Departmental Expenditure Limit (2010-11)

Simon Burns Excerpts

Monday 14th February 2011 Written Statements

[The Minister of State, Department of Health (Mr Simon Burns)]

Subject to the necessary supplementary estimates, the Department of Health’s element of the departmental expenditure limit (DEL) will reduce by £789,000 from £106,281,232,000, to £106,280,443,000 the administration cost limit remains unchanged at £215,280,000. The Food Standards Agency DEL remains unchanged at £114,930,000. The administration cost limit remains unchanged at £50,910,000. The overall DEL including the Food Standards Agency will reduce by £789,000 from £106,396,162,000 to £106,395,373,000. The impact on resource and capital is set out in the following table:

Hospital Services (Shropshire)

Simon Burns Excerpts

Wednesday 9th February 2011 Westminster Hall

[The Minister of State, Department of Health (Mr Simon Burns)]

I congratulate my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing this debate on hospital services in Shropshire. I am sure that his constituents will be pleased to know that he has raised an issue of such great importance to his local community. I also pay tribute to the staff of the NHS across the whole of the county of Shropshire, who do such an incredible job caring for the constituents of my hon. Friend and the hon. Member for Telford (David Wright). They deserve and will receive the Government’s full support.

Before I come to the specifics of Shropshire, I shall set out the Government’s general approach to the reconfiguration of health services, as my hon. Friend referred to the answer that he received from my right hon. Friend the Prime Minister last week. The Government passionately believe that local decision making is essential to improve outcomes for patients and to drive up quality. We do more than just talk about pushing power to the local level; we are doing it.

In May 2010, my right hon. Friend the Secretary of State for Health identified four crucial tests that all reconfigurations must pass. First, they must have the support of GP commissioners. Secondly, arrangements for public and patient engagement, including local authorities, must be further strengthened. Thirdly, there must be greater clarity about the clinical evidence base underpinning any proposals. Fourthly, any proposals must take into account the need to develop and support patient choice.

I understand that NHS West Midlands has given an assurance that the case for change is underpinned by those tests. Let me be clear what that means. Hospital closures that do not have the support of GPs, local clinicians, patients and the local community should not happen. There should be ample opportunity for patients, local GPs and clinicians and local councils to have a far greater role in how services are shaped and to ensure that these changes will lead to the best outcomes for patients.

It is important to remember that local public consultation is the vehicle through which to ensure that everyone with an active interest in proposed changes to their local health service gets their say. In this case, local consultations began on 9 December 2010 and are scheduled to conclude on 14 March 2011. My hon. Friend mentioned it, but if it is any consolation to him, Christmas and the new year holidays came during that period. The normal consultation time is 12 weeks, and if my maths is right this consultation process will take 13 and a half weeks including the holidays.

It should be stressed that consultation is by no means a fait accompli. It is a democratic process that allows full and open participation in considering all the options for service change. If an overview and scrutiny committee is not satisfied that adequate NHS consultation has taken place, or decides that proposals do not meet the needs of the local community, it may refer the matter to the Secretary of State for Health.

I understand that there has been a long history of debate on the best way to organise hospital services in Shropshire. A previous review failed to provide a lasting way forward for the county. Local organisations are now taking this review forward, and they believe that changes need to be made in the near future to ensure that services continue to be provided safely. Over the last decade, the NHS in Shropshire has identified a number of services, including accident and emergency, acute surgery, maternity, neo-natal, in-patient, paediatrics and urology, that face an increasing challenge in trying to provide 24-hour cover by senior medical staff at local hospitals.

As the public consultation document explains, there are five main reasons for that. First, the increasing specialisation of staff means that fewer consultants are able to provide general emergency cover. That is a particular problem in general surgery if it is split between two sites. Secondly, out-of-hours arrangements mean that some consultants have to cover a number of services and sites at the same time. That places unrealistic pressure on staff, and it can put patients at risk. Thirdly, the European working time directive limits the time that medical staff are allowed to work to an average of 48 hours a week. Fourthly, due to the relatively spread-out nature of the Shropshire sites and the area’s rurality, it can be difficult for junior doctors to see the wide range of patients necessary for their training. Fifthly, those factors collectively could make it difficult to recruit high-quality medical staff, particularly consultants.

The current configuration of services results in duplication between the Royal Shrewsbury and Princess Royal hospitals. It also limits the ability to develop the more specialised services that could be provided in Shropshire, Telford and The Wrekin. That is not sustainable.

This is the opportunity for all those with an interest in making changes to local health services to become involved. My hon. Friend has called for an additional public meeting in Shrewsbury; that takes place on Friday 11 February. As I said in my letter, I strongly encourage my hon. Friend to note the views raised at the public meeting, so that they can be fed in to the consultation process. Before a final decision is made following the conclusion of the consultation process, those views will have been heard and considered.

The consultation document explores four options. Option 1 is to do nothing. That is not considered feasible by the local NHS. A second option is to concentrate all major and emergency activity on the site of one or other of the existing two hospitals, with planned activity at the other. That has been looked at carefully, and I understand that that is not considered feasible either. A third option is to build a new hospital, but that has been discounted because of the financial climate. A fourth option, the preferred local NHS option, means moving services between the two sites to make the most effective use of staff, equipment, and buildings.

The consultation document suggests that this is likely to mean that the bulk of in-patient, children and maternity services—

--- Later in debate ---

On resuming—

[Mr Burns]

As I was saying when we broke for the Division, the consultation document suggests that this is likely to mean that the bulk of in-patient, children and maternity services will be provided at the Princess Royal hospital in Telford. A range of acute surgery, including trauma and orthopaedic surgery, and various surgical and other services would remain at, or move to, Shrewsbury. Both sites would continue to provide midwife-led maternity units, with improved accommodation provided for the midwife-led unit at the Royal Shrewsbury hospital site. All pregnant women who are assessed as being likely to have a low risk of complication in the later stages of pregnancy would still have the opportunity to choose to have their baby in a midwife-led maternity unit or at home.

Gynaecological services and antenatal out-patient and day care services will continue to be available at both sites, as will children’s out-patient services. It is proposed that a number of specialist surgery services, whether for planned or emergency operations, would be concentrated at the Royal Shrewsbury hospital: vascular surgery; colorectal surgery, and upper gastro-intestinal surgery. I also understand that funding will be made available so that the Royal Shrewsbury hospital will gain phase 3 status as a specialist aortic aneurism centre.

The consultation states that most surgery for life-threatening trauma is already carried out by surgeons at the Royal Shrewsbury hospital and that would continue to be the case under these proposals. Also, 24-hour accident and emergency services will remain at both hospitals. Therefore, proposals in the consultation document appear to point to a vision of both hospitals providing a diverse range of services that complement each other.

This review has been led by clinicians. Proposals are based on work led by senior doctors, nurses and other health care professionals in the county, working with partners from local authorities, community and voluntary organisations, and patient and public representatives. I understand that the local NHS has involved a number of clinical staff in its local assurance process, including clinical experts from outside Shropshire, such as the director of nursing from Leicester Royal Infirmary and a consultant paediatrician from Manchester, as well as a number of clinical staff with related experience who work within the trust but who had not been involved previously in developing future options.

I am assured that NHS West Midlands will consider results of the public consultation, as is appropriate, before any results are presented to the local NHS boards. I also understand that the local NHS is keeping all local MPs briefed on the consultation process.

I know that my hon. Friend the Member for Shrewsbury and Atcham has campaigned vigorously in the past for retaining services at his local hospital. May I assure him that I fully appreciate his desire for a process that is open and transparent, one that does not end with decisions made behind closed doors after only a derisory nod to public consultation? His constituents, like those of all right hon. and hon. Members, deserve local health services that have the confidence of local GP commissioners and of local people themselves.

I also point out to my hon. Friend that because we are in the middle of a consultation process it would be totally inappropriate for me to seek to influence or compromise that process by becoming directly involved. There are avenues open through the consultation process, as my hon. Friend knows well, and I know that he is working vigorously, as demonstrated by his holding a meeting in Shrewsbury on 11 February, to make sure that the voice of his constituents is heard and considered as part of what is a very important consultation process for the whole county of Shropshire, to ensure the right configuration of services in local hospitals to meet the needs of local people.

Question put and agreed to.

NHS: Negligence

Simon Burns Excerpts

Tuesday 1st February 2011 Ministerial Corrections

[Mr Andrew Turner]

To ask the Secretary of State for Health how much the NHS has paid to patients in ex-gratia payments to avoid ligation proceedings in each of the last three years.

[Official Report, 18 January 2011, Vol. 521, c. 732-33W.]

Letter of correction from Mr Simon Burns:

An error has been identified in the written answer given to the hon. Member for Isle of Wight (Mr Turner) on 18 January 2011. Unfortunately two of the figures in the table were incorrect.

The answer given was as follows:

[Mr Simon Burns]

HM Treasury consider ex-gratia payments to be a form of special payment. HM Treasury’s definition includes personal injury claims that are settled out of court. Information about local ex-gratia payments made by the national health service to patients to avoid litigation is not held centrally. Local NHS bodies record ‘losses and special payments’ in their consolidated accounts and these will include all ex-gratia payments, not just those paid to patients or to avoid litigation.

The NHS Litigation Authority (NHSLA) records data held centrally specifically on ex-gratia payments made for clinical, employer and public liability claims settled out of court. As the NHSLA settles the vast majority of its claims this way, they fall under HM Treasury’s definition of ex-gratia. Data provided by the NHSLA will cover payments to patients, although some will be made to families/dependants, employees and visitors.

Data on actual payments made each year can be provided only at disproportionate cost. The NHSLA has therefore supplied data in the following table which shows the total amount of damages paid on claims settled out of court where the claim was closed between 2007-10. It should be noted that some actual payments for these claims may have been made in earlier years to when the claim was closed.

[Mr Simon Burns]

HM Treasury consider ex-gratia payments to be a form of special payment. HM Treasury’s definition includes personal injury claims that are settled out of court. Information about local ex-gratia payments made by the national health service to patients to avoid litigation is not held centrally. Local NHS bodies record ‘losses and special payments’ in their consolidated accounts and these will include all ex-gratia payments, not just those paid to patients or to avoid litigation.

The NHS Litigation Authority (NHSLA) records data held centrally specifically on ex-gratia payments made for clinical, employer and public liability claims settled out of court. As the NHSLA settles the vast majority of its claims this way, they fall under HM Treasury’s definition of ex-gratia. Data provided by the NHSLA will cover payments to patients, although some will be made to families/dependants, employees and visitors.

Data on actual payments made each year can be provided only at disproportionate cost. The NHSLA has therefore supplied data in the following table which shows the total amount of damages paid on claims settled out of court where the claim was closed between 2007-10. It should be noted that some actual payments for these claims may have been made in earlier years to when the claim was closed.

Health and Social Care Bill

Simon Burns Excerpts

Monday 31st January 2011 Commons Chamber

[David Miliband (South Shields) (Lab)]

It is a pleasure to follow the hon. Member for Central Suffolk and North Ipswich (Dr Poulter). I congratulate him on his important and interesting speech, and I wish to pick up his challenge. The choice is not between no reform and reform; it is between good reform and bad reform. I believe that the proposals in front of us represent not a curate’s egg, with some good reforms and some bad, but a set of poison pills for the NHS.

The first poison pill is the massive upheaval that the Bill proposes at the time of an unprecedented efficiency drive. The right hon. Member for Charnwood (Mr Dorrell) said that it was precisely because of the efficiency drive that we should have massive upheaval, but he must know that all the evidence from reorganisations throughout the years is that projected savings are double the out-turn, and projected costs turn out to be half the actual level. When the Prime Minister says that there is a £300 million difference between the costs and the savings—£1.7 billion of savings and £1.4 billion of costs—he is actually treating us to a reorganisation that will end up costing money and causing redundancy costs at a time when hospitals and GPs are trying to get the job done.

[The Minister of State, Department of Health (Mr Simon Burns)]

May I correct the right hon. Gentleman before he goes too far down that path? The impact assessment suggests that the one-off cost will be £1.4 billion, and that the savings from that investment over the life of this Parliament will be £5 billion. By the end of the decade, the saving will be £13.6 billion, which is £1.7 billion a year after 2013-14.

[David Miliband]

I am happy to wager the hon. Gentleman that the costs will turn out to be more like double those estimated and the savings more like half.

The Bill is myopic, or “deluded”, to use the word of the British Medical Journal, in three key areas, which I wish to mention. First, it assumes that all GPs are ready now to take on hard budgets in the commissioning framework. It took the previous Tory Government six years to get 56% to be GP fundholders. Secondly, it will deepen the divide between primary and secondary care. The hon. Member for Central Suffolk and North Ipswich raised that matter, which is vital. We all know that in our constituencies, collaboration between primary and secondary care is key, especially for chronic conditions. The Bill will make the divide worse, because collaboration will be deemed anti-competitive.

Thirdly, the Bill has absolutely nothing to say about quality control of GPs. In fact, it will remove the local drivers for improvement that I have seen in my constituency. The hon. Member for Basildon and Billericay (Mr Baron) mentioned cancer survival rates, and the Appleby research shows that we in this country have made more progress over the past 30 years than any other country in Europe, and will overtake France in 2012. It also shows that the extent to which we are behind can be explained by late diagnosis in the first year of cancer, which is the responsibility of GPs. They should focus on improving their cancer treatment, not commissioning care.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Simon Burns)]

When NHS funding has reached the European average, but the outcomes for care have not; when doctors are seeking to improve the quality of care but are hindered by politically imposed targets; and when the defence of bureaucracy is put above front-line services, we know that something has gone very wrong. That is why the coalition Government will act, act now and act with determination to improve and modernise our national health service. The Bill will create an NHS that puts patients first, that frees clinicians to deliver the best and most innovative care they can, and that focuses on what matters most to patients—health outcomes.

This has been an interesting debate, although at times, sadly, not a well informed one. I begin, however, by congratulating the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) on her fluent debut speech in the Chamber. I wish her every success in her future contributions, although I warn her that she will not get such a quiet ride next time around. I also congratulate my right hon. Friend the Member for Charnwood (Mr Dorrell) on an interesting and incisive speech, and my hon. Friends the Members for Boston and Skegness (Mark Simmonds) and for Central Suffolk and North Ipswich (Dr Poulter). The latter has great experience, having worked in the NHS.

I wish also to congratulate a number of my other hon. Friends on interesting contributions, including my hon. Friends the Members for Mid Bedfordshire (Nadine Dorries), for Basildon and Billericay (Mr Baron)—we will certainly write to him with answers to his questions—for Winchester (Mr Brine) and for Loughborough (Nicky Morgan).

It is always a delight to listen to the Member who, I suspect, is probably best described as the old Labour dinosaur, the right hon. Member for Holborn and St Pancras (Frank Dobson). I also enjoyed the elegant contribution of the right hon. Member for South Shields (David Miliband). Having listened to his fluent speech, all that I can say is, what a difference opposition makes. It is interesting that what he supported as part of a Labour Government in power he now seems to have abandoned in opposition. The hon. Member for York Central (Hugh Bayley) asked a number of intricate questions, and given the time that I have, I promise that I will write to him with answers to all of them.

Hon. Members might find it helpful if I debunk a few of the myths that have sprung up about our plans to modernise the NHS. The first, and perhaps the most insidious, is that they were kept secret and hidden from the electorate. Quite frankly, that is palpable nonsense. In June 2007, my right hon. Friends the Secretary of State and the Prime Minister, when in opposition, published the Conservative party’s white paper, “NHS Autonomy and Accountability”. It laid out our clear intentions, which we reiterated on pages 45 and 46 of our election manifesto. We said, as a commitment to the British people, that we would

“give every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers.”

We stated that we would

“strengthen the power of GPs...by...putting them in charge of commissioning local health services”

and

“set NHS providers free to innovate by ensuring that they become autonomous Foundation Trusts”.

We also stated that we would create an independent NHS board. It is quite ludicrous to suggest that we did not tell the British people our plans both before and during the election campaign.

A second myth is that our plans to modernise the NHS are revolutionary. In fact they are evolutionary and an extension of the policies of previous Administrations, notably the Blair and Brown Governments. That is particularly true of the move towards the “any willing provider” principle and patient choice. In 2003, when the Labour Health Secretary Alan Milburn moved to introduce a plurality of providers and patient choice, he argued that

“the NHS cannot be run forever like a 1940s-style nationalised industry”.

He was right. The NHS needs the constant drive of improvements to raise standards and improve outcomes.

More recently—perhaps Opposition Members would like to listen to this—in 2007, the Labour Prime Minister, the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown), gave evidence to the Liaison Committee. He stated:

“We have been asking in people from the private sector to review what we can do to give them a better chance to compete for contracts...so the independent sector increases its role, will continue to increase its role and, in a wider and broader range of areas, will have a bigger role in the years to come.”

He said:

“The test at the end of the day is not private versus public, it is value for money, and it is not dogmatic to support one against the other.”

In 2008, he said:

“We will continue to open up acute care with…choice of hospitals trusts across private and public sectors in England…including more than 150 private sector hospitals working as part of the NHS and at NHS cost and standards of quality. We will use all mechanisms available to us to improve our NHS—public, private and voluntary providers can all play their part”.

This Government have also been falsely accused of wanting somehow to privatise the NHS. Privatisation is defined as making people pay for their health care. That is not going to happen under this Government. This Government are totally committed to the values of the NHS: paid for through general taxation; free at the point of need; and always based on clinical need and never on a person’s ability to pay.

Others have erroneously claimed that any involvement of the private sector will undermine the public sector ethos. That is a rather surprising view, considering that it was the last Labour Government who embraced the private sector. I shall quote Dr Howard Stoate, who was recently elected chair of Bexley’s shadow GP consortium. Opposition Members will remember that, until the last election, he was the Labour Member of Parliament for Dartford. In a recent article in The Guardian, he said:

“We have found the idea that services can be offered by any willing provider can actually strengthen the ethos of the NHS rather than weaken it.”

Dr Stoate went on to say that, in his experience, GPs

“reveal overwhelming enthusiasm for the chance to help shape services for the patients they see daily…Far from miring GPs in bureaucracy...GP commissioning can free them to operate more effectively.”

This Government have one simple objective for the NHS: that it should give patients health outcomes that are consistently among the very best in the world, including higher survival rates, greater clinical effectiveness and safer care for patients. Excellence cannot be delivered by having Ministers bark orders down the chain of command. It is done by encouraging innovation and creativity, and by putting the interests of patients ahead of the system and of tomorrow’s headlines.

We will free local clinicians to use their expertise to shape local services. We will free patients to choose the best possible care for their specific needs. We will bring a culture of openness and transparency to the health service, and we will allow any willing provider to compete to provide the best patient care. These plans are consistent, coherent and comprehensive, and they will deliver care that is free at the point of use for all. They will build on the best of what has gone before.

Some say that the reorganisation of the national health service will cost £3 billion, but that is factually incorrect. The impact assessment shows that there will be a one-off cost of £1.4 billion. It also demonstrates how the changes will pay for themselves by 2012-13, saving £5.2 billion by the end of this Parliament. They will continue to save £1.7 billion in every year after that, up to the end of the decade. Every penny of those savings—the equivalent of 40,000 extra nurses, or 17,000 extra doctors or 11,000 extra consultants every year—will be completely and totally reinvested in front-line services, not wasted on back-office costs.

As society evolves, so too must the NHS. The Bill will deliver a modern NHS fit for the 21st century. It is the natural progression of the original vision to deliver the finest health care for all our citizens, remaining true to the founding principles set out by Nye Bevan.

Question put, That the Bill be now read a Second time.

Oral Answers to Questions

Simon Burns Excerpts

Tuesday 25th January 2011 Commons Chamber

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

17. What recent representations he has received on his plans for the internal reorganisation of the NHS; and if he will make a statement.

[The Minister of State, Department of Health (Mr Simon Burns)]

The Government received more than 6,000 responses to the NHS White Paper consultations. As a result, we have strengthened both our approach to implementation and our proposals in the Health and Social Care Bill, which was introduced in Parliament last week.

[Alison McGovern]

The Government have embarked on a reorganisation of our health service that involves altering the commissioning process, handing responsibility to those with less experience of contracting, and at the same time unleashing the market, allowing a whole load of new providers in. What risks does the Minister see might be associated with that approach?

[Mr Burns]

The risk is that if we do not go ahead with these reforms, which are crucial to raising standards and improving outcomes, patient care, survival rates and treatment, we will be doing a grave disservice to the people of this country.

[Bridget Phillipson]

Last week, north-east regional board members of the British Medical Association made it abundantly clear to me and other north-east colleagues that they have serious concerns about the Government’s plans and that they risk patient care. How is it that the Minister is right and they are wrong?

[Mr Burns]

Because I am afraid that the hon. Lady has not read the whole document, in this case from the BMA, or those from other organisations. What many say, including the BMA, on many of the proposals is that they are supportive of them, but naturally the hon. Lady and others cherry-pick those parts that suit their arguments.

[Patrick Mercer (Newark) (Con)]

The Minister will be only too aware of the worries of my constituents in Newark about the future of the hospital. Will he assure me that the internal reorganisation of the NHS will run in parallel with and improve the delivery of the Newark health care review, rather than the contrary?

[Mr Burns]

Yes, and let me reassure my hon. Friend—because last summer I had the pleasure of joining him to visit what is an excellent hospital for the people of Newark—that under our reforms, given the commissioning powers of the GP consortia in the area, they will be able to help strengthen and tailor the health care that the hospital delivers, ensuring that it meets the needs of the people of Newark.

[Mr Edward Timpson (Crewe and Nantwich) (Con)]

How does my hon. Friend envisage the commissioning of ambulance services under the new GP commissioning regime?

[Mr Burns]

Ambulance services will be commissioned through the GP consortia at the local level. What I envisage—this is not prescriptive from the Department of Health, but what I think will develop—is that, just as ambulance services are currently commissioned for geographical areas in England through one PCT, the consortia will appoint lead consortia to commission the services for that area.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Does the Minister agree with the representations of the Select Committee on Health, chaired by the hon. Member for Charnwood (Mr Dorrell), when it said that it was

“surprised by the change of approach between the Coalition Programme”

in May

“and the White Paper”

in July? The Committee continued:

“The White Paper proposes a disruptive reorganisation of the institutional structure of the NHS which was subject to little prior discussion and not foreshadowed in the Coalition Programme.”

If he cannot convince his hon. Friend the Member for Charnwood, how is he going to convince the rest of us?

[Mr Burns]

Let me begin by congratulating my, in fact, right hon. Friend the Member for Charnwood on the report that his Committee produced. The Government will give a full response to it in due course, as is usual. What I would tell the hon. Lady is that what happened in the Bill and the White Paper was what we and our coalition colleagues, the Liberal Democrats, had outlined in our election manifestos, which—[Interruption.] Hon. Members may say that, but I suggest that they look at pages 45 to 47 of the Conservative manifesto, which probably very few of them have bothered to do. GP commissioning, along with “any willing provider” et al, are there, and if one looks at the Liberal Democrat one—[Interruption.]

[Mr Speaker]

Order. The Minister’s answer must be heard.

[Mr Burns]

I am extremely grateful, Mr Speaker.

If we look at the Liberal Democrat manifesto, we can see that it also contains proposals for the abolition of strategic health authorities. The hon. Member for Hackney North and Stoke Newington (Ms Abbott) has alluded to the abolition of PCTs, and the reason for their abolition is that, when we have given the commissioning to GP consortia and the public health responsibilities to local authorities, there will be no job for the PCTs to do. Why keep them? There will be £5 billion savings during this Parliament that can be reinvested in front-line services.

[Philip Davies (Shipley) (Con)]

9. What assessment he has made of the effectiveness of video link medical consultations in prisons.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Simon Burns)]

The proposed changes will focus the NHS on quality and the results that matter to patients—such as how successful their treatment was—and not just on bureaucratic processes such as waiting time targets. Waiting times are important to patients, along with the quality of their experience and outcomes, which will drive improvements in the future.

[Mr Bradshaw]

Well, what a revelation! I think that the Minister will find that the public do care about waiting times. Will he confirm that waiting times are already going up, that more people are already waiting more than 18 weeks—the maximum that we achieved when we were in government—and that the performance of accident and emergency departments has deteriorated since he watered down our A and E targets?

[Mr Burns]

I think that the right hon. Gentleman either did not hear my earlier remarks or had penned his question prior to hearing them. What I said was that waiting times are important to patients—and if he looks at the record tomorrow, he will see that. May I also explain to him that the average median time for the latest month available—November—shows patients completing a referral to treatment pathway in about 8.3 weeks? The right hon. Gentleman’s comments on A and E are just factually wrong and somewhat cheap.

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

There are concerns that some of the expertise of cancer networks might be lost because of the funding gap between the end of the Government’s funding for the networks and the transition to full GP commissioning. Will the Government consider bridging this gap, at least until GP consortia are fully up and running—and therefore better able to make informed decisions about the commissioning of cancer network services?

[Mr Burns]

I am grateful to my hon. Friend in view of the considerable interest he takes and work he does in this field of health care. Let me reassure him that we have guaranteed the funding for next year, so it can work itself out to a successful conclusion thereafter through the cancer networks in the commissioning plans.

[Derek Twigg (Halton) (Lab)]

Under Labour, hospital waiting times were at a record low and satisfaction with the NHS in its current form was at a record high. Over the last few months, however—no matter how much the Secretary of State does not like it—we have seen more and more operations cancelled or postponed at our hospitals. A number of nurses in my constituency have written to tell me that they are short staffed. One of them pointed out that

“those who have left are not being replaced”.

Is that not the true picture of what is going on in the NHS at the moment? If the Minister is confident in his Secretary of State’s plans for the NHS, will he guarantee that under those plans, hospital waiting times will not rise—or is he going to duck the question like the Prime Minister did last week?

[Mr Burns]

Under these reforms, by concentrating on raising quality and outcomes, we will give improved quality health care for patients. What I can guarantee is that under these reforms, when implemented, people will not only get improved quality treatment but will see times based on clinical decisions rather than being distorted by political processes.

[Fiona Mactaggart (Slough) (Lab)]

14. What recent discussions he has had with primary care trusts on their policies on halting elective treatments in cases where such treatment has been demonstrated to be effective.

[The Minister of State, Department of Health (Mr Simon Burns)]

Strategic health authorities have recently been reminded of the statutory commissioning responsibilities of their primary care trusts in this area, and the need to base commissioning decisions on clinical evidence and discussions with local GP commissioners, secondary care clinicians and providers.

[Fiona Mactaggart]

What is the Minister’s response to the trusts that have been saving money by halting procedures such as hip and knee replacements, hernias and hysterectomies, which have proved to be clinically effective? My constituent, John Deas, has just lost the care of the nurse practitioner who has managed his prostate cancer over some years and has been referred to a GP who will not see him. As the president of the Royal College of Surgeons said that the immediate need to

“save money by going for the soft targets of elective surgery will leave a lot of people with unpleasant symptoms and build up future health problems. Medically that makes no sense.”

Does it make any sense governmentally?

[Mr Burns]

I am sorry to hear about the example that the hon. Lady mentioned; if she would like to write to me with the details, I would be more than happy to look into it. PCTs have a continuing responsibility to provide clinical treatment for their patients. Obviously, once the PCTs cease to exist, that will happen through the GP consortia and the national commissioning board. There is also a legal right in the NHS constitution for patients to be treated when they need to be.

[Mr Stewart Jackson (Peterborough) (Con)]

A number of patient groups across the country are concerned about the future of in vitro fertilisation treatments, particularly when many PCTs downgraded it and put it on a par with things like tattoo removal and cosmetic surgery. Will the Minister confirm that, in future, IVF treatments will fall under the remit of the NHS commissioning board?

[Mr Burns]

Let me reassure my hon. Friend on IVF. PCT commissioners should have regard to the National Institute for Health and Clinical Excellence guidelines for fertility treatment, including to the recommendation that up to three cycles of IVF treatment are offered to eligible couples. To reinforce this, in November last year, the NHS operations board reminded PCTs, through the SHAs, of that responsibility. Indeed, Mr David Flory of the Department of Health has in the last month or so written to PCTs to remind them of their responsibilities.

--- Later in debate ---

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

T6. Can the Minister tell us how much money is spent each year on disposable surgical instruments, and whether any thought has been given to greater use of properly sterilised reusable instruments?

[The Minister of State, Department of Health (Mr Simon Burns)]

The straightforward answer to my hon. Friend’s question is, £18 million per annum. The decision to use single-use instruments as opposed to reusable ones is based on many complex clinical factors. For this reason, these decisions are left for the determination of local trusts on the basis of safety, quality and value for money.

--- Later in debate ---

[Alun Michael (Cardiff South and Penarth) (Lab/Co-op)]

Does the Minister accept that during times of illness people often experience associated problems, for example, difficulties with employment and housing, and personal problems, with which they can be helped by the information available through StartHere? Will he ensure that his Department and others treat StartHere as essential to the provision of high-level public service?

[Mr Burns]

I am very grateful to the right hon. Gentleman for that question because, as he is aware from meetings that we have had, we have been supporting StartHere through NHS Choices. We are now reviewing the benefits of this joint working, and that will help us to understand potential contributions to savings to improve the information flow to those who may be excluded from the use of the internet. He may be interested to learn that I have today written to Ms Hamilton-Fairley, outlining where we are at the moment. I am anxious to resolve this as soon as possible, once the review has been completed.

General Practitioners

Simon Burns Excerpts

Thursday 20th January 2011 Ministerial Corrections

[Dr Pugh]

To ask the Secretary of State for Health what proportion of doctors working in GP practices in England are partners in the practice where they work.

[Official Report, 26 July 2010, Vol. 514, c. 833W.]

Letter of correction from Mr Simon Burns:

An error has been identified in the written answer given to the hon. Member for Southport (John Pugh) on 26 July 2010.

The full answer given was follows:

[Mr Simon Burns]

As at 30 September 2009, there were 35,719 general practitioners (GPs) (excluding GP registrars and retainers) in England. Of these, 28,607 (79.6%) were partners in the practice they worked in.

The correct answer should have been:

[Mr Simon Burns]

As at 30 September 2009, there were 35,719 general practitioners (GPs) (excluding GP registrars and retainers) in England. Of these, 27,613 (76.9%) were partners in the practice they worked in.

New Dental Contracts (Pilot Schemes)

Simon Burns Excerpts

Thursday 16th December 2010 Written Statements

[The Minister of State, Department of Health (Mr Simon Burns)]

We said in the coalition agreement that we would introduce a new dental contract based on registration capitation and quality to increase access and improve oral health, particularly of children. We are today announcing the publication of our proposals for piloting that new contract, and inviting expressions of interest in taking part in the pilots.

The current dental contract, which was introduced by the previous Administration in 2006, has been a bone of contention for dentists since its inception. The House of Commons Health Select Committee report published in July 2008 found that the contract had failed to solve problems of access, that the UDA-based system (that is units of dental activity) of remuneration was extremely unpopular with dentists, and that commissioning of dentistry by primary care trusts was often of poor quality. It called for registration to be reintroduced.

Under our planned new contract dentists will be rewarded for the quality of care they deliver for patients rather than the number of treatments and, through registration, patients will have the security of continuing care. Our reforms will give dentists the encouragement they need to provide a service that meets the needs of today’s population. The Select Committee noted that there was widespread criticism that the UDA system introduced in the 2006 contract was not piloted. We have decided that we will carry out pilots as part of the development of our reforms.

To help us develop our proposals, we have taken advice from a national expert steering group, containing representatives of the dental profession, and patients, and NHS commissioners. Professor Jimmy Steele, author of the independent review of dentistry published last year, was also a member of the group.

The three different models set out in the publication will be piloted in 50 to 60 areas around the country from next April. The three pilot models will be slightly different in order to provide information and evidence on different aspects of the proposals, which will then help inform the development of a new national contract.

The proposals we are announcing today mark a first step towards delivering this new and better system of dentistry. In the light of the pilots we will bring forward proposals for a new national contract, with the intention of bringing forward legislation.

Oral Answers to Questions

Simon Burns Excerpts

Tuesday 7th December 2010 Commons Chamber

[Andrew Stephenson (Pendle) (Con)]

4. What recent representations he has received on management and administration costs in the NHS; and if he will make a statement.

[The Minister of State, Department of Health (Mr Simon Burns)]

Administration costs across the health sector will reduce by a third in real terms over the spending review period. That is a £1.4 billion cash reduction and a £1.9 billion real-terms reduction, from a baseline of £5.1 billion. Every penny of the savings will be reinvested in front-line services.

[Andrew Stephenson]

I thank my hon. Friend for that answer. Will he give me and my constituents examples of how the billions that are saved will make a difference on the front line when invested in patient care?

[Mr Burns]

I am extremely grateful to my hon. Friend and I will certainly give such examples. Every penny that is saved by cutting excessive management and bureaucracy will be spent on providing health care and drugs for his and other hon. Members’ constituents, and on ensuring that we have proper front-line services that provide the best quality care for all the people of England.

[Nick Smith (Blaenau Gwent) (Lab)]

Due to the snow, many falls and fractures have been reported in my constituency and around the country in the last few days. What plans are there to cope with such winter pressures?

[Mr Burns]

I fully appreciate the hon. Gentleman’s concern, because particularly at this time of the year and throughout the winter months there is both an extra duty on the NHS and an increased problem. I can assure him that for over a month now, as is the custom, the NHS has been meeting regularly to plan for the winter and ensure that we have the services in place to help those who suffer falls or illnesses due to the inclement weather.

[Simon Kirby (Brighton, Kemptown) (Con)]

5. On what date he expects to make an announcement on compensation for those infected by contaminated blood products supplied by the NHS.

--- Later in debate ---

[Paul Goggins (Wythenshawe and Sale East) (Lab)]

6. What steps he is taking to reduce energy consumption in hospitals.

[The Minister of State, Department of Health (Mr Simon Burns)]

The NHS continues to improve its energy efficiency. The Department provides guidance to the NHS and supports the NHS sustainable development unit, which promotes energy awareness and carbon management across health care providers. Hospitals are working with the Department for Business, Innovation and Skills to engage with suppliers who provide innovative solutions.

[Paul Goggins]

I thank the Minister for his answer and invite him to join me in congratulating all the staff at Wythenshawe hospital in my constituency, which was recently named overall winner this year in The Guardian public services award as the country’s greenest hospital and for reducing energy emissions by 26%. What further pressure is he putting on other hospitals and health service providers to ensure that they follow that fine example?

[Mr Burns]

I am happy to join the right hon. Gentleman in congratulating the university hospital of south Manchester on its fantastic achievement and the award that it has won. As he knows, his local hospital did that by reducing its energy consumption and carbon emissions by 26% over the past three years in ways such as the greater use of biomass fuels. It is a fantastic achievement and the staff should be justifiably proud of it. They are a beacon for other hospitals to follow to reach the same level of sustainability, and I am delighted that a number of hospitals throughout the country are striving to reach the position of the one in his area. I am confident that through greater sharing of information and work, more and more hospitals will make their contribution to reducing carbon levels.

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

The Minister will be aware of the extreme weather conditions and extremely low temperatures of minus 17° C in and around Thirsk and in other parts of North Yorkshire where we have community hospitals and trust hospitals. Has he reviewed the impact on their funds of heating costs when low temperatures come so early in the winter and will carry on for such a long period?

[Mr Burns]

I can reassure my hon. Friend. She is absolutely right that the winter period and harsh weather impose extra costs, but I am pleased to tell her that partly through winter planning and partly through the experience of past years, hospitals are aware of that. They take into their planning and financial budgeting the possibility of weeks and perhaps longer—depending on the weather—when their costs will increase, and adjust to meet those demands. I am confident that bad weather will not impact on front-line services because of the work that hospitals do to account for it over the 52 weeks of the year.

[Annette Brooke (Mid Dorset and North Poole) (LD)]

7. What assessment he has made of the Health Protection Agency’s recent report on the incidence of tuberculosis.

--- Later in debate ---

[Jonathan Lord (Woking) (Con)]

9. What steps he is taking to improve the information provided to patients on their diagnosis and treatment.

[The Minister of State, Department of Health (Mr Simon Burns)]

As part of our White Paper reforms, a wide-ranging review of the information required to empower patients is in progress. Related current initiatives include the information standard scheme, information prescriptions and quality standards produced by the National Institute for Health and Clinical Excellence.

[Jonathan Lord]

I am grateful to the Minister for his reply. Currently good comparative data on the individual performance of doctors and surgeons are not readily available. How does he envisage compiling that data in a way that does not create too much bureaucracy or use up too much of doctors’ valuable clinical time?

[Mr Burns]

My hon. Friend is absolutely right: if we are to put patients at the heart of an NHS in which it is their care and views that are important and drive the provision of health care, we must empower them by giving them information that is consistently accurate, unbiased and easily understandable. We are currently consulting on our information revolution papers, and we await a chance to study the responses. However, we are determined to empower patients by giving them far more information, so that they can exercise their right of choice to get what they deserve, which is the very best health care.

[Keith Vaz (Leicester East) (Lab)]

I would like to declare an interest and remind the Minister that we currently spend £1 million an hour dealing with diabetes-related illnesses. One key way of helping to reduce that cost is giving patients diabetes tests and ensuring they get as much information as possible so that they can change their lifestyles.

[Mr Burns]

The right hon. Gentleman is absolutely right. We have to supply all patients, including those suffering from diabetes as well as other conditions, with as much information that they can understand as possible, so that they can make the choices about the health care they need. They also need to be backed up with advice from their GPs, community pharmacists and others in the health sector, because that will empower them to take decisions in their best interests to manage their medical condition.

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

The Government have rightly announced, in the consultation document on patient choice, that all patients with long-term conditions will be offered a care plan. May I urge the Minister to ensure that that will apply also to cancer patients?

[Mr Burns]

As my hon. Friend is aware, we are still consulting on that document and will consider the results of the consultation process before making any final decisions. On his specific point, however, my understanding is that that will be case.

[Mr David Blunkett (Sheffield, Brightside and Hillsborough) (Lab)]

10. What decisions he has reached in respect of additional funding for the purpose of the tariff applying to specialist children’s hospitals.

--- Later in debate ---

[Richard Graham (Gloucester) (Con)]

17. What recent representations he has received on the management and administration costs of the NHS; and if he will make a statement.

[The Minister of State, Department of Health (Mr Simon Burns)]

As I said to my hon. Friend the Member for Pendle (Andrew Stephenson) earlier, administration costs across the whole health sector will reduce by a third in real terms over the spending review period. This is a £1.4 billion cash reduction and a £1.9 billion real-terms reduction, from a baseline of £5.1 billion. Every penny of the savings will be reinvested in front-line services.

[Richard Graham]

I am grateful to the Minister for his reply. Can he reassure my constituents in Gloucester that this is broadly the degree of savings that we should expect from NHS Gloucestershire’s expenditure on management, and that those savings will be spent on the rising demand for front-line services, including in the new, soon-to-be-opened women’s centre?

[Mr Burns]

Yes, I can give my hon. Friend the assurance that he seeks. We have made it quite clear that we will reduce management costs throughout the NHS by more than 45% over the next four years, and establishing GP consortiums will allow us to strip out the costly top-down bureaucracy that now exists. All the money that will be saved through these initiatives will be reinvested in front-line services, which will benefit the constituents of my hon. Friend and those of every other right hon. and hon. Member throughout England.

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

I am concerned about the quality of services that patients and their families receive. In my constituency, 100 jobs are already going, and I am worried that the cuts in staffing will have an effect on the services that are available. Can the Minister guarantee that front-line services will be protected, because the reality is that, in constituencies such as mine, staffing is crucial to ensuring that decent services are available?

[Mr Burns]

I have to tell the hon. Lady that, in this very difficult financial situation, which we inherited from her Government, it is only by making efficiency savings and getting rid of excess bureaucracy that we can generate the income to reinvest to save front-line services—[Interruption.] She and the Greek chorus in front of her must understand that, if we had not been left in this mess in which £43 billion a year is being spent on the interest on the debt that we inherited, we would not have the problems that we now have—

[Mr Speaker]

Order. I think we understand what the Minister is trying to get at.

[Mr Speaker]

Let us have the answer.

[Mr Burns]

My hon. Friend is absolutely right. Although the last Government significantly increased health spending —I do not dispute that; it is a self-evident fact—the trouble is that we did not see increases in productivity pro rata. That is the challenge that we face; that is what we are addressing; that is what we are going to achieve through QIPP—quality, innovation, productivity and prevention—by cutting out inefficiency, cutting out excess management and administration so that every single penny can be reinvested in improving front-line services and giving our constituents the finest health they—

[Mr Speaker]

Order. The Minister will resume his seat. His answers have been excessively long-winded and repetitive—and it must not happen again. I have made the position clear and I hope that the Minister will learn from that.

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

18. What estimate he has made of the change in average waiting times for patients waiting for diagnostic tests since May 2010.

[The Minister of State, Department of Health (Mr Simon Burns)]

Patients are continuing to receive timely access to diagnostic tests. In September 2010, the median waiting time for 15 key diagnostic tests was 1.7 weeks, compared with 1.8 weeks in May.

[Mr Brown]

I thank the Minister. Does he expect waiting times to stay down now that they have been scrapped or will they simply be ignored by no longer being performance-managed?

[Mr Burns]

I suggest that the hon. Gentleman studies the response given earlier by my right hon. Friend the Secretary of State to the right hon. Member for Exeter (Mr Bradshaw). By concentrating resources and reforming the system to improve outcomes, we will provide enhanced health care for all our constituents in England.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

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

--- Later in debate ---

[Mr Speaker]

Just as the answers from the Minister of State, the hon. Member for West Chelmsford, were too long, those questions were too long as well.

[Mr Burns]

Chelmsford.

[Mr Speaker]

Order. I do not require any assistance from the hon. Gentleman. We must speed up from now on. That is the situation.

--- Later in debate ---

[Richard Graham (Gloucester) (Con)]

T8. Can Ministers reassure me that, given the relative health deprivation in Gloucester, the ring-fenced funding promised in the White Paper on public health will in fact benefit people there?

[Mr Burns]

Yes, I can certainly give my hon. Friend that assurance. The money will be ring-fenced to ensure that local communities can enhance the quality of public health for all constituents both in Gloucestershire and throughout the country.

[Mrs Mary Glindon (North Tyneside) (Lab)]

T4. The north of England cancer network has been working since 2007 to improve cancer commissioning across primary and secondary care and to improve standards of cancer care for my constituents. Can the Secretary of State confirm that it will continue to play that role after the introduction of GP commissioning?

Dental Practitioners

Simon Burns Excerpts

Monday 29th November 2010 Commons Chamber

Outcome 10, on the safety and suitability of premises, duplicates matters under the jurisdiction of the Environment Agency, water companies and the Health and Safety Executive. The HSE has the power to enforce the requirement for practices to have a risk assessment. It also has jurisdiction over equipment and its use to ensure that it is properly maintained and serviced. I am sure that the Minister will have done some homework for tonight and will be aware that the fire prevention regulations also fall under CQC outcome 10.

[The Minister of State, Department of Health (Mr Simon Burns)]

indicated assent.

[Sir Paul Beresford]

The Minister is nodding sagely so perhaps I will believe him. The fire prevention regulations are enforced by the local fire authority and any CQC interest in that area is duplication. To my amazement, there is even duplication in the CQC requirements, some of which are addressed many times. For example, evidence that practices have appropriate confidentiality protocols in place must be provided to satisfy outcomes 1, 2, 6 and 21.

Dental providers must comply with 28 standards, but there is no guidance on what the CQC requires as evidence of compliance. Furthermore, it is unclear who the auditors of the process will be. To give an example provided by people who have lobbied me, the NHS Partners Network and the NHS Confederation state that generally, their members have been subject to mixed messages and unclear instructions from the CQC about what to expect from it. They say that in the current financial climate, such uncertainty is particularly difficult for their members and runs the risk of adding significantly to costs without yielding safety and quality benefits. The ultimate guillotine is having one’s practice shut down for failure to comply with a potential deadline of April next year, which is causing deep concern in the dental profession.

Finally, I turn to costs. The current situation is that there is no fee for CQC registration. In contrast, my fee to be paid this month to the General Dental Council is £576, the same as for the majority of dentists. However, the CQC is consulting on proposed fees, which it wishes to divide up depending on the size of a provider. The fees proposed are disproportionate, as the lowest fee is to be £1,500, for a provider with one location, such as my own small, part-time surgery, whereas £48,000 is to be charged for a provider with 101 or more locations.

One of the most glaringly ludicrous points is the extreme jump in fees from one level to another. For example, if a dental firm has 100 practices it will pay £24,000, but if it merely adds one more practice, its fees will double to £48,000. The situation has to be dealt with, and it is in the hands of the Minister and his colleagues to do so. The CQC is charging ahead blindly, apparently with little knowledge and with no response to concerns that have been expressed. It has finally agreed to sit down with the General Dental Council in the next week or two and discuss the potential duplications in registration costs.

I understand that there are organisations similar to the CQC in Wales and Scotland, and both appear to be working closely with the GDC without duplication. The result is that the annual cost to Welsh dentists for their organisation is not between £1,500 and £48,000, but probably in the region of £80 and certainly less than £100.

There is an opportunity for Ministers to act before it is too late, and before too much money is wasted. If necessary, the forthcoming Public Bodies Bill will enable Ministers to remove the CQC from its role of regulating dentists. I remind the Minister that all the problems that it is having with dentists, and dentists with it, are likely to be repeated, and more, in the case of general medical practitioners. They are next on the list.

I await the Minister’s considered response, and I hope that he will take a step back and promise to consider the points made by me and, in particular, by the many organisations that have lobbied on the matter. It would be helpful if there were a serious meeting between Ministers, the GDC, the CQC and the BDA. It is overdue.

[The Minister of State, Department of Health (Mr Simon Burns)]

I begin by congratulating my hon. Friend the Member for Mole Valley (Sir Paul Beresford) on securing this debate on an issue that I know is of some concern to him and other dentists throughout England. He said at the beginning of his comments that he was a friend of mine and hoped that he still would be by the end of my speech. I echo that, because I, too, hope that we are still on friendly, and hopefully speaking, terms by the end of the debate.

My hon. Friend will know that the coalition Government do not believe in regulation for the sake of regulation. However, there are areas in which regulation is important for the interests of vulnerable people who are less able than others to defend their own interests. The provision of health care and adult social care services is one such area, and since 1 April 2009, the Care Quality Commission has been responsible for regulating those sectors under the Health and Social Care Act 2008.

The Government support the role of the CQC in ensuring that providers of health care and adult social care provide services that, at the very least, meet the essential levels of safety and quality that every patient and service user has a right to expect. I am sure that my hon. Friend would not argue with that, or with the enforcement powers that the CQC can use when providers fail to meet essential levels of safety and quality. He will be aware that the Government are committed to strengthening the CQC’s role as an effective regulator of health and adult social care services in England.

At the moment, NHS and private health care providers are registered by CQC under the 2008 Act, as are providers of adult social care. From April next year, providers of primary dental care and private ambulance services will also be registered. From April 2012, providers of primary medical care will be brought into the registration system.

There are a number of reasons why it is right to bring primary dental care providers into registration and to require them to meet essential levels of safety and quality. First, the current regulatory systems for dentists focus on the competence of the individual. However, how organisations and systems are managed is just as important in protecting the safety of patients. CQC registration will provide the framework to ensure that the provider, as well as the individuals within it, meet essential levels of safety and quality.

Secondly, increasingly complex treatments are being provided in primary care settings. For example, it is likely that more oral surgery will be carried out in primary care in future, and the General Dental Council has seen an increase in complaints about harm caused to patients by the placing of dental implants. Those developments make it even more important to ensure that providers have adequate systems in place to protect the safety of patients. Registration with the CQC will allow potential problems to be identified and addressed before they result in harm to patients.

[Sir Paul Beresford]

The Minister mentioned the GDC and complaints about dental implants. There has also been an increase in poor endodontic work, all of which can be dealt with adequately by the GDC. The situation does not need a huge, monolithic organisation such as the CQC.

[Mr Burns]

I am very grateful to my hon. Friend for making that point. If he will bear with me, I will, at a slightly later stage in the course of my remarks, address whether working together can minimise the level of overlap so that there is no unnecessary duplication.

Thirdly, registering primary dental care providers will ensure that the same levels of safety and quality are met irrespective of where care is provided. One patient could be treated in hospital where the quality and safety of their care is regulated by the CQC, while another receives the exact same treatment elsewhere without that same guarantee. Wholly private dental providers, treating some 7 million patients, are currently subject to no formal scrutiny of the service that they provide.

Finally—I know that my hon. Friend has raised this subject in the past—registration will provide greater controls on the decontamination of used dental instruments. Guidance on decontamination is set out in “Health Technical Memorandum 01-05”. Although that has no legal standing, the CQC can monitor whether providers, including those in the independent sector, meet its requirements by enforcing the cleanliness and infection control registration requirement.

It is the view not just of the Government that the registration of dentists will bring benefits; that view is shared by the dental profession. Responding to the consultation on registration of dental providers with the CQC in June 2008, the GDC said:

“We broadly welcome the establishment of the Care Quality Commission…Whilst we are responsible for the registration and regulation of the whole dental team, whether they work in the private or public sector, there has been no additional means of regulating wholly private dental services…up until now. We believe that this role can be covered by the CQC and would further enhance patient protection”.

The British Dental Association was equally supportive, saying:

“Wholly private providers are currently unregulated (beyond individual professional regulation) and we believe it is essential for this to be addressed.”

[Sir Paul Beresford]

I actually touched on that at the beginning of my short address. The Minister has to realise that the consultation came before the CQC moved into the area of dentistry, before the BDA realised what the CQC was going to do and before the monolithic and, what I called, almost cancerous growth of this organisation.

[Mr Burns]

I am grateful to my hon. Friend for that intervention. As far as I know, however, the BDA was aware at the time that dentists were going to be registered under the CQC, and as I see it, the comments on the consultation process were made in the knowledge of that information.

I know there has been concern among dentists about the potential impact of registration with the CQC, and my hon. Friend made an interesting and vigorous case highlighting what he perceived to be some of the problems. However, I have some sympathy with those dentists concerned that the process of registering with the CQC will be onerous and time consuming. I can assure him, however, that for the majority of dentists—those who already provide high-quality services—there will, to my mind, be no difficulty in meeting the essential levels of safety and quality.

The experience of HTM 01-05 demonstrates this point. Before the introduction of the guidance, dentists raised concerns about the burden that complying with it would place on them. Only today, we have published the results of the dental national decontamination survey, showing that when HTM 01-05 was published in November 2009, about 70% of practices were already meeting the essential quality requirements for decontamination, with approximately a further 20% of practices very near the essential quality requirements. The remaining small minority of practices were not.

This experience will, I believe, be repeated with CQC registration. Most dental providers already give their patients a high-quality service and will find that they already meet the registration requirements. In those relatively small numbers of cases where dentists do not meet essential levels of safety and quality, registration with CQC will force them to improve. This is the purpose of regulation, and such an outcome would result in safer and better dental care for patients.

My hon. Friend has spoken about the potential for overlap in the role of the CQC and the General Dental Council in the registration of dentists, and he raised it again in his first intervention on me. I would like to address that point now. I read with interest the recent letter from a number of dentists in The Daily Telegraph making the same point as him. The CQC and the GDC are working closely to ensure that the roles of the two regulatory bodies are closely co-ordinated. Indeed, the two regulators have agreed and set out a memorandum of understanding that explains how they will co-ordinate their activities and share information to ensure that they do not duplicate actions and therefore create any risk of double jeopardy. It is vital that CQC registration complements the professional regulation of dentists by the GDC. The important word there is “complements”.

[Sir Paul Beresford]

I spoke to the president of the GDC last week, and she said they are having a meeting to discuss this for the first time. So the Minister’s information might have gone a little awry.

[Mr Burns]

I take on board what my hon. Friend says. However, the information I have been given, as I said earlier, is that the two regulators have agreed and set out a memorandum of understanding explaining how they will co-ordinate their activities and share information to ensure that they do not duplicate actions. I trust that that action is correct, I trust that they work closely together to achieve that aim, and I will certainly get back to him if—despite what I have been led to believe—that is not the case.

My hon. Friend also referred to the proposed level of registration fees for dental providers. As he is aware, the Care Quality Commission is currently consulting on its proposals for annual registration fees, which will apply to all providers, including dentists, from April next year. I would like to emphasise that they are proposals for consultation. I would certainly urge all dentists in England to make their views known to the CQC through the consultation process as soon as possible, and certainly before it ends, on 17 January. I heard what my hon. Friend said, and I have seen the consultation document. I can only repeat—and repeat quite vehemently—that it is important that all dentists take part in the consultation process and ensure that the CQC is fully aware of their views before it ends. I should also add that the CQC’s final fees scheme is subject to the consent of the Secretary of State. It would obviously be wrong of me to prejudge the consultation process or what will happen at its conclusion. All I can do is advise my hon. Friend and the profession to ensure that they lobby the CQC as part of the consultation, so that it is left in no doubt about the views and concerns of dentists on the issue.

My hon. Friend also mentioned Criminal Records Bureau checks, which I know have been a particular issue for some dentists. CRB checks are important to ensure that those responsible for the delivery of services are fit to do so. In earlier registration rounds, CRB checks have revealed convictions that were not otherwise declared. Those dentists who already have a CRB disclosure countersigned by their primary care trust can use it for CQC registration. I know that there have been practical problems with getting the required CRB checks carried out, and I understand the frustration that this has caused for some dentists. As a result, the CQC has increased to 100 the number of post offices that can process CRB disclosures on its behalf. That will go some way towards helping to deal with some of the practical difficulties experienced in getting a CRB check. The CQC is also exploring with Post Office Ltd the possibility of extending the service to the entire post office network.

Although there is a degree of anxiety among dentists about CQC registration, I hope—although I am not convinced—that I have reassured my hon. Friend that the majority of dentists, who already provide good services, have no need to fear CQC regulation. For the small number who do not provide a safe service, registration will provide an effective mechanism to bring about improvements for patients. Indeed, that is the very purpose of regulation.

In spite of the concerns, I am pleased to have been told by the CQC that the registration of primary dental care providers is so far proceeding smoothly. More than 7,000 dentists, including nearly 1,600 who operate solely in the private sector, have enrolled in the CQC’s registration process. The CQC has now invited those primary dental care providers to submit applications. I understand that the first completed application was returned to the CQC within three hours and that more than 400 applications for registration had been returned by the end of last week. With what I believe has been a good start, I am hopeful that the task of registering dental providers with the CQC will be completed on schedule by 1 April 2011, and that patients will have the assurance that whichever dental practice they use, whether NHS or private, they will receive care that meets essential levels of safety and quality.

Question put and agreed to.

Dental National Decontamination Survey 2010

Simon Burns Excerpts

Monday 29th November 2010 Written Statements

[The Minister of State, Department of Health (Mr Simon Burns)]

In recent years we have gained a better understanding of the risks of transmission of infectious diseases like hepatitis from poorly maintained health care premises and instruments which have not undergone effective decontamination. The risk to individual dental patients is small but, with 1.5 million people undergoing dental treatment each week and some 500,000 people infected with blood-borne viruses many of whom may be unaware of their infection, we cannot afford to be complacent.

Because of this risk and evidence that some dental practices might not be achieving adequate standards, the Department issued health technical memorandum 01-05 “Decontamination in primary care dental practices” in November 2009. In implementing the HTM we have sought to strike a balance between protecting patients and the constraints imposed by the layout and structure of dental practices which, while being easily accessible in the high street, may have limited scope for expansion and upgrading.

I am today publishing the report of the dental national decontamination survey which was undertaken at the start of the year. The primary aim of this, the first national survey of current standards of decontamination in primary care dental practices, was to provide a baseline to compare standards in general dental practice at the time of issue of the HTM 01-05 with those set in the guidance. The HTM is intended to encourage continuous improvement in local decontamination by giving dental practices a range of options to achieve the essential quality requirements (EQR) identified in the HTM and progress to best practice.

EQR is a level of decontamination which will achieve significant risk reduction, while best practice offers an optimum level of protection. The main features of best practice are the provision of a dedicated room for decontamination away from where clinical care is delivered and the use of an automated washer-disinfector, for the cleaning of instruments.

All practices are expected to be operating at EQR by the end of this year; no timeframe has yet been set for the achievement of best practice because of the need for further information to be obtained about the constraints imposed by the design and structure of some dental practices.

I am very grateful to the primary care trusts (PCTs) and the dental practices which participated in this voluntary survey, and to the Health Protection Agency which worked with the Department in bringing it to completion. In total 75 PCTs participated in the survey which involved nurses with training and experience in infection control visiting 487 randomly selected dental practices. Practices were assessed in relation to essential quality requirements and best practice at the time that the HTM was published.

The results of the survey showed that around 70% of practices were already working at EQR with some 20% of practices already achieving best practice. Approaching 20% of practices were very near EQR with the remaining minority operating at an unsatisfactory standard.

These results show that the majority of practices were meeting EQR and it is likely that this figure would have increased over the year as practices began to implement the HTM.

I was very encouraged to learn that well over two thirds of practices were already meeting EQR. As to the remainder, the survey data show a number of practices need to improve their cleaning of instruments which is a critical part of the decontamination cycle. The Department is encouraging practices to acquire automated washer-disinfectors, whose use is a feature of best practice, to achieve a uniformly high standard of cleaning of dental instruments.

The Department has, in collaboration with the Infection Prevention Society, produced a self-assessment audit tool to allow all dental practices to assess their level of compliance with the quality standards in the guidance. By applying the audit tool, practices will be able to compare their standards to those included in the sample survey.

The quality of local decontamination will be one of the factors the Care Quality Commission (CQC) will take into account in monitoring standards when dental practices are brought within its remit from April 2011. The CQC will wish to ensure that it only registers practices that can demonstrate local decontamination is carried out to acceptable standards.

The dental national decontamination survey report has been placed in the Library. Copies are available for hon. Members in the Vote Office and for noble Lords in the Printed Paper Office.