Oral Answers to Questions

Philip Dunne Excerpts

Tuesday 10th October 2017 Commons Chamber

[Thelma Walker (Colne Valley) (Lab)]

6. What recent assessment he has made of trends in staffing levels in the NHS.

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

Not only has the number of nurses on our wards increased by more than 11,000 since May 2010, as my right hon. Friend the Secretary of State mentioned earlier, but the NHS has nearly 11,300 more doctors, over 2,700 more paramedics, over 26,000 more supporters for clinical staff, and 5,700 fewer administrators. However, we recognise the pressures on staff from increasing demand. That is why last year my right hon. Friend announced a 25% increase in the number of doctors in training, and why last week he announced a 25% record increase in the number of nursing training places.

[Thelma Walker]

Huddersfield Royal Infirmary, which is in my constituency, is currently facing plans for a downgrading that would result in the loss of 500 hard-working professionals. Is it too much to ask for the Minister, or the Secretary of State, to visit the hospital, as I have requested, before those hard-working trained professionals are lost, and can he assure me—and my constituents—that those cuts, and the pressures on nearby hospitals, will not jeopardise the safety of patients?

[Mr Speaker]

Order. There is a growing tendency for colleagues to ask two questions rather than one, which is not fair on other colleagues who are trying to get in. Forgive me, but the questions are too long, and frequently the answers are as well.

[Mr Dunne]

I will try to keep this answer short, Mr Speaker.

As the hon. Lady will know, the local joint health overview and scrutiny committee has referred those proposals to the Secretary of State, and it would not be appropriate for me to visit the hospital while the referral is in progress.

[Julie Cooper (Burnley) (Lab)]

On the subject of vital NHS staff, will the Minister join me in congratulating the thousands of community pharmacists on their daily commitment and professionalism? Will he confirm, once and for all, that he has no intention of downgrading their role and putting patients at risk? Surely he agrees that the Prime Minister would have been well advised to seek a cough remedy from a qualified community pharmacist rather than relying on an unqualified Chancellor of the Exchequer.

[Mr Dunne]

As the hon. Lady will know, we have inserted payment for extra activity into the contract for community pharmacists because we want more activities to take place in community pharmacies. For example, many flu vaccinations throughout the country are now being carried out by pharmacists.

[Martin Vickers (Cleethorpes) (Con)]

I thank the Minister for the recent meeting that he had with me and other colleagues about Grimsby Hospital, which is in special measures. It was clear from a recent meeting I had with the chief executive that staff vacancies are one of the biggest problems preventing the hospital from getting out of special measures. What additional support can the Department offer in order to get the hospital back on track?

[Mr Dunne]

I was pleased to welcome my hon. Friend to a meeting a few days ago to discuss the situation, together with his Opposition constituency neighbours. One of the things that we will be looking at in the coming weeks is the allocation of the new doctor training places. As part of the criteria, we will be looking to ensure that some of those places are allocated to areas where it is difficult to recruit, such as rural and coastal areas.

[Mr Philip Hollobone (Kettering) (Con)]

The Minister has visited Kettering General Hospital and knows the wonderful work that the doctors and nurses there do. The problem that the hospital faces, however, is that too few of the doctors and nurses are full-time permanent members of staff, and too many locums are being hired, at great expense to the hospital budget. What is my hon. Friend’s advice for Kettering hospital on tackling the issue?

[Mr Dunne]

When I visited Kettering General Hospital we discussed excessive agency staff costs. One of the measures announced last week by my right hon. Friend the Secretary of State was a drive to invest more in both regional and local bank agencies within the NHS so that we can reduce the reliance on more expensive agency staff.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

7. What steps his Department is taking to improve end-of-life care.

--- Later in debate ---

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

As the hon. Lady knows, the adult congenital heart disease service provided in Manchester has been included in the long-standing clinical assessment of CHD services undertaken by NHS England, which is now reviewing the more than 7,500 responses to the public consultation, which ended in July. The adult CHD service in Manchester was suspended by the trust in June, when the only CHD surgeon left. Hospitals in Leeds and Newcastle continue to deliver level 1 care and paediatric CHD services continue to be provided by Alder Hey Children’s Hospital in Liverpool.

[Lucy Powell]

Is not the truth behind what happened that Ministers and NHS England prejudged the review and therefore left services untenable and unviable in Manchester? There are no level 1 adult congenital heart services anywhere in the north-west and patients are having to travel to Leeds and Newcastle for the treatment. Will the Minister apologise today to those patients for this botched review, which has left patients with a great deal of uncertainty and has meant that they have had to travel huge distances?

[Mr Dunne]

I am sure that the hon. Lady will not want to confuse her patients by suggesting that relying on a single surgeon for prolonged periods is necessarily in their best interests. The facilities that remain in Central Manchester University Hospitals NHS Foundation Trust are intended to remain and include CHD outpatient services for adults and children. Level 2 services also continue to be provided in Manchester.

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

15. What estimate he has made of the number of people living with unmet social care needs.

--- Later in debate ---

[Jack Lopresti (Filton and Bradley Stoke) (Con)]

T9. The last Labour Government downgraded Frenchay hospital in my constituency. My constituents and I have been waiting for several years for the much-needed and much-promised community hospital. What action are the Government taking to ensure that that finally happens?

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

My hon. Friend is a doughty campaigner for Frenchay hospital and keeps it uppermost in our minds. The way in which we are looking at the pattern of health provision for the next period is through the STP process, and I encourage him to engage with the STP leadership in his area and make the case for Frenchay hospital.

[David Linden (Glasgow East) (SNP)]

T3. The palliative care we provide to terminally ill children is an incredibly serious topic. I want to refer to the point made by the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) and to press the Minister on giving children’s care parity of funding with adult care. Will she follow the example of the Scottish Government and provide parity of funding?

--- Later in debate ---

[Richard Graham (Gloucester) (Con)]

The Gloucestershire Hospitals NHS Foundation Trust capital expenditure bid would fund a 24-hour urgent care service, and it would also increase bed capacity and improve hospital performance in Gloucester and Cheltenham, to the benefit of patients throughout the county. When do Ministers expect to announce the results of the bid? Will they take this particular bid into careful consideration?

[Mr Dunne]

I am aware that, under the Gloucestershire STP, a proposal has been submitted for capital funding to support plans to improve the clinical environment for patients and staff at the Gloucestershire Royal Hospital. I am afraid that my hon. Friend will have to join me in awaiting the Chancellor’s announcement in the Budget as to whether there will be a second phase of capital funding for STPs. If there is any funding, it will be allocated thereafter.

[Kate Green (Stretford and Urmston) (Lab)]

GPs in my constituency tell me that because of changes to personal data rules they will no longer be able to charge for providing reports for private insurance and legal claims. Will Ministers update the House on the situation? What assessment has been made of how GPs will cope with the additional costs they will face?

--- Later in debate ---

[James Frith (Bury North) (Lab)]

Newly released NHS guidance makes it clear that walk-in services can have a future as part of urgent treatment centres. Does the Secretary of State agree with me and thousands of patients in Bury North that Bury walk-in centre can, should and must stay open and that Bury CCG should ensure this when it concludes its review?

[Mr Dunne]

Current plans by NHS England to look at the urgent and emergency care pathways include creating 150 urgent treatment centres by the end of this year. I am happy for the hon. Gentleman to write to me about Bury and will respond in due course.

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

Is the Secretary of State aware that there is widespread support in the House for his Government’s commitment to enact the principle of deemed consent for organ donation? He knows from a previous meeting that my private Member’s Bill is due for its Second Reading early in the new year. Will he therefore agree to an early meeting now, so that we can co-ordinate the two and see how to advance his intentions? I know that my hon. Friend the Member for Barnsley Central (Dan Jarvis) will be with me again and, with the Secretary of State’s commitment to this, we look forward to an early meeting.

--- Later in debate ---

[Mohammad Yasin (Bedford) (Lab)]

Yesterday the private ambulance service that provided non-urgent patient transport at Bedford hospital ceased trading, leaving the East of England Ambulance Service NHS Trust to pick up the pieces. Will the Minister order an inquiry to establish what went wrong, and does he agree that using private companies to run key services for our NHS is simply not working?

[Mr Dunne]

The hon. Gentleman will be aware that private and independent providers of patient transport services provide services all across the country and support the ambulance services in that work. I will look into the case that he raises in relation to Bedford and write to him.

[Ruth George (High Peak) (Lab)]

All of the local dementia and rehabilitation beds in my rural constituency of High Peak are earmarked for closure. In some cases, patients and their families will have to travel 25 miles across the moors to Chesterfield. Given the importance of staff being able to work with families to support patients to return home, will the Minister agree to look again at such decisions, which make this work practically impossible?

[Mr Dunne]

The hon. Lady will be aware that the STP plans being considered for her area include providing more services in the community by community nurses and other nurses in our community hospitals being reassigned, which will allow them to undertake care for more patients than they can at present within community hospitals.

[Several hon. Members rose—]

Baby Loss Awareness Week

Philip Dunne Excerpts

Tuesday 10th October 2017 Commons Chamber

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

Before I start the debate, Madam Deputy Speaker, let me say that I am delighted that you were able to pay tribute to all of our Doorkeepers and, in particular, to Trevor, on his last day here.

I beg to move,

That this House has considered Baby Loss Awareness Week.

I am personally very pleased that this debate is being held in Government time, having participated in last year’s debate on baby loss. It was one of the most moving experiences I have had in this Chamber, as Members from both sides of the House gave expression to their own experiences. That helps to send a signal outside this place of the significance that we accord this, not just within the Department of Health and the NHS; Members of this House sympathise with the many members of the public who go through such experiences. It does this House a good service when Members who feel able to do so place on the record their own experiences. It is right and important that we continue to raise awareness of the devastating impact of baby loss.

I wish to restate at the outset this Government’s commitment to providing high-quality bereavement care and to reduce the numbers of babies who are lost too soon through miscarriage, stillbirth or other causes such as sudden infant death syndrome. I pay tribute to all those who are sharing their personal experiences this week. In particular, I thank my hon. Friends the Members for Eddisbury (Antoinette Sandbach) and for Colchester (Will Quince), who are in the Chamber today, and all members of the all-party parliamentary group on baby loss, which they co-chair, for achieving so much in raising awareness during this past year.

I wish to update the House on some of the initiatives that the Government and the NHS have put in place since last year’s debate to improve safety, reduce stillbirths and other adverse maternity outcomes and improve bereavement care. I believe that all hon. Members support the ambition of the Secretary of State to halve the rates of stillbirth, neonatal and maternal deaths and brain injuries that occur during or soon after birth by 2030, and to achieve a 20% reduction in rates by 2020.

Shortly after the debate last October, the Secretary of State launched the safer maternity care action plan, which set out additional support for the maternity and neonatal services working to achieve that ambition. The plan set out a range of initiatives on five themes. First, there is a focus on leadership, with the establishment of local, regional and national maternity safety champions to promote professional cultures, teamwork and continuous improvement. Every trust with maternity services has pledged to appoint a maternity safety champion, and 88 out of the 134 trusts that provide maternity services now have named leads.

Secondly, there is a focus on learning and best practice. This includes the Saving Babies’ Lives care bundle to reduce stillbirths, which was launched by NHS England in March 2016. Saving Babies’ Lives brings together four elements of care that are recognised as evidence-based and/or best practice: reducing smoking in pregnancy; risk assessment and surveillance for foetal growth restriction; raising awareness of reduced foetal movement; and effective foetal monitoring during labour. The Department has also funded Sands and Best Beginnings to develop and promote the “Our Chance” campaign to give parents knowledge and confidence to maximise their chances of healthy outcomes.

Thirdly, there has been a focus on multi-disciplinary teams with an £8.1 million maternity safety training fund, which is designed to ensure that staff have the skills and confidence they need to deliver world-leading safe care. All 134 trusts with maternity units have now received funding and are implementing training packages. Many of those are being delivered by the charity Baby Lifeline, which I met this morning to learn some of the benefits that this training is bringing to improving safety, reducing error, and helping patient outcomes.

I visited Leeds teaching hospital a couple of weeks ago and heard from midwives about their multi-disciplinary training programme “Deliver me safely” in which they and doctors undergo training together in the recognition that human factors can contribute to harm in maternity systems. These simulations focus on situational awareness and team interactions, challenging some cultural hierarchical attitudes, which I am afraid can be prevalent in parts of the NHS, and encouraging everybody to speak up if they have safety concerns.

Lastly, there has been a focus on innovation, with the launch of a maternity safety innovation fund of £250,000, which has supported 25 local maternity services to create and pilot new ideas, and of the national maternal and neonatal health safety collaborative to build local capability in quality improvement and to provide structured support for local teams. One example of this is the safer films project at the University Hospitals Coventry and Warwickshire NHS Trust, which is developing staff training films, using headcam devices to show interactions with clinicians from the mother’s perspective. The patient’s view of the drills undertaken around her allows clinicians to look back at the impact that their activity, including how they communicate with women and their partners, has on the patient.

Just last month, the Secretary of State hosted a roundtable with 25 key partners across the health system to discuss evidence and current NHS clinical practice on supporting women to have safe births. There has been an enthusiastic response to the Secretary of State’s ambition, with a range of initiatives developed by national and local NHS organisations, royal colleges and charities. We will continue to work with our partners to align these initiatives with the work of the maternity safety action plan. I am happy to report that we are on track to achieve our 2020 ambition. The stillbirth rate in England has fallen from 5.1 per 1,000 births in 2010 to 4.4 in 2015. The neonatal mortality rate was 2.6 deaths per 1,000 births in 2015, down 10% from 2.9 in 2010.

I would like to touch briefly on the importance of learning from when things go wrong in clinical care. Many parents I have spoken to have made it clear they want maternity and neonatal services to learn from the deaths of their babies so that other families do not have to go through the experience of losing a much-loved and wanted child if that can be prevented. Recent publications from the Royal College of Obstetricians and Gynaecologists and MBRRACE-UK—Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK—found that some local reviews of stillbirths and neonatal deaths were of poor quality. Input from parents or independent experts is not routinely sought, and there is insufficient information to understand the quality of care provided.

To improve the quality of those reviews and to learn from them, the Department of Health, together with the Health Departments in Scotland and Wales, has funded the development of a national standardised perinatal mortality review tool to support systematic, multidisciplinary reviews of the circumstances and care leading up to every stillbirth and neonatal death. The tool, which will be available at the end of this year, will also support clinicians to talk with parents about the care review and how they can contribute to the process.

Last month, I laid the draft health service safety investigations Bill in Parliament. This Bill will take forward the work of the current independent healthcare safety investigation branch, which came into operation last April. Under the proposals, HSIB will have far-reaching access so that it can investigate serious safety incidents or risks to patient safety; help to develop national standards on investigations; and provide guidance and training to improve investigative practice across the health service.

Earlier this year, we also consulted on proposals to introduce a system of consistent and independent investigations for all instances of severe avoidable birth injury, along with access to ongoing support and compensation for eligible babies through an administrative scheme. The public consultation into a rapid resolution and redress scheme for severe avoidable birth injury concluded at the end of May, receiving more than 200 responses. We are currently in the process of listening to people’s views, and we aim to publish a formal response soon.

Turning to bereavement care, a clear message that we heard last year, particularly from my hon. Friends the Members for Eddisbury and for Colchester and the hon. Member for Kingston upon Hull North (Diana Johnson), who I am pleased to see with us this evening, was about the need for a bereavement care pathway to ensure that all families experiencing baby loss receive the highest quality of care, no matter where they live.

Since last year’s debate, the Department has funded Sands to deliver a national bereavement care pathway. I am delighted that 11 wave 1 pilot sites were announced yesterday. I know from the experience of my friends and colleagues that care in bereavement is best described as patchy. In some cases, I could use a less flattering adjective. There is no doubt that we need to do more to raise the training of staff and the facilities available to look after families who go through a bereavement in a hospital setting, and indeed to provide care and support to those who suffer loss outside a hospital setting. That is an important initiative.

Earlier this year, Sands, NHS England and the London maternity clinical network published a new maternity bereavement experience measure. That tool aims sensitively to enable parents whose baby has died to feed back about the care they received. It also aims to support services to learn from the experiences of bereaved parents and identify where local improvements may be needed.

Sands is also working on a project for NHS England on the role of the bereavement midwife. The project will make recommendations for the remit of the role of the bereavement midwife and give guidance on the support structures required around the role.

Since 2010, the Government have invested £35 million in the NHS to improve birthing environments, including better bereavement rooms and quiet spaces at nearly 40 hospitals to support bereaved families. Whenever I visit maternity units, I ask to see the bereavement suite. I am always impressed by the quality of the suites, by the feedback from families and staff alike and by how the commitment of many families who have gone through such terrible loss has often led to them raising funds to help to create better bereavement facilities in hospitals.

[Anna Soubry (Broxtowe) (Con)]

I commend the Minister for his excellent speech. I am sure that he will join me in congratulating Forever Stars, which is exactly the sort of charity that he has described. It was started by two of my constituents, who sadly lost their baby, Emily, who was stillborn. They have raised about £200,000 for two suites. A third is on the way, and they are now fundraising for counselling services for the siblings of babies who have not survived.

[Mr Dunne]

I congratulate my right hon. Friend and thank her for drawing that to the House’s attention. That is one of the most significant examples of fundraising for such suites that I have come across. I pay tribute to the family involved and to the efforts to raise funds for the counselling of siblings, who go through a traumatic experience as well.

I conclude by reiterating that the Government are fully committed to reducing the number of babies who die during pregnancy or in the neonatal period, and to providing support for bereaved families.

--- Later in debate ---

[Mr Dunne]

I am grateful for the opportunity to respond to some of the points that have been raised during this excellent debate. It is important to recognise and welcome the cross-party support from Members, including the hon. Member for Ellesmere Port and Neston (Justin Madders). We heard 14 contributions from other Members, including five, by my count, who have personally suffered—or their families have suffered—the loss or miscarriage of a baby, as well as two from experienced doctors: my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) and the hon. Member for Central Ayrshire (Dr Whitford), who brought their particular expertise to the debate. I am grateful for the support from Members on both sides of the House for the Government’s action plan—for what we have done in the 12 months since our last debate on this subject, and for what we are planning to do.

A number of issues have been raised today. I will not go into detail about Members’ constituency concerns, although I will say to the hon. Member for Kingston upon Hull North (Diana Johnson) that when, as a Shropshire Member, I was dealing with one of my constituents who suffered an inability to find out what had happened to the ashes of the baby they had lost, which was similar to what occurred in Hull, my experience was of talking to the local authority and persuading it that this was the right thing to do. I should be happy to help the hon. Lady, if she needs help from the Department, to emphasise again to her local authority that it is indeed the right thing to do.

Members have challenged me on a couple of issues, particularly that of coroners’ reports. We are introducing a perinatal mortality review tool to allow investigations to be undertaken, with information collated in a manner that can then inform and be learned from. We will watch with interest what happens in Scotland, but at this point I think we need to get the tool working and see how it goes. In my opening speech, I mentioned the health service safety investigations branch on which we are consulting. We envisage it as having a role in looking at some of the more extreme cases, but only if it decides to do so.

A number of colleagues talked about the use of private Members’ Bills to try to drive this agenda forward. I can confirm to my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) that the Government will support his Bill on bereavement leave, which was also mentioned in the excellent speech of my hon. Friend the Member for East Renfrewshire (Paul Masterton). I cannot promise that we will support all the other measures that the all-party parliamentary group comes up with, but we will certainly look at them with interest.

Following last night’s launch of the national bereavement care pathway, I am particularly pleased, in Baby Loss Awareness Week, that that has received so much support from the APPG, the charities and the healthcare professionals who work in this field. Finally, let me say a big thank you to all the midwives, doctors and healthcare support workers who do such a fantastic job, delivering more than 700,000 babies successfully and also helping parents who, sadly, do not experience the happiness of a healthy baby.

Question put and agreed to.

Resolved,

That this House has considered Baby Loss Awareness week.

Corby Urgent Care Centre

Philip Dunne Excerpts

Wednesday 13th September 2017 Westminster Hall

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

Thank you, Mr Chope, for chairing the debate in your inimitable style. I was intrigued to learn that my hon. Friend the Member for Corby (Tom Pursglove) had not used the precincts of Westminster Hall to raise an issue before; I was somewhat surprised, because he is such an assiduous campaigner for his constituency and such a frequent contributor in the main Chamber. The reason may simply be that he does not manage to find time to get into Westminster Hall, so often does he raise his constituents’ interests on the Floor of the House. It is good to see him so well supported again today by his constituency neighbours from Wellingborough and Kettering.

We have discussed this matter privately and, to a limited degree, on the Floor of the House. My hon. Friend the Member for Corby referred to the Adjournment debate to which he contributed before Parliament rose for the summer recess. We have also discussed during the summer, as events unfolded in a more unpredictable way, what could be done to secure the future of the facility for which he has advocated so well today.

I feel reasonably up to speed with events in Corby; for the benefit of other Members present, I will rehearse a small number of them. I will not go into too much detail, not least because at the heart of the issue has been a contractual dispute, which has limited the ability of participants to describe the nature of it. That has, in itself, given rise to some problems in communicating to the local population what the problem has been. We remain bound by the confidentiality arrangements around the legal procedure, but suffice it to say that, as my hon. Friend correctly observes, we are close to a point where action has to be taken to maintain the facility from the end of this month.

From my conversations with the CCG leadership in preparation for this debate, I can assure my hon. Friend that on that side of the negotiating table they are determined to ensure that continuity of service is provided through the rolling four-month contract. They alerted him to that contract at the end of last month and are engaging with the provider, Lakeside Plus, to try to reach agreement. There is no doubt that without an agreement, some of the services would have to be provided in an alternative and less satisfactory way for the local population. That is inevitable, if it is put together in a short timeframe.

It is in everybody’s interest to make this work, but it will be a precursor to a longer-term solution, which is clearly required for the local population. I am pleased that my hon. Friend recognises that such a solution needs to be widely consulted on. Indeed, he is pressing for a more fulsome consultation than is perhaps typical. Given the circumstances surrounding this case, I will be urging the CCG regarding that full consultation. I have been alerted that it is due to start in November, and think that he has been given the same information.

I was not aware of a pre-consultation, and am not quite sure what it means. Hopefully, it means providing an opportunity to ensure that the full consultation is as detailed as necessary. I am quite sure that my hon. Friend will encourage all those who have been in touch with him to participate in that consultation when it gets under way. I was pleased to learn from him about the cross-party nature of the support and full engagement that he has been working, alongside the action group, to generate. I am sure that all those taking an interest will participate in the consultation.

To touch on the substance of the issue, I should say that the GP practice co-located with the urgent care centre has the largest patient list of any GP practice in the midlands, certainly, and possibly across NHS England’s footprint, so it has some unusual characteristics. One of the pressures on that practice, which my hon. Friend alluded to, is access to that GP surgery. Pressure is put on the urgent care centre by the difficulty in securing access to that part of the GP provision in the area. My understanding is that there is a federation of GPs, beyond the immediate catchment of the UCC but within the CCG area, that has much better access. Work should be done as part of the consultation to see how the performance across the entire CCG area can be improved to relieve some of the pressure on the urgent care centre.

A consequence of that pressure is that the original contract, designed to undertake 120 patient episodes a day, has been dealing with more like 170 patients a day attending the urgent care centre. Of those patients, the vast majority—88%—could be dealt with either in that facility or in the GP practice itself. As I understand it, 12% definitely require treatment at the urgent care centre, and some of those are then referred to either Kettering General Hospital or, in a small number of cases, to Northampton’s A&E facility.

There is a need for an urgent care setting, but there is as much of a need to ensure that those who could be treated in the primary care environment can be. Part of the consultation will look at the appropriateness of a primary care home arrangement. That is an establishment that brings together primary care providers, social care providers and other providers, such as pharmacies, within an area, to provide a more integrated primary care service. That in itself might have benefits for improving access to treatment for the population served by the UCC at present.

My hon. Friend will be well aware of the history of the contracting challenge between the CCG and Lakeside Plus. I will not exhaust his patience by going into that in any detail, but will simply say that it is the intent of the CCG to re-establish a contractual relationship. The CCG wishes to have this moving forward on a four-month rolling basis while the consultation takes place, and then any subsequent arrangements will need to go out to tender. The intent is that this contract will continue until the successor arrangements are in place, so that there is continuity of care for his constituents—something that the Department absolutely supports.

I conclude by saying that it is really important that we use this public consultation to get the model of care right for the people in the area served by the UCC. That needs to take into account the evidence base for the clinical model, the right to patient choice for the people who will be using it, to meet the local need—my hon. Friend spoke eloquently about the particular local needs in the Corby area, and those are recognised—and also value for money. The approach has to be coherent and comprehensive, to come up with the right solution for the future.

I heard what my hon. Friend’s neighbour, my hon. Friend the Member for Wellingborough (Mr Bone), said about looking for a similar hub in Wellingborough. I will look with interest to see how his private Member’s Bill progresses, to endeavour to bring that about. I also note his comments regarding the structure of the CCGs in the area. That is really a matter for the STP—the sustainability and transformation partnership—to make progress on and decide the structure of both commissioning and provision of service in the area. It is not really for me to comment on that off the cuff here today, but I note what he says and am aware that this is one of the smallest CCGs in the country. I am also aware that there is a very substantial programme of collaboration already underway with the neighbouring CCG at Nene, so I think that the CCGs themselves see the benefits of closer integration of their working.

On that basis, I say to my hon. Friend the Member for Corby that I will endeavour to keep him informed as matters come to my attention, and I am quite sure he will continue to keep me and the Department informed as well.

Question put and agreed to.

[Mr Christopher Chope (in the Chair)]

Order. As we have got a minute and a half spare, we can go straight on to the next debate because the Minister is here. I now call the next speaker, Mr Linden.

NHS Recruitment

Philip Dunne Excerpts

Thursday 7th September 2017 Written Statements

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

I am today updating the House on the future of NHS Professionals Ltd (the company).

The Department of Health has today announced that NHS Professionals Ltd—a company which supplies flexible staffing to the NHS—will remain in wholly public ownership, after offers to buy a majority stake in the company undervalued its growing potential.

In November 2016, the Government decided to instigate a sale of a majority share in NHS Professionals Ltd as a potential path to providing it with the extra expertise, technology and investment it needed to work with more hospitals and drive greater savings for the NHS. However, after careful consideration, the Government have concluded that none of the offers received for the company through the open, rigorous bidding process reflected the company’s growing potential and improved performance.

NHS Professionals was established as a limited liability company by the last Labour Government in 2010, with a specific intention to give it greater commercial freedoms and “prepare it for sale” (Department of Health, “Explanatory Memorandum to The NHS Professionals Special Health Authority (Abolition) Order 2010”, February 2010). It currently holds a bank of over 90,000 workers filling more than 2 million shifts, saving the NHS £70 million every year. However, it only works with around a quarter of trusts, meaning that many others rely heavily on more expensive agencies to supply additional staff. We would like more trusts to work together to fill shifts via collaborative banks, and there will be opportunities for NHS Professionals Ltd and others to support this work.

Since the decision was taken to seek offers for the company, NHSP has significantly increased its performance such that audited profit before tax for the year ended 31 March 2017 was 44% higher than in the previous year. This improvement in financial performance continues to be built upon in the first quarter of the current year. The company’s improved financial and operational performance means it can now invest in improved IT infrastructure, expand its services to the NHS and transform into a world-class provider of flexible staff while remaining under public ownership—generating further savings for the NHS, all of which will continue to be reinvested in frontline services.

The Government are fully committed to providing world-class NHS services that are free at the point of the use, now and in the future.

[HCWS116]

Contaminated Blood

Philip Dunne Excerpts

Thursday 20th July 2017 Commons Chamber

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is disappointing that we are here again today, so soon after last week’s announcement. A week ago, this House united in agreement to finally facilitate justice for those tragically affected by this scandal. Yet, as we have heard, in recent days Ministers have reneged on last week’s promises and run roughshod over the affected community.

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

indicated dissent.

[Mrs Hodgson]

The Minister of State may shake his head, but that is how the community feel; we have spoken to them. There are three key questions that the Under-Secretary before us this morning must answer, and I hope she will be more forthcoming with much-needed answers than she was to my hon. Friend the Member for Kingston upon Hull North (Diana Johnson).

Understandably, the community have deeply held suspicions when it comes to the Department of Health, so why are Ministers ignoring these concerns and the demands to facilitate an inquiry through another Department, such as the Ministry of Justice? This concern has been well documented in the letter to the Prime Minister by my hon. Friend, the Haemophilia Society, the 10 campaign groups and the law firms Collins Law and Leigh Day. Why does the Minister think the Government can so easily disregard all these people?

Events over the past few days have shown that last week’s promise to consult, engage and listen to the community was simply warm words. The audacious move to hold a roundtable meeting this morning with so little notice to potential attendees from throughout the UK has hindered many from being involved in the process of setting up the inquiry. Will Ministers explain why the meeting was held at such short notice? Who did they plan to invite so that the meeting was properly consultative? In the end, who was scheduled to attend following the mass boycott by many of those invited, who felt that the offer of a meeting was a slap in the face?

It is important that the inquiry is held sooner rather than later, but not at the risk of jeopardising justice. Will the Minister publicly outline, now, the timetable for the inquiry? Do the Government intend to initiate the inquiry in September? If so, why has that not been made public? Why is it that we must bring Ministers to the House again to make this clear? Does that not go against everything we were promised last week? The Minister must remember the promises made just last week and ensure that consultation is central to the whole process; otherwise, the Government will fail this community, who must have the justice they so rightly deserve.

Future of the NHS

Philip Dunne Excerpts

Thursday 20th July 2017 Commons Chamber

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

It is a great pleasure to join you in the House for the last debate before the summer break, Mr Deputy Speaker.

I congratulate my hon. Friend the Member for South Dorset (Richard Drax) on securing this debate and commend his timing, as it is two days after we laid the Department of Health and NHS entities’ 2017 accounts before Parliament. He will note from what I am sure will be his diligent scrutiny of those accounts that provider deficits have been much reduced in the year that has just ended compared with the figure he cited for the previous year. That is a tribute to the focus of managers and trust leaders on securing the financial balance that the NHS as a whole has delivered over the past year.

To put all that in context, this is a time when more people than ever are using the health service. In 2016-17, some 23.4 million people attended A&E departments in England—2.9 million more than in 2010. The overwhelming majority of patients continue to be seen within four hours, and the NHS overall sees more than 1,800 more patients within the four-hour standard every day compared with 2010. In the previous year, the NHS carried out 11.6 million operations—some 1.9 million more than in 2010. That provides the context of the achievement and the treatments that have been given to patients throughout the land.

I am pleased that my hon. Friend recognised the excellent care that the NHS provides, which has been demonstrated for the second year running by the Commonwealth Fund report: in its international study published last week, the UK was ranked as the No. 1 health system in a comparison of 11 countries. That is a testament to NHS staff. The patients who benefit from those treatments rate their experience of care highly. The adult in-patient survey, which was released in May, shows that the majority of patients report that their overall experience was good, with 85% rating it as at least seven out of 10—a slight improvement on the previous year.

Looking to the future, which is the subject of the debate, the Government are committed to increasing the NHS budget to ensure that patients get the high-quality care they need. By 2020-21, NHS spending will increase by £8 billion in real terms from the 2015-16 baseline. That will deliver an increase in real funding per head of the population for every year of this Parliament. Nevertheless, my hon. Friend is right to point out that whatever funding we provide, it is important that we spend it to achieve the best possible outcomes for patients.

It is essential that we ensure that the NHS continues to make the most effective use of its resources to deliver high-quality patient care, so I recognise what I think was my hon. Friend’s motivation in securing this debate and raising this subject before the House rises for the summer recess. We all agree that it is important to target NHS funding to frontline services, which is why we are investing in the workforce and there are already more than 33,800 extra clinical staff, including almost 11,700 more doctors and almost 13,000 more nurses on our wards since May 2010.

NHS management is an important element of ensuring an efficient NHS, but of course we are keen to ensure that an increasing proportion of NHS funding goes to patient-facing services. Between 2010-11 and 2016-17, the proportion of the NHS pay bill spent on managers declined from 6.5% to 5.8%, which I am sure my hon. Friend will welcome. We are also reducing the number of people involved in management, which he called for. Between May 2010 and March 2017, the number of managers and senior managers in NHS providers and support organisations reduced from some 37,000 to around 31,000—I think that is similar to the effective percentage to which my hon. Friend referred. We are also looking to manage the rate of pay of senior managers, again to ensure that as much as possible is focused on the frontline.

It is important that we recognise that leadership is as important in the NHS as it is in any organisation—we must ensure that we have high-quality leadership across organisations. I for one am keen not to bash the managers in a somewhat traditional manner, but to recognise that high-quality leadership in our NHS organisations is important in driving high-quality performance for patients. That is why I have been working with the leadership academy in Health Education England to ensure that we have two things: a pipeline of talent so that we can identify quality individuals at the beginning of their careers in the NHS and track them as they pursue their careers, identifying the leaders of tomorrow, in a similar system to that with which my hon. Friend will be familiar from his service in the military; and some consideration of how we can get more clinicians involved in leadership roles in their organisations. Clearly, we have directors of nursing and medical directors in all provider trusts, but too few go on to take up the most senior leadership positions as chief executives.

[Richard Drax]

I am listening carefully to the Minister. Would it be naive to say that what we want to see is matron, in the form of Hattie Jacques, back on the wards and to hand far more administrative work, if that is the right phrase, back to clinicians, with whom it originally lay?

[Mr Dunne]

I am not keen to hand administrative work to clinicians, but I recognise that there is a role for ensuring that senior clinicians are present and in charge of activity in wards. That is the experience I am seeing as I visit acute hospitals around the country: senior members of staff, normally coming out of nursing staff —so they are a matron or other senior nursing officer—are responsible for what happens on their ward.

My hon. Friend says that an independent review might be appropriate, and I say gently to him that we think that the right way to drive improvement across the NHS and help position it for the challenges of the future is to back the plans prepared by the leadership of NHS England with colleagues from across the system through the five year forward view. This is the NHS’s own plan for change and it lays out how the NHS can transform services and improve standards of care while building a more responsive modern health service. We are backing this plan, enabling the NHS to deliver Government objectives including seven-day services and improved access to cancer treatments and mental health services. We agree that the answer to the challenges faced by the NHS lies in modernising services and keeping people well and independent for longer.

The NHS is using the sustainability and transformation partnerships mentioned by my hon. Friend to deliver that vision through transformation across local areas. These are clinically led, locally driven and can deliver real improvements for patients. The five year forward view also announced the development of new care models and we are already seeing the results.

My hon. Friend referred to the announcement yesterday about the first allocation of capital funding for the most advanced STP areas, including Dorset, which covers his constituency. It is fortuitous that the largest single beneficiary of capital through the STP allocation was Dorset, and what a great day for him to secure this debate and give an albeit somewhat guarded welcome to that significant capital injection. I am aware that he has a number of issues with how that money will be spent.

[Richard Drax]

It was totally unguarded. I am extremely grateful, as I am sure all clinicians and all those who work in the NHS in Dorset will be.

[Mr Dunne]

That applause is on the record, and I am delighted that my hon. Friend takes that view.

We see this investment as backing the exemplar STP plans that have been published thus far, and we hope that other areas, whose plans are in less good shape, will be encouraged to look at those that have succeeded to see what they can do to follow their example for the next phase of the roll out in the coming years.

I will conclude with a couple of comments about how we drive efficiency through the NHS and make best use of resources. My hon. Friend referred to the Carter and the Naylor reviews. Carter is driving heavily towards using best practice and removing variability across the NHS, whether in clinical practice or in financial performance, in areas such as procurement. Alongside that, Naylor is looking at how we drive out inefficiency from back-office functions, from estates and from the facilities management element of running such a substantial network of hospitals and facilities across the country. There is scope to do more. That will appeal to my hon. Friend’s desire to put more resources on the frontline. We are looking at encouraging organisations to share back-office facilities—as he called for—to bring down cost and drive up efficiency and operational productivity, which is the right way to go.

I conclude by confirming that we are making good progress in small steps. We need to continue to make progress to try to raise the depth of the tread of the steps that we are taking to ensure that the NHS is fit to serve the health needs of this population for the future.

Question put and agreed to.

Ambulance Services (Devon)

Philip Dunne Excerpts

Wednesday 12th July 2017 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Davies. I wish you every success in your endeavours elsewhere today. On that note, I congratulate my hon. Friend the Member for Totnes (Dr Wollaston) on securing not only this debate but unopposed re-election to the Chair of the Select Committee on Health, which role I am delighted to see her continue in.

By happy coincidence, I had the pleasure of visiting the South Western Ambulance Service NHS Foundation Trust only last week. Having visited the chief executive in his office, and seen for myself some of the challenges presented by the rurality and the distances—as mentioned by hon. Members in this debate—I feel slightly better briefed than I would otherwise have been. I drove from Exeter to Barnstaple to Plymouth on the same day, in the height of summer, on a Friday, when the roads were, it is fair to say, not at their least busy. I do absolutely appreciate some of the challenges reflected in this debate that are imposed on the ambulance service’s ability to deliver the service to residents in this large, very rural and very beautiful county. It is particularly appropriate therefore that we have the chance to discuss this briefly this afternoon.

I thank my hon. Friend for the characteristically considerate and appropriate way she posed challenges to me and thanked people employed in the ambulance service, and those who support it as volunteers, for the magnificent work that they do. She began her speech by recognising that the ambulance service in the south-west, like all other ambulance services in the country, is busier than ever. Demand has been rising significantly. Across the country, there were some 7 million face-to-face responses from the ambulance service in the year ending 31 March—a 14% increase over the last five years. In the south-west of England, demand has increased even more sharply, with a 29% increase over five years; I think she mentioned a 19% increase in her area of south Devon.

The trust is challenged by the geography of the area it serves, with its greater distances and slower transport routes. Nevertheless, it is doing well, not just in meeting national targets but in comparison with other trusts. We should congratulate all those involved, but that does not mean that there are not a number of challenges. My hon. Friend the Member for Totnes mentioned a particularly difficult case in which an elderly lady was left waiting for some time, and my hon. Friend the Member for Torbay (Kevin Foster) raised a case from his constituency in which a child had to wait some time for an ambulance.

This is clearly an operational issue. I strongly encourage hon. Members who are concerned about individual cases to bring them to the attention of the chief executive of the relevant trust, and to continue to represent to their constituents that even if the overall number of such incidents is not great, the ambulance service is required to provide an appropriate response through the disposition of its resources. From experience in my own area, I know that MPs are listened to by chief executives of ambulance trusts and can make a difference in securing deployment of resource to meet the particular demands and concerns of their constituents. It is well worth pursuing that approach.

Let me touch on some of the initiatives under way to meet the challenges that we all recognise and that have been referred to in the debate. Sir Bruce Keogh undertook a review of the NHS urgent and emergency care system, which is trying to cope with the root causes of demand. Following the review’s recommendations, ambulance services will increasingly be transformed into mobile treatment centres, with greater use of “hear and treat”, in which telephone calls are closed with advice, and “see and treat”, in which paramedics are equipped to treat patients on the scene without a conveyance. There will also be greater integration with the rest of the health system. Some 2,600 more paramedics are now operating within our ambulance services across the country than in 2010, and in the past year 1,400 trainees have started on paramedic courses. There has been a big shift towards training more ambulance staff to undertake treatment on the ground.

The Care Quality Commission has recognised that SWASFT is one of the highest-performing trusts in England, particularly in its “hear and treat” service, which enables clinicians to assess and triage patients over the phone and close the call without the need to send an ambulance. In April, 49.1% of calls to SWASFT were resolved without transportation to A&E—the highest percentage of any trust in England. That allows more patients to be treated in their own home or in the community without needing to be taken to hospital, helping not only the patient, but the system.

Another way in which SWASFT is addressing the growing demand for services and the need to better manage peaks of activity is through reviewing how emergency vehicles and staff are rostered. Its review has moved ambulance resources closer to areas of high public demand. Instead of a paramedic crew logging on for a shift at a rural station and then getting pulled into an urban area—an issue highlighted by my hon. Friend the Member for Totnes as a particular challenge in her constituency—resources should now be positioned in the right places and should stay more local, more of the time. She expressed a degree of scepticism about whether that is actually happening. I can confirm that in my area in the west midlands, we have worked with the ambulance service to ensure that ambulance stations are not necessarily kept in the same physical location, but are placed in parts of the country where demand is highest. This can now be well mapped by ambulance systems to ensure that service is provided as close to areas of demand as possible.

Evidence from the trust’s rota review shows that the patients with the most serious, time-critical and life-threatening injuries have experienced improvements in response times, and that ambulance resources stay local more of the time. My hon. Friend makes a perfectly reasonable challenge for that to be proven—for the facts that demonstrate it to be provided to Members of Parliament and the public—and I will encourage the trust to provide that information.

My hon. Friend and other hon. Members referred to the trust’s fleet. It is being reviewed to enable the right resource to be sent the first time. The trust has invested £3.6 million, which has allowed an additional 61 double-crewed ambulances—an increase of 20%—across the operational area, meaning that in South Devon four more double-crewed ambulances will be available this year than last year. This approach has allowed a reduction in rapid response vehicles, which—as my hon. Friend said—are not being utilised as fully as the ambulance crews themselves and are therefore not always the best resource to send.

There are now some 57 fewer rapid response vehicles. My hon. Friend the Member for North Devon (Peter Heaton-Jones) highlighted some areas in which that has caused local concern. I would say to him that the ambulance service needs to demonstrate to local people that fully crewed paramedic-staffed ambulances are now more readily available to serve communities, so that the people in most need of conveyance to hospital are more likely to get there more quickly. The trust needs to demonstrate that as it moves its resources to this new pattern.

My hon. Friend the Member for Totnes is aware of the ongoing review of the way in which ambulance services respond to calls through the ambulance response programme. SWASFT has been involved in piloting new operating models. The new programme seeks to deliver clinically appropriate responses to all patients and is part of ensuring that the ambulance service in England remains sustainable. The evidence behind the ARP is extensive, covering data collected from more than 14 million emergency 999 calls. The review has looked at a number of key issues for the south-west, including the provision of ambulance services in rural areas and putting an end to unacceptably long waits by removing the long tail of ambulance response times.

A revised operating model is crucial to achieving sustainability in the ambulance service, given the growing demand that we have all described. Trials have been independently evaluated, and the Secretary of State has recently received recommendations from NHS England. I hope to report to the House the ARP’s findings and NHS England’s recommendations shortly.

In addition, SWASFT has adopted a number of recommendations to improve response times, particularly in rural areas. One such initiative, which my hon. Friend referred to, is the increasing use of community first responder groups across the south-west. Totnes is one of the focuses for the next phase of recruitment in South Devon, which will start later this month. There are some 458 community first responders and a further 110 fire co-responders across the county, alongside the network of public access defibrillators that she mentioned. SWASFT is in discussions with three of its local fire services about introducing a conveyance and support service by fire crews, which would help to supplement conveyance when ambulances are not available. These initiatives do not change the priority or category of a 999 call, but they help to ensure that a patient with a life-threatening emergency can begin to receive the required care as soon as possible.

My hon. Friend rightly raised staffing. I understand that the clinical vacancy rate at the trust is currently 7.7%. The trust has undertaken a very successful graduate recruitment campaign, which has resulted in 130 graduates accepting offers to join it. They are expected to start in September, including 31 who will start in the west division, which covers Devon.

Motion lapsed (Standing Order No. 10(6)).

Contaminated Blood

Philip Dunne Excerpts

Tuesday 11th July 2017 Commons Chamber

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

I thank you, Mr Speaker, for explaining to the House the sequence in which we are speaking today in this very important debate.

I wish to start by offering my personal apology to all those who have been affected by the tragedy of infected NHS-supplied blood or blood products. This has had a terrible impact on so many individuals and families. I know that, quite rightly, there have been many debates on the subject in this Chamber, which have been prompted by the quite proper concern of Members on both sides of this House over many years.

There have been two previous inquiries on this issue: the privately funded Archer report, which was published in 2009, and the Scottish Government-funded Penrose inquiry report, which was published in 2015. However, I am aware that, over the years, there have been several calls for a full independent inquiry.

In addition to those reports, the Department of Health has worked to bring greater transparency to the events. Many documents relating to blood safety, covering the period from 1970 to 1995, have been published and are available on The National Archives website. Those documents provide a comprehensive picture of events and decisions, many of which were included in the documents reviewed by the Penrose inquiry. However, I recognise that, for those affected, these steps do not go far enough to provide the answers that they want or to get to the truth of what happened.

In the light of those concerns and of reports of new evidence and of allegations of potential criminality, we think that it is important to understand the extent of what is claimed and the wider issues that arise. I am pleased to be able to confirm to the House that the Government intend to call an inquiry into the events that led to so many people being infected with HIV and/or hepatitis C through NHS-supplied blood or blood products.

[Norman Lamb]

I am very pleased with the news that the Minister has just confirmed. Will he ensure that the process that is followed—I very much support a Hillsborough-style inquiry—facilitates the ability to bring criminal charges so that the full force of the law can be applied to anyone who may be guilty of criminal wrongdoing?

[Mr Dunne]

I shall come on directly to the form that the independent inquiry should take, and I hope that that will help to address the right hon. Gentleman’s question.

We have heard calls for an inquiry based on the model that was used to investigate the Hillsborough tragedy—the so-called Hillsborough-style panel—which would allow for a sensitive investigation of the issues, allowing those affected and their families close personal engagement with an independent and trusted panel. There have also been suggestions that only a formal statutory inquiry led by a senior judge under the Inquiries Act 2005 will provide the answers that those affected want. Such an inquiry would have the power to compel witnesses and written evidence—an apparent shortcoming in previous reports. The Government can see that there are merits in both approaches, and to ensure that whatever is established is in the interests of those affected we will engage with the affected groups and interested parties, including the all-party parliamentary group, before taking a final decision on the type of inquiry.

[David T. C. Davies (Monmouth) (Con)]

Will the terms of the inquiry allow for recommendations to be made about the correct levels of compensation for those who have been affected?

[Mr Dunne]

I shall make a little progress, then endeavour to answer that.

My right hon. Friend the Secretary of State and Ministers at the Department of Health will meet those affected and their families so that we can discuss the issues and understand their preferences directly about the style, scope and duration of the inquiry.

[Diana Johnson]

I am grateful for what the Minister is saying, but can he give a time estimate of when the meetings will take place? My experience of the Department of Health is that, on this issue, deadlines are not met and things have to be dragged on to the Floor of the House to get Ministers to respond. Is there a set timetable for when a decision will be made and those meetings held?

[Mr Dunne]

The hon. Lady, who has taken an active lead in encouraging inquiries, will want to make sure that we get it right. We will take the time that is necessary to consult colleagues and interested groups. Our intention is to be able to come back to the House as soon as practicable—I anticipate in the autumn.

[David Hanson]

The Minister has mentioned the Department of Health, and he will know that my constituents live under a devolved Administration in Wales but were infected in a hospital in Liverpool. What consultation is he undertaking with the Welsh Assembly, including on the schemes that it is running, and on the liability ultimately for any objective?

[Mr Dunne]

We recognise that there is a legitimate interest for all constituent nations in the United Kingdom. As many of these incidents took place before devolution, we intend to consult devolved Governments.

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

Does my hon. Friend agree that, quite rightly, the inquiry has to give answers to the victims of the scandal and their families? There will be great interest in the conclusions of the inquiry in the House and among the wider public to ensure that historical circumstances that led to the scandal are never repeated.

[Mr Dunne]

I completely agree with my hon. Friend.

[Several hon. Members rose—]

[Mr Dunne]

I shall make a little progress on devolved matters before responding to other colleagues. Regardless of the style of the inquiry, our intention is that it should cover the whole of the UK, so we will be in direct contact with counterparts in Wales, Northern Ireland and Scotland to discuss that with them and to seek their views before determining those aspects of the inquiry.

[Lady Hermon (North Down) (Ind)]

First, I apologise to the House, the Minister and to you, Mr Speaker, for not being present at the beginning of this very, very important debate. The Minister said that he is going to consult on the inquiry, which will be UK-wide. He will know that we do not have an Assembly, and there is no corresponding Health Minister in Northern Ireland, which is absolutely disgraceful. There is no prospect of our having such a Minister before the autumn, so with whom will the Minister liaise in Northern Ireland in the Assembly’s absence?

[Mr Dunne]

We will ask the Northern Ireland Office to facilitate discussions with officials and representatives in Northern Ireland.

[Albert Owen]

On the point about devolution made by my right hon. Friend the Member for Delyn (David Hanson), is the Minister telling the House that this is a UK-wide inquiry and that the consultation will take place across the UK, so that there will be equality for people such as Mr and Mrs Hutchinson in my constituency in the outcome of the inquiry?

[Mr Dunne]

The scope of the inquiry will be determined as part of the discussions which, as I have said, will take place over coming weeks and short number of months. Our intention is that the devolved Administrations and their residents will have full access to participation in the inquiry, irrespective of where people live or were infected.

The Government intend to update the House once the discussions are complete, and I encourage colleagues with a specific interest to engage in discussions through the all-party group or other relevant groups. In the meantime, if anyone in the House or outside has any evidence of criminality, they should take that evidence to the police as soon as possible. If anyone has any other evidence that they want the inquiry to consider, I would request that they submit it to the inquiry once it has been established. The Government will write to everyone in receipt of payments from the current schemes to make sure that they all know about today’s announcement and to inform them of next steps.

[Kevin Foster (Torbay) (Con)]

I very much welcome the Minister’s comments. Will he confirm that when the scope of the inquiry is drawn up care will be taken not to do anything that might endanger future trials? Will he further emphasise that anyone with information should make sure that it is made available to the police?

[Mr Dunne]

My hon. Friend will recollect that the recent Hillsborough inquiry gave rise to certain information that was made available to the police and led to charges being made. We would envisage that the inquiry that is established would have the ability to do the same thing if appropriate.

[Several hon. Members rose—]

[Mr Dunne]

I must make progress, because Mr Speaker has encouraged me to take 10 minutes so that everyone can make a contribution, and I have already exceeded that.

I should like to take the opportunity to inform the House that implementing the reforms to the infected blood ex-gratia support scheme remains a priority for the Government. That is why, as David Cameron established a year or so ago, within this spending review period, until 2020-21, up to £125 million of additional funding has been added to the budget for the ex-gratia support scheme. That more than doubles the annual spend over the spending review period. The second consultation on scheme reform, which closed on 17 April this year, received over 250 responses. The consultation contained proposals for a special category mechanism that would allow people with stage 1 hepatitis C to apply for the higher annual payment, greatly increasing the number of individuals eligible for the higher payment. The responses are being looked at and the consultation response will be published in due course. All the annual payments will remain linked to the consumer prices index and will be disregarded for tax and benefit purposes.

[Stephen Doughty]

I thank the Minister for what he said about input into the inquiry. As the new chair of the all-party group on HIV and AIDS, I am sure that our members will want to contribute. I want to press him on the financial liabilities arising from the inquiry and the impact of devolution. Will he guarantee that, no matter where anyone was infected or where they live now, they will be treated with equality across the United Kingdom when it comes to financial liabilities and payments arising from the inquiry?

[Mr Dunne]

I have just described the additional contribution to the financial scheme for England. It will be for the inquiry to decide whether it wants to make recommendations about financial arrangements. At present, I am not in a position to give the hon. Gentleman the confirmation that he is seeking. That will have to come through the inquiry.

[Dr Julian Lewis (New Forest East) (Con)]

My constituent Lesley Hughes was infected with hepatitis C in 1970, but this was discovered only about three years ago. Will any consideration be given to those long years of suffering when the compensation scheme is put into effect?

[Mr Dunne]

I offer my sympathy to my right hon. Friend’s constituent for the challenges she finds herself facing. We have to say at this point that it will be down to individuals to make their applications. We will respond to the consultation in due course. I strongly encourage my right hon. Friend to make representations on his constituent’s behalf to the inquiry when it is established.

[Chris Stephens]

I thank the Minister for being extremely generous in giving way. May I press him on the issue of health records? Many families are still trying to establish what has actually happened, while the Minister is discussing the scope of the inquiry. Should we write to the Minister if there are any issues with families obtaining health records?

[Mr Dunne]

I think it would be appropriate to write to the inquiry, once it is established. I completely concur with an earlier point about ensuring that any evidence of medical records being tampered with should be made available to the inquiry.

I am afraid that I must bring my remarks to a conclusion. I thank those on both sides of the House who have worked tirelessly on the issue over the years. I add my voice to those of others who have already spoken to commend the hon. Member for Kingston upon Hull North (Diana Johnson). She has spoken very powerfully in the House on this subject not only today, but on many occasions and for many years. I also commend my hon. Friend the Member for Worthing West (Sir Peter Bottomley), who co-chairs the all-party parliamentary group. As the hon. Member for Kingston upon Hull North did, I thank past and present members of that group, notably the former chair, Jason McCartney, late of this parish. Finally, I thank ministerial colleagues who have handled this delicate issue in previous Administrations, particularly my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who has worked so hard not just for his constituents, but for all those affected by the tragedy.

--- Later in debate ---

[David Hanson]

I am grateful to my hon. Friend. The point that I want to finish on—[Interruption.] Does the Minister want to intervene?

[Mr Dunne]

Briefly. I remind the right hon. Gentleman, who is making some important points, that we intend to contact all the families who are in touch with us through the different schemes to alert them to today’s announcement, so that they will have the opportunity to contribute to our determination of the best form of inquiry. On the hon. Gentleman’s second point, it will be for the inquiry, once it is established, to determine how it engages with people, and those involved will be interested in any advice from Members or others.

King George Hospital, Ilford

Philip Dunne Excerpts

Monday 10th July 2017 Commons Chamber

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

It is a pleasure to serve under your chairmanship, Mr Speaker, and to contribute to another debate introduced by the hon. Member for Ilford South (Mike Gapes). I congratulate him on his tenacity in keeping the subject of King George Hospital at the forefront of Health Ministers’ minds in recent years, not least during my tenure. As he rightly said, he and I had a meeting in February with my former colleague, David Mowat, to discuss many of the issues that he has raised this evening. I therefore hope that he will forgive me if he has heard some of my remarks before. I congratulate the hon. Member for Ilford North (Wes Streeting) on joining us. He obviously has experience of these matters as well, given his role in the local council.

I join the hon. Member for Ilford South in paying tribute to the achievement of all the staff and management involved at Barking, Havering and Redbridge University Hospitals NHS Trust in exiting special measures after what has undoubtedly been a long journey for them over the past three years. I was very pleased that they were able to exit special measures in March of this year. That is a huge tribute to everyone involved in ensuring that they were focused on the areas where the CQC had identified what was not best practice. They have focused on improving the deficiencies, and the fact that they were awarded an “improved” rating enabled us to take the decision we did. I also join him in congratulating the quality of management now substantively in place within the trust, at least one of whose members has himself been a beneficiary of treatment locally; I think it was for a different complaint from the one that the hon. Gentleman was treated for in the intermediate treatment centre. That was a very substantial experience, and all credit to that member of the executive team.

The hon. Gentleman touched on a couple of clouds, as he described them. The first was the intermediate treatment centre, which conducts elective and planned procedures provided by an independent provider, Care UK. As he will appreciate—in fact, this took place under the previous Labour Government, when the independent sector provided capacity to support the NHS in a number of areas—we have had a policy of allowing independent providers to be commissioned to undertake care, and it is a matter for the local commissioners in his area to do so; it is not for me to tell them who are the best providers to be able to undertake care. I am very pleased that he was a beneficiary of some of that care. It will be up to the commissioners, working with the NHS, to decide who is best to provide services in his area as they come up for renewal from time to time.

The hon. Gentleman referred to the social care challenge that exists in north-east London, as it does in many other parts of the country. That is why we decided in the Budget in March this year to inject an additional £1 billion into the adult social care budgets of local authorities across the country and a further £1 billion in the next financial year. Moreover, last week, we announced some measures to scrutinise the performance of local authorities in managing those budgets—in particular, so that they contribute to the patient flow challenge, which we experience in many of our hospitals, including the King George: patients occupying hospital beds in acute settings who have no medical reason to continue to be there, because of the challenge of providing placements in the community. It is important that there is closer integration with social care through the local authorities, but also, as he rightly identifies, through other NHS providers, particularly if they are co-located on the site. He mentioned what he describes as an opportunity for the North-East London NHS Foundation Trust to work alongside Barking, Havering and Redbridge University Hospitals NHS Trust to try to smooth the passage and find other opportunities in the community for more appropriate flow. That is very interesting and I hope he is engaging with the leadership of the sustainability and transformation plan and proposing imaginative ideas, in the hope that they will be assessed appropriately when consideration is given to the provision of the future pattern of healthcare in his area.

The hon. Gentleman focused mostly on the challenge to A&E at King George. I will spend most of the rest of my remarks addressing his concerns as best I can. He will appreciate that, across the country, the NHS is coming together, through the STPs published at the end of last year, to identify the right pattern of care across an individual NHS footprint. North-east London has come together with the STP for that area. Our view is that that is the right way to encourage a more holistic approach to the future provision of NHS services. It needs to be led by clinicians and those responsible for managing NHS organisations, and it needs to work in a collaborative and perhaps more open way than it has in the past with local authorities, which have a part to play, as I have said, in facilitating the passage beyond hospital and back into the community.

We are absolutely clear that any significant service change that arises out of the implementation of STPs, if they get to that stage, must be subject to full public consultation, and proposals must meet the Government’s four reconfiguration tests, which are support from clinical commissioners, clarity on the clinical evidence base, robust patient and public engagement, and support for patient choice. Additional NHS guidance means that proposed service reconfigurations should be tested for their impact on overall bed numbers in the area, which the hon. Gentleman has identified appears to be absent from the STP at present. I urge him to continue to challenge that in his area.

[Wes Streeting]

Will the Minister clarify whether he expects the STP process to now publicly consult on any future proposal to close the A&E at King George Hospital? Furthermore, were the STP to recommend to Ministers that the A&E should remain, will they heed that advice and agree that the STP process should not be constrained by the decision made in 2011by the then Secretary of State?

[Mr Dunne]

I am going to have to disappoint the hon. Gentleman, because I am not in a position to second guess the conclusions of the STP discussions and recommendations. It is appropriate for them to take into account clinical decisions made in the recent past, one of which is the decision about the A&E at King George. It is up to the STP management to decide whether to take that forward as the STP evolves. It is right that the STP management looks at health provision in the round. It will be responsible for delivering healthcare to local residents and it needs to take into account all the information sources available to it. I do not think it is right to say that it necessarily has to re-consult on certain issues. It needs to form a view on the right configuration and then use its available data sources and go through the processes.

I will try to explain to the hon. Gentleman the process that, as I understand it, is now under way in his area. Both hon. Gentlemen are right to say that, in 2011, on advice from the independent reconfiguration panel, which approved the proposal, the then Secretary of State took the decision that the north-east London scheme should be allowed to proceed. The Secretary of State made it clear at the time—it has since been repeated in response to questions about the health authorities in the area—that no changes were to take place until it was clinically safe to do so. I believe that remarks that the Secretary of State might have made when visiting the area recently must be considered in that context.

There have been a number of changes since the decision was made, and there are four elements to the process. First, the STP team is reviewing and revalidating the modelling used back in 2010 to ensure that the proposals that were made remain appropriate, as one would expect the team to do. Secondly, the governing members of the CCG board, the trust board and the STP board will need to agree the business case that arises from the STP recommendations. Thirdly, if that is achieved, NHS England and NHS Improvement will be required to approve the business case. Finally, it is envisaged that a clinically led gateway assurance team—an NHS construct —will manage a series of gateway reviews at different stages of the process from planning to implementation, as the project proceeds, to assure system readiness and patient safety at every step of the way, should the decisions necessary to get there be taken in the intervening period.

[Mike Gapes]

Does the Minister think that the whole process could be completed by 2019?

[Mr Dunne]

I will have to disappoint the hon. Gentleman, because it is not for me to prejudge how long the process would take. In all honesty, I think it is most unlikely that it would be completed in less than two years. It is conceivable that it would be concluded by the end of 2019, but a two-year process is likely to be required as a minimum.

In the meantime, CQC visits and reports will continue on a routine basis. Now that the trust is out of special measures, those visits will be somewhat less frequent than they were while the trust was in special measures. Any information coming out of that process will inform decisions taken by the trust and the STP area.

In my final comments, I want to reassure the hon. Gentlemen and their constituents that the proposals include a new urgent care centre at King George Hospital to provide emergency support to local residents for the majority of present A&E attendances. Blue-light trauma and emergency cases requiring full support from emergency medical teams would be taken to other hospitals in the area, but the majority of cases currently treated at King George would continue to be treated there. The new urgent care centre would benefit from several improvements, including more space and access for diagnosis, X-ray, blood tests and so on. I hope that that gives the hon. Gentlemen some reassurance that the facilities that remained at King George would continue to provide the majority of their constituents with the care that they would need in an emergency.

[Wes Streeting]

Is the Minister saying that the STP process should not be constrained by the 2011 decision if those in charge of the process think that that was the wrong decision?

[Mr Dunne]

The process should be informed by the decisions taken in 2010, but it will be up to today’s STP leadership to decide what to do.

Question put and agreed to.

Oral Answers to Questions

Philip Dunne Excerpts

Tuesday 4th July 2017 Commons Chamber

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

Health Education England is responsible for meeting the workforce requirements of the NHS in England. The number of dermatologists in the NHS continues to grow, with 18% more consultants and 13% more doctors in training since May 2010. HEE’s latest workforce plan shows a 2% increase in funded training places for dermatologists compared with the previous year. Dermatology remains a popular choice for doctors, and it typically enjoys 100% fill rates.

[Rebecca Pow]

I am pleased to say that, through a combined approach by the clinical commissioning group and Musgrove Park hospital in my constituency of Taunton Deane, it has been possible to prevent the long-term closure of the dermatology department and to put in place an interim service, with a full service reopening in 2018. Given the seriousness of the conditions of people coming through this department—including an increasing number of cases of skin cancer—will my right hon. Friend give further assurances about how we can ensure there is a sufficient supply of specialists in this area?

[Mr Dunne]

I know that my hon. Friend has campaigned actively to ensure that dermatology services at Musgrove Park hospital in her constituency have been retained following a consultant retirement, which prompted the temporary arrangements. I am pleased that, since the beginning of April, Somerset CCG has successfully commissioned regular dermatology clinics at Musgrove Park using specialists from Bristol, with a view to restoring a full service from next April. We recognise the important service that dermatology clinics provide and are committed to encouraging that specialty in Somerset and nationally.

[Mr Ben Bradshaw (Exeter) (Lab)]

Dermatology is one of the specialisms that is particularly dependent on doctors from other EU countries. Is it not becoming clearer by the day, whether on the staffing crisis in the NHS or the threat to our pharmaceutical industry highlighted by the Health Secretary in his letter today, that the extreme hard Brexit being pursued by the Prime Minister is disastrous for our NHS? What are the Minister and the Secretary of State doing to pull the Prime Minister back from that damaging course?

[Mr Speaker]

Order. In relation to dermatologists is, I think, what the right hon. Gentleman had in mind.

[Mr Dunne]

I cannot tell the right hon. Gentleman precisely how many of the excellent dermatologists come from the EU, but I can tell him that, since the referendum, 562 non-UK EU doctors have come to work in the NHS.

[Tom Brake (Carshalton and Wallington) (LD)]

4. When he last discussed the future of St Helier Hospital with the Epsom and St Helier University Hospitals NHS Trust.

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

The Secretary of State recently met the chief executive of Epsom and St Helier University Hospitals Trust and was impressed by the fantastic work staff are doing despite the surroundings and facilities, which are clearly in need of improvement, for which the right hon. Gentleman has been campaigning. Any significant service change must be subject to consultation with local people, be based on clinical evidence, consider patient choice and have support from GP commissioners.

[Tom Brake]

Indeed the Secretary of State did visit the hospital on the first day of the election campaign—nothing suspicious about that timing. The Minister will have heard that 43% of the estate is unsuitable for the delivery of modern healthcare yet, thanks to the hard work of staff, St Helier is one of the few hospitals that manages to keep on top of A&E waiting time targets. Would he like to be the bearer of good news and confirm that the Government will reinstate the £219 million that the Secretary of State cancelled to enable a new hospital to be built?

[Mr Dunne]

As the right hon. Gentleman knows, the south-west London sustainability and transformation plan area is in the process of turning its proposals into plans, with public consultation when appropriate. It has yet to make any recommendations. As he knows, it set up four local transformation boards to consider how best to transform services, including at both Epsom and St Helier hospitals, for the decade beyond 2020. It would therefore be wrong for me to prejudge those conclusions at this stage.

[Paul Scully (Sutton and Cheam) (Con)]

Rather than having empty political campaigns, does my hon. Friend have a sympathetic ear for an alternative, well thought-out plan for healthcare in Sutton which works clinically and financially and listens to all residents in Sutton?

[Mr Dunne]

My hon. Friend is right. We need to look to the proposals coming from the clinicians on the ground who are responsible for running acute services for the whole of south-west London. They have made it clear that they intend to consult the public once they have made their recommendations transparent. They intend to retain all five hospitals but to look at the configuration of services among them, and that needs to be led by clinicians.

[Bridget Phillipson (Houghton and Sunderland South) (Lab)]

5. What assessment he has made of the adequacy of the number of GPs.

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[Mr Marcus Fysh (Yeovil) (Con)]

6. What steps are being taken to broaden routes into nursing.

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

Developing new routes into nursing is a priority for the Government. That is why we launched, as the Secretary of State set out, both the new nursing associate role and the nursing degree apprenticeship earlier this year. They will open new routes into the registered nursing profession for thousands of people from all backgrounds and allow employers to grow their own workforce from their local communities.

[Mr Fysh]

My constituents welcome the manifesto commitment to expand the number of clinical staff for mental health. What more can my hon. Friend say about plans for mental health nurse training and how they will benefit dementia services, in particular, in my constituency?

[Mr Dunne]

Health Education England’s “Workforce Plan for England” for 2016-17 indicated an increase of more than 3% in the number of mental health nurse training places. It stated:

“The current level of mental health nurse training is the highest of any nursing branch as a percentage of the workforce it serves”,

which should allow for an increase of some 22% to more than 8,000 full-time equivalent staff members in the mental health workforce by 2020.

[Wes Streeting (Ilford North) (Lab)]

The fact is that when the Government chose to charge students record levels of tuition fees and scrap their NHS bursary, the Secretary of State and his Ministers were warned that that would lead to a fall in the number of applications, and what has happened since then? The number of applications for nursing degrees has fallen by 23%. Given that the Secretary of State has already acknowledged that we cannot continue our over-reliance on EU staff following Brexit, when will Ministers understand that the biggest challenge facing nursing recruitment is not our policy on the EU, but the Government’s own health policies?

[Mr Dunne]

The hon. Gentleman is right to draw attention to the fact that we continue to have a surplus of applicants for nursing degree courses in this country. The level of that surplus has fallen somewhat as a result of the change in funding structures. We shall have to see where it ends up, because at present universities are not recruiting directly outside the UCAS system, but we are confident that there will be more applicants than places this year by a ratio of some 2:1.

[Jim Shannon (Strangford) (DUP)]

Does the Minister agree that there are opportunities for more mature students to gain access to courses easily, and that more work must be done with adult learning institutions to provide courses that allow such direct access?

[Mr Dunne]

The hon. Gentleman is right to point out that the more mature workforce, particularly people resuming careers later in life—perhaps, in the case of women, after they have had children—is an important source of experienced professionals, and we need to do more than we have been doing to try to encourage such people to return to the workforce.

[Jeremy Lefroy (Stafford) (Con)]

7. What steps he has to secure the future of accident and emergency departments.

--- Later in debate ---

[Paula Sherriff (Dewsbury) (Lab)]

11. What steps he is taking to reduce the number of children admitted to hospital for dental surgery.

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

Public Health England leads a wide-ranging programme to improve children’s oral health. Its oral health strategy, which was published last year, showed a marked improvement across the country in the proportion of children with no obvious tooth decay—it rose from 69% in 2008 to over 75% in 2015. NHS England is finalising plans for the “Starting Well” programme, which will operate in 13 high-needs areas to improve the oral health of under-fives.

[Paula Sherriff]

Prevention and early intervention are crucial, but no NHS dentists are accepting new patients in Dewsbury, which has the second-worst provision in the country. Children in Dewsbury have five times the national average level of tooth decay. I have asked for help on this for two years, but absolutely nothing has been done. Can you tell me why the dental health of children in Dewsbury is so unimportant to this Government?

[Mr Speaker]

I cannot, but I hope that the Minister can—preferably rather briefly.

[Mr Dunne]

I will try, Mr Speaker.

NHS England recognises the significant challenges in dentistry in Yorkshire, which was why it ran a pilot scheme from January until the last week of June to improve access to primary care dentistry in the Bradford City, Bradford Districts and North Kirklees CCG areas. The pilot will inform the wider work that the NHS is considering across Yorkshire.

[Mr Speaker]

New Members probably will not know that the hon. Gentleman is a dentist.

[Mr Dunne]

I believe that my hon. Friend is the only dentist in the House, and he still practises occasionally. I would be delighted to meet my hon. and experienced Friend to discuss the issues about dentistry that he raises.

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

13. What assessment he has made of the consistency and quality of GP services in (a) Newcastle and (b) England.

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[Nic Dakin (Scunthorpe) (Lab)]

15. What steps are being taken to ensure that NHS Improvement provides timely and effective support to health communities to deliver consistently high-quality care.

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

NHS Improvement offers tailored support to the organisations it oversees, particularly those that have gone into special measures as a result of a Care Quality Commission review. The Department, of course, has responsibility for holding NHS Improvement to account, and it does that through me.

[Nic Dakin]

Northern Lincolnshire and Goole NHS Foundation Trust is in special measures for both financial and quality reasons, but the support given to date by NHSI has been neither timely nor effective. What are the Government going to do about that?

[Mr Dunne]

We are clearly disappointed that Northern Lincolnshire and Goole NHS Foundation Trust has gone back into special measures. It is one of a very small number of trusts that have emerged from special measures and then reverted, so this is something in which we are taking a lot of interest. NHS Improvement has appointed an improvement director and is in the process of arranging for a nearby buddy trust to provide some support. I assure the hon. Gentleman that the Department is receiving weekly updates.

[Bridget Phillipson (Houghton and Sunderland South) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

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[Edward Argar (Charnwood) (Con)]

T4. Leicester and Leicestershire MPs, irrespective of party and led by the hon. Member for Leicester West (Liz Kendall), are united with local people, patients and medical professionals in opposition to NHS England’s badly thought out and, frankly, wrong proposals to close Glenfield hospital’s children’s heart unit. Can my right hon. Friend reassure me that he continues to appreciate the strength of feeling on this issue and that he will ensure that the eventual decision reflects the responses received to the consultation?

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

My hon. Friend and other Leicestershire MPs have made their views very clear to me. I hosted a number of them, from both sides of the House, to discuss this issue. He is aware that the public consultation on congenital heart disease services continues until 17 July. Obviously, we will take all the comments made into account when we come to the conclusions from that report.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Today is the sixth anniversary of the publication of the Dilnot commission’s report on the funding of social care. In those six years, Ministers have legislated for a cap and a floor on care costs, and then abandoned those measures. They brought forward disastrous proposals in their manifesto for what became known as the “dementia tax”, and they appear to have abandoned those measures, too. Will the Secretary of State confirm that those policies have indeed been abandoned? Will he tell me, and more than 1 million people with unmet care needs, when he expects to have some new proposals for reform?

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[Rishi Sunak (Richmond (Yorks)) (Con)]

T8. Last week I met doctors and nurses at the Friarage, an excellent small hospital serving a rural population spread over 1,000 square miles. Will my right hon. Friend urge South Tees Hospitals NHS Foundation Trust to do everything it can to ensure the continued provision of emergency care clinicians and anaesthetists at this vital local hospital?

[Mr Dunne]

I am aware that my hon. Friend has taken a strong interest in the number of consultants and anaesthetists available at the Friarage hospital. I will be happy to meet him to discuss his concerns in person.

[Matthew Pennycook (Greenwich and Woolwich) (Lab)]

T7. At the height of the recent election campaign, NHS England took forward plans to merge, in effect, six south London CCGs, including Greenwich CCG, under one single chief officer. Does the Minister agree that that would be a retrograde step, not only in terms of local accountability, but at a time when primary care has been devolved downwards and all the emphasis is on collaboration and integration at a local borough level?

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

Funding our national health service to meet the needs of UK residents is one proposition; funding an international health service open to the world is another proposition entirely. Are there any indications that advance charging for non-emergency treatment for overseas patients is putting more money into our NHS?

[Mr Dunne]

My hon. Friend is a doughty campaigner for ensuring that non-resident visitors to this country contribute for healthcare received here. We put in place a number of measures to enhance the appropriate charging structures and increased the funding received by the NHS from £89 million to £289 million in 2015-16. We expect similar action to result in a further increase.

[Karin Smyth (Bristol South) (Lab)]

NHS Property Services has just signed a £1 million lease on a central London location. May I suggest that other properties were available? Would the Secretary of State like me to inquire in my constituency, where NHS Property Services increased Knowle West Health Park’s rent threefold? Better value for the taxpayer is available.