maintaining services, let alone improving them. The Imperial trust has huge deficits and, as far as I can see, most of the sustainability transformation funds for last year have gone to addressing those deficits. That is the difficulty, which is why I asked for a review of where we are going—because hopes are not being fulfilled.

[Mr Dunne]

It is fair to say that part of the STP’s objective is to help the NHS in a particular area to work more co-operatively, to encourage better public health for the population as a whole, and thereby work within the available budgets that have been allocated by NHS England. We think that creating a coherent plan for the entire area is the most logical way to try to ensure that that happens.

As I have said, the service change is a matter for the local NHS, which has been clear that there will be no changes at Charing Cross before 2021, as the hon. Gentleman has acknowledged. He did not mention that, in the meantime, NHS England has confirmed its commitment to Charing Cross Hospital and invested £8 million in the hospital in the last year alone. That funding enabled refurbishment of urgent and emergency care wards, theatres, out-patient clinics and lifts, as well as the creation of a patient service centre and the main new facility for north-west London pathology. Further significant investments are also planned, notwithstanding what the hon. Gentleman says about the current financial situation of the Imperial trust.

It remains the case that the STP is planning, in due course, a phased new build across north-west London rather than refurbishing existing buildings, including on the Charing Cross site, but it is not yet at the point of finalising that plan. I can confirm, as the hon. Gentleman asked me, that no hospital run by Imperial College Healthcare NHS Trust, including Charing Cross, has declared any site surplus land. He asked what commitment that means for the future; clearly, until the plans are completely finalised it would be wrong of me to give any further indication of what that might mean in relation to land, because that will depend on the configuration of the buildings, which have yet to be designed. It would be an unrealistic expectation to be definitive about that today.

I am glad that the hon. Member for Ealing Central and Acton (Dr Huq) raised the point about the workforce. It is unsurprising that discussions about proposed service change have created some uncertainty for staff, patients and other stakeholders, including local residents. However, there has been a very clear position on the future development of Charing Cross since the STP plan for north-west London was published a year ago. This position has been shared widely with staff and all stakeholders. As I said earlier, I sincerely hope that my remarks can help to reassure staff working at the hospital that there will be no changes to service levels until 2021 at the very earliest, and that the local NHS commitment to Charing Cross Hospital has been reaffirmed.

In August, the trust leadership undertook a review to more fully understand staff morale at Charing Cross and to develop actions in response. The conclusion was that site-level data do not indicate that Charing Cross is affected by poor morale or that it has more difficulty than other sites in the trust in recruiting and retaining staff. However, there are higher vacancy levels in a few specific staff groups in certain areas, such as elderly care. In response to that review, the trust leadership team has established an action plan, including organising a succession of staff briefings. This week, the trust announced a public meeting for local residents on 27 November to ensure clarity on the future position of Charing Cross and to share information about recent and planned investments on the site. I strongly encourage the hon. Member for Hammersmith to attend that meeting, if he is able to do so, to understand what the trust is saying and to provide reassurance to local residents on the state of the hospital.

The trust has been in correspondence with the leader of Hammersmith and Fulham Council regarding mailings that the council has sent to residents that do not reflect the evolving position at Charing Cross. As well as raising constituents’ concerns, we have a responsibility to allay fears when discussing this subject. We can best do that by being clear about what is and is not in prospect, and by encouraging constituents to take up the offers of engagement made by local decision makers. I understand that the council has expressed some concern about doing that.

The Government remain committed to supporting the local NHS in engaging well with its local population and local clinicians, to ensure that decisions about services in north-west London are made in the best interests of patients, now and in the future. I hope that the hon. Gentleman’s constituents, who are paying attention to this debate, will make the most of the opportunities to participate in future public engagement on the design of services in their area, and that as many as possible will attend the meeting at the hospital on 27 November.

Question put and agreed to.

Promoting Professionalism, Reforming Regulation

Philip Dunne Excerpts

Tuesday 31st October 2017 Written Statements

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

Today I am publishing a consultation on the reform of the regulation of healthcare professionals in the UK.

This takes forward the manifesto commitment to legislate to reform and rationalise the current outdated system of professional regulation of healthcare professions, based on the advice of professional regulators.

The UK’s model of professional regulation for healthcare professionals has become increasingly complex and outdated. It needs to change to protect patients better, to support our health services and to help the workforce meet future challenges. This consultation is a major step towards developing a modern system of regulation for healthcare professionals.

My Department has worked with the Governments in Scotland, Northern Ireland and Wales as well as the healthcare regulation bodies to develop proposals for reform. We have built on the work of the Law Commissions of England, Wales, Scotland and Northern Ireland.

The UK Governments have five objectives in taking forward reform:

Improve the protection of the public from the risk of harm from poor professional practice;

Support the development of a flexible workforce that is better able to meet the challenges of delivering healthcare in the future;

Deal with concerns about the performance of professionals in a more proportionate and responsive fashion;

Provide greater support to regulated professionals in delivering high quality care; and

Increase the efficiency of the system.

This consultation considers the reforms that are needed in order to maximise public protection while supporting workforce development. We want to design a flexible model of professional regulation that secures public trust, fosters professionalism and improves clinical practice, while also being adaptable to future developments in healthcare.

The responses to this consultation will allow the Government to consider future options for professional regulation. The consultation will run for 12 weeks and close on 23 January 2018. The consultation document has been attached and can be accessed online at: https://consultations.dh.gov.uk/professional-regulation/regulatory-reform.

Attachments can be viewed online at: http://www. parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2017-10-31/HCWS206/.

[HCWS206]

Healthcare: North Staffordshire

Philip Dunne Excerpts

Monday 23rd October 2017 Commons Chamber

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

I congratulate the hon. Member for Stoke-on-Trent Central (Gareth Snell) on securing this debate, and on securing the support of neighbours and colleagues from both sides of the House, who clearly share his interest in ensuring that we have high-quality healthcare for the residents of north Staffordshire.

The hon. Gentleman gave a wide-ranging account of several of the challenges facing healthcare provision in Staffordshire, and I shall frame my remarks in the context of the NHS plan for resolving them. The hon. Gentleman did not mention it, but he will be aware that Staffordshire and Stoke-on-Trent’s sustainability and transformation partnership is the vehicle through which all these issues are being brought together, to try to provide a sustainable, financially viable future of high-quality healthcare for the residents of Staffordshire. It is a complex area, and the rating given to the STP by the NHS earlier this summer reflects an understanding of the challenges being faced across Staffordshire, because it was rated in the lowest category. A number of steps are being taken to try to help leaders in Staffordshire to come to grips with the challenges that they face.

The area contains two local authorities, six clinical commissioning groups—as the hon. Gentleman mentioned—and five NHS trusts. Together, they provide services to more than 1.1 million people in Staffordshire. The hospital the hon. Gentleman invited me to visit, and on which he began his remarks, the Royal Stoke, also serves patients from Shropshire, including my constituents, as it is one of the leading trauma centres for the area. I have yet to visit that hospital, and I would be delighted at some appropriate point to take up his invitation; so at the outset I can give him that reassurance in answer to one of his questions.

We in the Department, and the Secretary of State in particular, are acutely aware that some of the pattern of provision in Staffordshire is coloured by the tragic events of Mid Staffs, and the importance of eradicating the poor care that the people in Staffordshire experienced because of the problems in that hospital at that time. Much has already been done to address the challenges that arose earlier in this decade, and I pay tribute to the NHS staff across Staffordshire, who have been working tirelessly to improve the way care is delivered. Just one year after the Mid Staffs inquiry, we saw a real shift in priorities, with new inspection regimes, additional nurses and a stronger voice for patients, leading to tangible improvements in the way care is delivered, but it is right for me to acknowledge, as the hon. Gentleman has in this debate, that the NHS in Staffordshire remains under significant pressure. The acute hospitals have been, and still are, struggling to meet quality standards and demand.

The STP has publicly stated that if the way services are delivered is not transformed, the majority of organisations across Staffordshire and Stoke-on-Trent will be in deficit by 2020, and many of them already are. Clearly, Staffordshire has long-standing local issues that need addressing. None of the organisations in the area can do that by themselves. Instead, they need to work together to deliver wide-ranging transformation. The STP is the vehicle to do this. It brings together the local population, NHS organisations and local authority bodies to propose how, at a local level, they can improve the way that their local health and care is planned and delivered. The plan published in December last year set out the scale of the area’s ambition, identifying five particular areas that, if implemented, will help to achieve that.

The first area was a focus on shifting from reactive care to prevention. That means increasing the proportion of care delivered in the community, rather than in hospitals. Some £24 million has already been invested in community services by two CCGs in the STP area, including the CCG covering the hon. Gentleman’s constituency, through changing the way local services are delivered. Further investments are being made to increase the capacity of primary and community care, which will, in turn, significantly reduce the pressures on A&E.

[Gareth Snell]

I want to push the point about community care if I may. The 168 community care beds are not only in my constituency; they are in Bradwell in Newcastle, and in Leek in the Culture Secretary’s constituency. Will the Minister answer the point about referrals specifically?

[Mr Dunne]

I specifically will; I will come to that point very shortly.

It is important that we get the right balance between primary, community and secondary care. NHS leaders believe that they can significantly reduce the 30% of patients who are currently being treated in Staffordshire in the wrong setting. Clearly, patients sometimes have to go to our acute settings. We have recognised that the Royal Stoke, having reviewed its emergency department, is under-bedded. There is currently a plan for 46 beds to be added over the winter to help to relieve the pressure on the acute services. I will come to the question of the community beds in a second.

[Jack Brereton]

I want to raise the point about acute beds as well, because it is a significant issue. It particularly relates to the design of the hospital, which does not have enough acute beds. Does the Minister agree, however, that some of these issues predate this Government?

[Mr Dunne]

I am sure that my hon. Friend is right, but I am not going to get into a dispute about that just at the moment. I would like to deal with the question of community beds that the hon. Member for Stoke-on-Trent Central raised. He has referred to the request by two local authorities concerning the community bed closures, seeking a referral to the independent reconfiguration panel. He suggested that there had been no response to that request, unless I have misunderstood him. I think that the hon. Member for Stoke-on-Trent North, who is sitting next to him, received a letter in February. The local authority received a letter to confirm that the referral request had been received, and the referral has been transmitted to the independent reconfiguration panel. We are currently awaiting the results of that referral and the panel’s report and recommendations. The hon. Gentleman will therefore understand that it would be inappropriate for me to pre-empt the panel’s conclusions by commenting on this specific case.

I want to touch on the financial challenges that the hon. Gentleman has referred to. I recognise some of the figures that he has referenced and questioned. We believe that Staffordshire needs to get into a financially sustainable position. At the moment, some areas of Staffordshire receive significantly more funding per capita than the rest of the county and than England as a whole. The Stoke-on-Trent CCG receives an allocation that is some 9% greater than the average for England per capita, reflecting the needs and challenges of that community. The NHS recognises that parts of Staffordshire are more challenged and need more money, but equally, the hon. Gentleman needs to recognise that each area of England needs to live within the budget that it has been set.

One of the challenges that Staffordshire has at present is that, for historical reasons that have not been addressed over the years—going back to the point made by my hon. Friend the Member for Stoke-on-Trent South (Jack Brereton)—the pattern of provision and the models of care have not developed in the way that they have in some other areas. This has meant that the cost of providing care—in some cases, in settings that are no longer as relevant as they could be—is resulting in Staffordshire running unsustainable deficits. It is unfair that other parts of the UK should provide even more funding into Staffordshire, resulting in their not having sufficient funding to look after their own populations.

The hon. Member for Stoke-on-Trent Central referred in particular to the better care fund. I understand that concerns are shared across the House about the funding that was pledged in the Budget. It was made clear to local authorities that as a condition of that funding they would need to make progress in reducing the delayed transfers of care. North Staffordshire has made huge strides in doing that and it currently has roughly zero delayed transfers of care, which is one of the best performances in the country. We need to see that improvement across the county as a whole. I know that there was a meeting last week to discuss that, and we will see how that progresses in the future.

Question put and agreed to.

Valproate and Foetal Anticonvulsant Syndrome

Philip Dunne Excerpts

Thursday 19th October 2017 Commons Chamber

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

I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this debate through the good offices of the Backbench Business Committee. He has, as he indicated, taken a particular interest in this issue since it was brought to his attention during his time as a Minister in the Department of Health, and all tribute to him for being so persistent in that endeavour.

This is a very important issue. Members on both sides of the House have come together once again—for two weeks in a row, as the hon. Member for Central Ayrshire (Dr Whitford) pointed out—to demonstrate their concerns. Those are not party political; these issues affect all our constituents, irrespective of any party political alliance.

We have had some very constructive suggestions on both sides of the House, and we have heard a number of the personal cases that constituents have brought to the attention of Members, which has been very moving. Rather than rehearse them, I will just point to my hon. Friend the Member for Congleton (Fiona Bruce), who went into some detail, as the hon. Member for Washington and Sunderland West (Mrs Hodgson) said, about the particular circumstances of the two outstanding campaigners—I am pleased they are here to witness this debate—who have spoken so powerfully about the effects that valproate has had on their lives and those of their children. Like other hon. Members, I have very great sympathy for those families who have been affected by valproate use in pregnancy.

The Association of British Neurologists advises that valproate remains the most effective treatment for generalised epilepsy, and this is reflected in NICE guidelines. For some women with epilepsy, it may be the only effective treatment—the only thing that prevents a potentially life-threatening seizure. However, because of its risks, valproate should be used to treat women of child-bearing age only if other drugs are ineffective or not tolerated. This is not a clear case of use or no use, as was clearly pointed out by the hon. Member for Central Ayrshire, who speaks with authority on these matters.

The key challenge for clinicians is to ensure that the drug is used only by those who really need it, that they are fully informed about the risks and that their treatment is closely monitored.

[Norman Lamb]

Does the Minister share my aspiration that we should be aiming to ensure that every woman, wherever they live, has access to a specialist unit?

[Mr Dunne]

I will come on to how access—and monitoring—needs to be improved.

As my hon. Friend the Member for Eastleigh (Mims Davies) acknowledged, it is vital that no woman stops taking valproate, or any other anti-epileptic, without first discussing it with their doctor and, if necessary, with the relevant specialist. The Medicines and Healthcare Products Regulatory Agency is currently working with European regulators, and with experts and healthcare bodies, to decide what further action should be taken. Like many anti-epileptics, valproate has always been known to carry a risk if taken during pregnancy. However, as hon. Members have pointed out, important questions have been raised, here in the Chamber and elsewhere, about the extent to which women have been informed over the decades about the risks.

At the time that valproate was first marketed in 1974 for the treatment of epilepsy, animal studies had shown that there might be a risk of birth defects. Health professionals were made aware of this and were expected to weigh the benefits against the risks. Difficult prescribing decisions had to be made. Campaigners have highlighted, as did the right hon. Member for North Norfolk in his opening remarks, the minutes of a meeting of the Committee on Safety of Medicines in 1973 where the Committee concluded that it would be best not to mention the risk of birth defects in package inserts. As has been said today, this paternalistic attitude has no place in the NHS of today. Now, patients and doctors are expected to make decisions based on open communication on the risks and benefits of a treatment, which is underpinned by legislation. However, that was not always the case, and the views expressed by the CSM in 1973 were not unusual at that time, particularly in relation to life-saving medicines such as anti-epileptics.

I am pleased to say that medical practice has changed considerably since then. Comprehensive patient information leaflets have been a legal requirement since 1999, and warnings have been issued when new evidence on risks has become available. The MHRA issued bulletins in 1983 and 1993 to update prescribers on the risk of birth defects, and in 2003 warned about a possible risk of developmental delay in children exposed to valproate during pregnancy. Warnings were extended to include a risk of autism in 2010, and a reminder bulletin was issued in 2013. Information on the full magnitude and nature of the risks with valproate first became available in 2013, following a long term follow-up of children whose mothers had taken valproate and other anti-epileptics.

Given those concerns, the MHRA initiated and led a Europe-wide review which completed in November 2014. The review found that there was still a clinical need for valproate despite the significant risks to the child if taken in pregnancy, and that it should remain an option for women of childbearing potential only where other treatments had failed or were not tolerated. To mitigate the risks, the recommendation was that women should use effective contraception and treatment should be supervised by a specialist. In January 2015, the MHRA sent a letter to doctors and pharmacists about the strengthened restrictions. As well as updating statutory information, the MHRA has developed the valproate toolkit referred to by hon. Members.

Although I am not allowed, quite properly, to use props while I am at the Dispatch Box, I cannot resist pointing out to hon. Members that the warnings now on valproate packaging include the following very specific warning:

“Warning for women and girls: This medicine can seriously harm an unborn baby. Always use effective contraception during treatment. If you are thinking of becoming pregnant or you become pregnant, talk to your doctor straight away.”

In addition to that warning on the packaging, there are other elements in the toolkit. I will not trouble the House to read them out, but they include patient cards, information for patients, and information for prescribers and clinicians. The toolkit was distributed to doctors and pharmacists in February 2016. Messages sent through different channels then and subsequently have reinforced the recommendation of its use to support discussions with patients.

In view of the importance of the issue, in the autumn of 2015 the former Minister for Life Sciences brought together healthcare bodies to support the promotion of the toolkit and ensure that there was co-ordinated messaging to health professionals and patients. The MHRA further developed that group into a 39-strong stakeholder network of health system organisations, health professional bodies, charities and campaign groups, which include In-FACT, FACS-Aware, the Organisation for Anti-Convulsant Syndrome, Epilepsy Action, the Epilepsy Society, the Royal College of General Practitioners and the Royal Pharmaceutical Society.

Our communications strategy has been informed at every step by the valproate stakeholder network, including NHS England. In response to concerns about gaps in awareness that have been identified by several Members in today’s debate, in July of this year the toolkit was redistributed to GPs and specialist prescribers, and additional materials were distributed to pharmacies. More than 100,000 healthcare professionals received the toolkit this year.

What are we doing beyond that? We are tracking changes in prescribing. Data show that between 2012 and 2017, there has been a decline of approximately 26% in the number of women of childbearing age treated with valproate. The decline is sharper among 10 to 17-year-olds. Although usage is declining, there has not been the step change that we would want, and, as has been mentioned today, the results of surveys of patient awareness of the risk clearly indicate that more needs to be done.

I am aware that campaigners have called for the use of the toolkit to be made mandatory. The MHRA and NHS Improvement sent out a patient safety alert in April 2017, which directs organisations systematically to identify women and girls taking valproate and to support them to make informed choices. MHRA and NHS Improvement are monitoring the implementation of the alert and are following up directly with relevant organisations. That action has been taken consistently across the UK and through the devolved Administrations.

The MHRA is fully involved in the new Europe-wide review to look into whether further restrictions are needed. An expert working group of the Commission on Human Medicines, a committee of the MHRA, has been convened to inform the UK’s position during the EU review, which is expected to conclude early in the new year. This review is also looking carefully at whether there is any evidence of adverse effects in babies whose father took valproate. I am sure the whole House was moved by the personal testimony of the hon. Member for Bury North (James Frith) about the consequences of childhood meningitis and his six years on valproate to control epilepsy.

I hope I have made it clear that we are taking the matter seriously. I have enormous sympathy for those families who have been affected by valproate use in pregnancy. In the short time that I have available, I want to touch on a couple of the issues raised by the right hon. Member for North Norfolk. He talked about support, and we have an established system, reinforced by the Children and Families Act 2014, to establish a new framework for local authorities and CCGs to secure services for children and young people who have special educational needs or disabilities.

I will not get into the question of compensation or an inquiry here. What I will say to the right hon. Gentleman is that a meeting has been arranged for the chair of the all-party group with my Lords colleague the Under-Secretary of State for Health, and the issues that the right hon. Gentleman has raised should be brought up at that meeting. I encourage other members of the all-party group to join him in that meeting at the Department.

I will look at the feasibility of extending the yellow card system, as hon. Members have described. I think it is right that we shine the spotlight of transparency to improve patient safety. No Government have done more than we have to make that happen in other areas, and the victims of valproate deserve nothing less.

Capital Funding: New Hospital in Harlow

Philip Dunne Excerpts

Wednesday 18th October 2017 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Howarth. You have chaired the debate admirably in allowing my hon. Friend the Member for Hertford and Stortford (Mr Prisk) to get in to support my right hon. Friend the Member for Harlow (Robert Halfon) in his excellent speech, which was both concise and heartfelt.

I visited the hospital with my right hon. Friend a year ago, shortly after the trust went into special measures. I share his view about the commitment of the staff, which was evident to us on that occasion, at a time when, it would be fair to say, there was a state of some unease, the trust having just gone into a special measures regime. In part, we were there to reassure them that it could be a learning process from which they could improve the services offered to their patients, notwithstanding the challenges presented by the consequences of the CQC report.

My right hon. Friend is a consistent and persistent champion for his area and for this project, which has been in germination for some time. It is timely that he should bring it to the House’s attention; I will go on to explain why. I may not be able to satisfy him completely on the questions he has put to me, but I will do my best.

The Princess Alexandra Hospital faces many issues with its estate, as is evident to anyone who visits the site. My right hon. Friend has explained that it has an aged infrastructure and a strong reliance on temporary buildings—it has “sub-optimal clinical adjacencies”, which is the civil service phrase for bits of activity dotted around the place in an unco-ordinated way—much of which is in a fragile condition. There are also capacity challenges posed by the growing demand that he referred to from a combination of demographics and increases in housing, which are happening all around him. That is a shared picture recognised by the Department and the local NHS.

Any service change that might come to the Princess Alexandra Hospital is primarily a matter for the local health authorities. They recognise that and therefore have come up with various proposals. As my right hon. Friend would expect, any proposed changes that are pursued will be subject to the usual procedures and public consultation.

My right hon. Friend pointed out that the local NHS trust looked at five options for a potential redevelopment of the Princess Alexandra Hospital. The strategic case for change concluded that a new hospital on a greenfield site would be not only the most affordable solution but the one that would deliver the most benefit for the local population. West Essex CCG, as lead commissioner for services provided by the Princess Alexandra Hospital NHS Trust, supports that proposal.

Harlow is due to undergo significant economic and residential housing growth in the next 10 years. I am pleased that my right hon. Friend referred to the contribution that Public Health England will be making to that: it remains our ambition to create a world-class health life sciences facility in his constituency. I understand that as part of the potential development of some 10,000 homes in the Gilston area to the north of Harlow, there is the possibility of a new junction for the M11. That gives rise to potential greenfield sites and the opportunity for significant planning gain. That will be available to the local authority as it considers assisting with the financing of any scheme. That puts the proposition in a somewhat unusual light in relation to other competing claims for capital on the NHS.

Before I return to the central issue of capital raised by my right hon. Friend, I will touch on the special measures regime, which the hospital has been in since October last year, following a CQC report that rated the trust as “inadequate” overall. He identified the new management and since we visited, the trust has got a new improvement director in post. I think the new chair was in post when we visited, and he has recently recruited a new chief executive with whom he worked in a previous trust to drive through turnaround improvement. They are individuals in whom the Department has considerable confidence. It is good to hear that much of that improvement work is starting to come through.

A multidisciplinary transformation team called “quality first” has been established, which aims to drive through quality improvement and service reconfiguration across the hospital. Peer reviews are taking place on a two-weekly basis, which are being fed down to departments and wards within the hospital to drive improvement from the bedside. The most recent external peer review was conducted in June and helped to highlight areas of focus to assist the trust in its journey out of special measures status.

A consequence of that work is that there is now compliance at the trust with referral-to-treatment waiting times, which is not universal across the NHS at the moment—would that it were. It is also meeting cancer standards and ensuring that cancelled operations are rebooked within 28 days. That is positive concrete evidence of progress coming through the regime. There have also been improvements in critical care and end-of-life care since the CQC inspection. The trust has developed and launched a framework for a five-year plan, “Your future, our hospital,” and is currently preparing for its next CQC inspection, which will take place next month. We will all look at the outcome of that with great interest.

To return to the core question of capital, my right hon. Friend is right to identify the emergence of Department funding from which Harlow benefited: waves 1 and 2 of the current £100-million A&E pot. There is a bid in train for the final tranche of that funding. We will see whether or not that succeeds, but, certainly off the top of my head, I think Harlow has achieved more than any other trust in securing capital to help improve the situation in its emergency department.

More significantly, the trust has submitted additional capital bids to cover funding for other ancillary aspects of improving care in the hospital: a second maternity theatre, urgent estates infrastructure work and strategic estates transformation. All capital funding bids have to follow the same course as those of any other trust in the country. As a result, I am not in a position to confirm the trust’s prospects for success in this competitive round. The timeliness of the debate is that all STP areas have submitted bids for the next round of capital funding. I confirm that a proposal has gone in for Princess Alexandra. We await the Budget this autumn to see whether the Chancellor will allocate phase 2 capital for STP transformation. He indicated in March that he was intent to do so, so we are hopeful that that will occur. The extent to which there is capital available to support very significant projects will depend on how much is made available by the Treasury.

My right hon. Friend has rightly pointed out that this is a high priority for the region, for the county and clearly for the residents of Harlow. I wish him every success in advancing his cause—as he has done so admirably here today—when we see the allocation of that capital following the Budget later this year.

Question put and agreed to.

Healthcare in Oxfordshire

Philip Dunne Excerpts

Tuesday 17th October 2017 Westminster Hall

[John Howell (Henley) (Con)]

Thank you, Sir Roger. I do apologise that I have to go to meet the Minister of Agriculture from Nigeria. He is here at my own invitation, so I can hardly be absent from the meeting.

Let me say straightaway that I chair a group of Oxfordshire MPs who meet approximately every six weeks to discuss their relationship with the CCG. The meetings were started in order to discuss delayed discharges of care, and I have to say, from the last meeting that we had, they are going very well. Oxfordshire had the difficulty that it was one of the worst performers in delayed discharges, but is now coming back to being one of the best. I have been outside the STP process because my area was handled separately in advance. Townlands Hospital in Henley needed a multi-million pound investment before the STP process started, but I agree with my hon. Friend the Member for Witney (Robert Courts) that the process of consultation that was started by the CCG left a lot to be desired. As a former professional in the area of consultation, I looked with some disdain at what was taking place, but I appreciate that the CCG had a particular difficulty in seeing the hospital as Henley’s or south Oxfordshire’s, which they deliberately intended it to become. In the villages outside Henley that make up the largest proportion of people in south Oxfordshire, there was enormous support for the proposals. It was only in Henley that people took the opportunity to complain about the lack of beds.

Let me turn to the lack of beds. My hon. Friend the Member for Witney spoke about treating people in hospitals close to them. I fully agree with that, but a better model would be to treat them in their own homes. That healthcare system is called ambulatory care. I have spoken about that in this Chamber at length, so I will not repeat all of what I have said before. Ambulatory care requires a full integration of social care activities and medical activities in an area, because it turns the hospital into an extremely efficient medical campus-type facility, with very few people needing to stay in overnight.

In fact, if people stay in overnight, the effects on them are quite horrendous. Anyone over the age of 60 who stays in for four or five days is immediately incontinent. Without wishing to comment on people’s ages, some of us in the Chamber would look at that with great horror. If people stay in for a lot longer than that, other bad effects come from that.

When the consultation took place, there was a tremendous amount of antagonism about the beds being put—

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

Will my hon. Friend give way?

[John Howell]

Of course.

[Mr Dunne]

I am sure that my hon. Friend, who is making a powerful, constructive contribution to the debate, would not want to give colleagues the impression that of necessity, someone over the age of 60 would become incontinent if they spent four nights in a hospital. I think he is trying to suggest that there is a greater risk of adverse effects the longer one stays in hospital.

[John Howell]

I thank the Minister for that point; I was not suggesting that it was an inevitability. However, at this stage let me extend an invitation to him to visit the hospital so he can see how it works and how it has integrated social care with the medical activities there. It is based around a RACU—a rapid access care unit—which is similar to the EMU—emergency multidisciplinary unit—in Abingdon that is being proposed elsewhere. As I said, it turns the hospital into a diagnostics hospital, similar to a hospital developed in Welwyn Garden City that I went to see.

I saw the difficulty for the CCG with regard to its consultation when I went to a SELF—a South East Locality Forum—meeting. People from Henley were sitting around the table with big beaming smiles on their faces saying how wonderful the hospital was, and a member of the CCG had to stop them and say, “Well, it is a pity you didn’t say that when we were developing the hospital. Right to the end of the consultation you were attacking us on this and on taking the beds out and putting them in a care home at the side of the hospital. That is working very well and now you say that it is absolutely wonderful.” The fact is that, apart from some minor snags with the new hospital, it is a fantastic new investment by the Department of Health. It shows the way a community hospital should be developed not just in Oxfordshire but across the country. I repeat my invitation to the Minister to come and visit.

The great thing about the hospital was not the consultation initiated by the CCG but the support that I got from the Royal College of Physicians, which came out very strongly in favour of an ambulatory healthcare model and very favourably in support of the hospital. That is an interesting point, which goes back to my comments in support of my hon. Friend the Member for Witney about the lack of consultation experience on the part of the CCG. That organisation is willing to learn, and I hope that it will. I also hope that we, as MPs who meet it from time to time, will be able to keep up our pressure on it to deliver the sort of services that we feel our constituents want.

--- Later in debate ---

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

It is a pleasure to speak under your chairmanship, Sir Roger. I congratulate my hon. Friend the Member for Witney (Robert Courts) on securing the debate and on the manner in which he spoke. I share the admiration of my right hon. Friend the Member for Wantage (Mr Vaizey) of the forensic skills he has brought here from a former life, and I feel somewhat fortunate that I am sitting on the same side of the Chamber as he is.

We have heard many powerful contributions about the strength of feeling in Oxfordshire from its many impressive elected representatives, and about how a large number of the service changes that are under consideration in the county have suffered from a lack of engagement, with the clinical commissioning group in particular failing to explain to local residents the purpose of and the objectives behind the changes. I take that on board, as something that needs to improve, and I will come back to it at the end of my remarks.

It is very clear, from the Government and the Department of Health, through the NHS leadership, that all proposed service changes should be based on clear evidence that they will deliver better outcomes for patients. That is at the heart of why service change is proposed. We have made an explicit commitment to the public that all proposed service changes should meet four tests. Just to rehearse them, they are that they should have support from GP commissioners, be based on clinical evidence, consider patient choice and, most specifically for the purposes of this debate, demonstrate public and patient engagement. In the case of the service change proposals that have been made thus far in Oxfordshire, when they are capable of coming to us for determination, for ministerial decision making on appeal, my colleague the Secretary of State and I are placed in some difficulty, because we need to remain impartial and consider the issues on their merits. I am sure that my hon. Friend the Member for Witney and other colleagues will therefore appreciate that I am unable to offer opinions on the merits of the proposals from the two transformation consultations, whether actual or anticipated.

We recognise that Oxfordshire, like many areas across England, faces unprecedented demand for its services. We are all aware of the growing number of older people, many of whom are living with more complex, chronic conditions, partially thanks to the success of the NHS in keeping people going for longer, but we have also heard from a number of colleagues that Oxfordshire faces particular population pressures, with welcome increases in house building planned for the coming decades. In addition, as my hon. Friend the Member for Banbury (Victoria Prentis) said when she intervened on the Opposition spokesman, the hon. Member for Burnley (Julie Cooper), there are particular challenges in recruiting high-quality NHS staff into many of our facilities, not just in rural and coastal areas but across the country. We accept that, and are looking to increase the numbers of medical and nursing staff being trained. There was an unprecedented 25% increase in doctors in training, announced last year by the Secretary of State, and earlier this month a record increase of 25% in the number of nurses in training was announced for the next two years. Those are all reasons why the Oxfordshire transformation programme has been reviewing the model of care to ensure that future health service provision in the county is clinically and financially sustainable.

My hon. Friend the Member for Witney began his remarks by referring to the closure of the Deer Park medical practice in Witney. I will not go into the full history, but he acknowledged that the closure took place in March this year. In the previous December, a judicial review had been requested and, as my hon. Friend pointed out, this was the first time in recent years that such a thing had happened to a primary care facility. The judge who heard the case refused permission to bring it for judicial review, and it was therefore passed to the independent review panel in March of this year. The panel concluded that the referral was not suitable for full review because further local action could address the issues raised.

The Secretary of State considered and accepted the recommendations—some of which my hon. Friend the Member for Witney read out—and the Oxfordshire CCG is now working to address them. Foremost among the recommendations was that all former patients of Deer Park medical practice should be registered at an alternative practice as soon as possible. My understanding is that, of the 4,400 patients who were registered with the practice, more than 4,000 had been reregistered, as of mid-September, and that the CCG is acting to encourage the remaining 400 patients to register at one of the three other GP practices in and around Witney, whose lists remain open so that patients can register at a practice of their choice, as long as they live within its catchment area. I believe that a further letter will be sent out to all those remaining patients, to encourage them to register with another GP.

The second key recommendation, which my hon. Friend the Member for Witney also referred to, was that a primary care framework be developed to provide direction for a sustainable GP service in Witney and the surrounding area. That is at the crux of his concern about the way in which the CCG engages. I happen to have a copy of its locality place-based plan for primary care, and I note that the consultation on how primary care services should be developed for west Oxfordshire opened last week. I strongly encourage my hon. Friend to engage with the CCG and to encourage his residents to do so, so that it learns from the lessons of the Deer Park lack of consultation and, in devising services for the future, fully takes into account local residents’ concerns. I believe that the consultation period is six weeks and is due to conclude at the end of November. A common theme in colleagues’ contributions today has been that lack of engagement, as they see it, with the local CCG.

My hon. Friend the Member for Banbury raised again today her historic championing of the cause of Horton General, which clearly goes beyond primary care into secondary care. She gave us another history lesson. She has been campaigning on this issue since she was seven years old, and I think she could probably trump any Member who wanted to stand up and say that they had been consistently campaigning on any issue since a young age. Having said that, I suspect that one or two older Members have been campaigning on the same issues for longer, but certainly not from such a young age.

My hon. Friend referred to the temporary suspension last October of the obstetric-led service in the Horton because of the difficulties in recruiting doctors and midwives. It has temporarily become a midwife-led unit. As she also pointed out, at a public board meeting this August, the CCG accepted recommendations following consultation. [Interruption.] She may regard that as inadequate, but there has been some consultation. Those recommendations include one to centralise Oxfordshire’s obstetric facilities in the John Radcliffe Hospital and one to make the midwife-led unit at Horton General a permanent establishment. As she has pointed out, that decision is subject to judicial review and referral to the Secretary of State, so no action will be taken to make that recommendation permanent until the referral process has run its course.

My hon. Friend has referred to a number of the challenges posed for local residents and for pregnant women in labour in getting access to Horton General. I have taken note of the comments made by her and other Members on the reliance on Google Maps to determine travel times. I understand that the CCG has undertaken an extensive travel survey. If a mother is in labour and is in an ambulance, she has the benefit of the blue light service to get through the traffic. That can mean a more rapid journey time than ordinary residents would expect or experience.

[Victoria Prentis]

I am so grateful to the Minister for giving way and for the comments he is making. Most people who go to hospital while in the later stages of labour to have a baby are not in an ambulance. The ambulance times relate only to transfers from the midwife-led unit to the Radcliffe. Although a significant number of the people who give birth in the MLU have to transfer during or immediately after labour—we are told that it is up to 40%—that is nothing compared with the vast majority of women, who travel in a private car, if they are lucky enough to have one.

[Mr Dunne]

Indeed, I recognise that. If we are moving to an obstetric-led service at the John Radcliffe, any mother who is high-risk or is expected to give birth will have time to travel in good order, rather than in an emergency. I accept that emergency transfers do take place from midwife-led units during the course of labour.

I have heard the criticism about the overall transformation programme for Oxfordshire being divided into two phases. At this point, we are where we are. The first phase has come to a conclusion, and we are entering the second phase. I recognise some of the criticisms that it is hard to comprehend a coherent system without seeing it all laid out together.

[Mr Vaizey]

I hate to interrupt the Minister’s flow as he is getting stuck into the STP, but as time is running out, will he prevail on his officials to write to me after this debate and answer two questions? First, when will the next tranche of capital funding be available for GP surgeries in Oxfordshire? Secondly, what engagements could his Department facilitate between Assura, myself and the clinical commissioning group to try to break the logjam at the Wantage surgery? I do not want to waste any more of his time, and I feel reluctant to prevail upon his officials’ time, but that would be very helpful.

[Mr Dunne]

I can do better than that; I can answer my right hon. Friend’s first question directly. The bids for STP capital funding have been made by all 44 STP areas. They are being assessed at the moment, and we will be making submissions to the Chancellor for the Budget to see whether there will be a capital release for phase 2 of STPs. It is a competitive process. I can confirm that the STP area covering Oxfordshire has made a bid, but I cannot confirm whether it will be successful, because we will not know until we know how much the Chancellor is prepared to release in the Budget. I will happily write to him on his second question and his concerns about Wantage.

Members have said much about some of their concerns about their community hospitals. In his absence, I thank my hon. Friend the Member for Henley (John Howell) for his invitation to visit his hospital and look at the rapid access care unit. I am pleased that he supports the impact it is having in ensuring that elderly and frail people are seen quickly and can return to their homes without needing to be admitted. As he pointed out, and I think we all agree, care at home is how we should be seeking to treat as many people as possible, because that allows people to lead longer independent lives instead of having a prolonged stay in hospital.

The second phase of the Oxfordshire transformation programme is continuing. As has been pointed out in the debate, the CCG leadership is going through a transition period. We have a process under way to recruit a new chief executive, who is expected to be in post in the coming weeks. I am sure that the chairman will read this debate and take note of the comments that have been made on the challenges in engaging in recent years, as will the new clinical lead, who was appointed only yesterday. It is important that Oxfordshire CCG undertakes full public engagement for the second phase of the transformation, and I am aware that that is what it is intending to do. It is likely to begin early in the new year, and I strongly encourage all Members to engage with that consultation in as forceful and impressive a way as they have with this debate, led by my hon. Friend the Member for Witney. I pay tribute to the passion with which everyone has spoken about their commitment to their local residents in providing high-quality healthcare in Oxfordshire.