Pancreatic Cancer

Simon Burns Excerpts

Wednesday 23rd May 2012 Westminster Hall

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

It is a first, and a pleasure, for me to serve under your chairmanship, Mr Scott. I congratulate my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) on securing this important debate. It was very moving to listen to his speech. His real knowledge and personal experience made it more powerful than many of the speeches one hears in this House.

I congratulate my hon. Friend on his appointment as secretary of the newly formed all-party group on pancreatic cancer, and congratulate all the other Members and people from outside this House who have an interest in this particularly nasty and difficult disease and who have recognised the need to set up such a group. I know that my ministerial colleague, the hon. Member for Sutton and Cheam (Paul Burstow), will watch the work of the group with interest, and no doubt the Department of Health will await with eagerness any reports or investigations that the group pursues in the coming years of this Parliament. All contributions, whether from the voluntary or charitable sectors, or from within the Department or the NHS, or at a parliamentary level, are important, because, as my hon. Friend has said, this is a very difficult disease which, sadly, can be extremely swift-moving. Far more needs to be known about it, so that one can address the alleviation of the symptoms and the longer-term management of the condition—if that is possible. Sadly, as my hon. Friend said, during the course of his experiences, time regrettably was not on his side.

We in the Department recognise that we need to do more to bring cancer survival rates up to the standards of the very best. The cancer outcomes strategy sets out our ambition to halve the gap between England’s survival rates and those of the best in Europe, saving an additional 5,000 lives every year by 2014-15. To achieve that, we must tackle common and less common cancers. We know that later diagnosis is a major reason for variation in cancer survival outcomes, and our strategy prioritises early diagnosis. To assist the NHS in achieving earlier cancer diagnosis, the strategy is supported by more than £450 million over four years. That funding is part of more than £750 million in additional funding for cancer over the spending review period.

To improve awareness of rarer cancers such as pancreatic cancer, we are considering piloting a symptom-based awareness campaign covering multiple cancers. Feedback from rarer cancer charities suggests that as a possible approach to improving public awareness. We are considering the results of discussions in order to find the best way forward. I hope that that addresses one of the important points raised by my hon. Friend.

We also need GPs to recognise symptoms and, where appropriate, refer people urgently for specialist care, as my hon. Friend said. A range of support, such as referral guidelines from the National Institute for Health and Clinical Excellence, is available to help GPs assess when it is appropriate to refer patients for investigation of suspected cancer. However, we can do more to support GPs. Cancer Research UK, Macmillan Cancer Support and the National Cancer Action Team are working together to develop a broader GP engagement programme for the coming years, including by working with the senior leadership of the Royal College of General Practitioners on a strategic initiative.

I commend the pancreatic cancer charities for the work that they do to support patients, raise awareness, promote research and identify how we can improve the survival rates of people affected by pancreatic cancer. They do a tremendous amount of excellent work, and we welcome that work and congratulate them on their commitment. We are determined to work with them and others to help minimise the problems highlighted by my hon. Friend.

As I said, we must tackle rarer or less common cancers alongside common cancers. That is why our cancer outcomes strategy set out a commitment to work with rarer cancer charities. Officials have held meetings with numerous rarer cancer charities, including Pancreatic Cancer UK and Pancreatic Cancer Action, to assess what more can be done to encourage appropriate referrals to secondary care for early diagnosis of rarer cancers. The discussions will inform the Department’s future work in the area.

Pancreatic Cancer UK, as my hon. Friend said, is hosting an early diagnosis workshop in June, which will be attended by national cancer director Sir Mike Richards and my ministerial colleague the hon. Member for Sutton and Cheam. The workshop will examine practical steps that can be taken to help GPs and secondary care health professionals diagnose pancreatic cancer at the earliest possible stage. We look forward to receiving the workshop’s findings. As my hon. Friend rightly said, the earlier the diagnosis, the better it is for addressing individual patients’ problems. That is the nub of the challenge facing us all.

Pancreatic Cancer UK’s survival study 2011 confirms what we already know about regional variations in survival rates. “Improving outcomes: a strategy for cancer” makes it clear that reducing variations and tackling health inequalities is essential if we are to improve outcomes and save 5,000 additional lives by 2014-15. To support the national health service in tackling regional variations in cancer survival rates, we are supplying data to providers and commissioners that will allow them to benchmark their services and outcomes against one another and identify where improvements need to be made, so that they can move forward on making the improvements that we all desperately require and seek.

In December 2010, we published the report of the 2010 cancer patient experience survey, which recorded the views of more than 67,000 cancer patients treated across 158 trusts. The results enabled providers to assess the experience of cancer patients locally, benchmark performance against other trusts and identify areas for improvement. It also showed that cancer patients supported by a clinical nurse specialist had a better experience of care overall. My hon. Friend mentioned the importance of ensuring sufficient numbers of clinical nurse specialists. We expect the NHS to consider that in developing policies to improve patient experience. Field work for the 2011 survey is now complete. We will look closely at the results when they are published in summer to see where improvements have been made and more are needed.

The Department is fully committed to clinical and applied research into treatment and cures for cancer. The percentage of cancer patients in trials in England is now more than twice that in the United States. The UK now has the world’s highest national rate per capita of cancer trial participation. I hope that that reassures my hon. Friend.

In August 2011, the Government announced £6.5 million in funding for the Liverpool biomedical research unit on gastrointestinal disease. About half that investment will support pancreatic cancer research. It forms part of this Government’s total yearly spend of more than £200 million on cancer research. Patients and clinicians can find out about trials in all therapeutic areas, including pancreatic cancer, on the UK clinical trials gateway website.

On the important issue of clinical audits, I reassure my hon. Friend that we are committed to extending national clinical audits across a much wider range of conditions and treatments, and to developing their role as a driver of quality improvement. Following a call in early 2011 for new topics for national clinical audit, the National Advisory Group on Clinical Audit and Enquiries provided advice to the Department on new topics to be included as part of the national clinical audit and patient outcomes programme. A proposal for a pancreatic cancer audit was considered as part of that process, but the advisory group’s view was that elements of the proposal should be taken forward as part of the existing bowel cancer audit when it is retendered during 2012. We will ensure that that option is considered when the Department reviews the existing arrangements for the bowel cancer audit later this year.

I reassure my hon. Friend, other hon. Members and the all-party group that, although the challenge of preventing cancers and improving diagnosis and treatment is huge, we are committed to it. Our cancer outcomes strategy, published in January 2011, set out how we will deliver health-care outcomes as good as those anywhere in the world. That is our commitment. The first annual round of the strategy, published in December 2011, highlighted our priorities for this year, which include providing benchmark data to the NHS as a lever for improvement.

Of equal importance is the commitment of the many charities and campaigning organisations that provide vital support to thousands of people with cancer and—as importantly, but sometimes forgotten—to their families. However terrible it is to suffer from cancer, we must not forget the knock-on effects that it has on the emotions of families and friends, who must do so much to support patients through difficult health conditions at a time when they themselves are in a fragile emotional position. They also advocate on behalf of family members and friends suffering from cancer. That is a crucial role, and one that we must not forget.

The contribution of the charitable and voluntary sector to our recent cancer strategy has been invaluable, and I trust that we can continue to count on its help in delivering our aims and objectives. I thank my hon. Friend for bringing up this important issue. As he made clear in his remarks, because relatively few people suffer from pancreatic cancer, it may not always get as much attention as more common cancers such as breast cancer and lung cancer. I am grateful to have had the opportunity to outline the Government’s position and assure him that we continue to work towards achievement.

Health Transition Risk Register

Simon Burns Excerpts

Thursday 10th May 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

Back in the rose garden, the talk was of the most open and transparent Government ever. Today, those words are as worthless as “no rise in tuition fees” and “no top-down re-organisation of the NHS”. We have heard self-serving rubbish today from a Secretary of State who does not want patients and the public to know the whole truth about his NHS re-organisation, but he has been brought here by the sheer tenacity of my right hon. Friend the Member for Wentworth and Dearne (John Healey).

My right hon. Friend has been completely vindicated by the Information Rights Tribunal, which was scathing about the way in which the Government have conducted their re-organisation of the NHS, their failure to give an indication of their wide-ranging plans before their hastily drawn-up White Paper, and their decision to implement them on the ground before a Bill had been presented to the House.

After last Thursday, in interviews following the local election results, Government Members all promised to listen, but what is the first thing that they do? They take this unanimous ruling from a judge-led legal tribunal and tear it in two with trademark arrogance—a Government who believe that they are born to rule and above the law. In doing so, they have made a major departure from the established policy on freedom of information, and from the precedent set by the previous Government.

Hitherto, the ministerial veto has been used on only three occasions, all related to Cabinet discussions; applying the veto to operational matters of domestic policy breaks that precedent. As such, it is a major step backwards towards secrecy and closed government. Is there not now a real risk that other Departments will cite this shoddy decision as a precedent and seek to withhold public information that, in the spirit of policy intention of the Freedom of Information Act, should be placed in the public domain?

Where does this decision leave the Information Commissioner and, indeed, the Information Tribunal? Have they not been completely undermined by the Cabinet’s decision? The truth is that there is confusion in government about the decision, and the Secretary of State has failed to clear it up today. In his statement on Tuesday he said clearly that the risk register would not be published following Cabinet agreement and that it was a “final decision” by the Secretary of State, but just hours later on the “Today” programme the Health Minister Earl Howe said:

“We have every intention of publishing the risk register in due course, when we think the time is right”.

I have a simple question: will it be published or not? Was the Secretary of State’s Minister speaking for him and his Department when he made that statement, and if so will the Secretary of State tell us what his Minister means by “when…the time is right”? Most people, including those on the tribunal, felt that the time was right when the Bill was going through the House of Commons—before the right hon. Gentleman shamelessly rammed it on to the statute book.

The shambles is not just in the Department of Health, however; it is right across government. The shadow Leader of the House has just left the Chamber, but in a blog post earlier this week he said—

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

The Deputy Leader of the House.

[Andy Burnham]

The Deputy Leader of the House said that

“it would also be right to publish as much of what is contained in the risk register as possible”.

He said that this week—that the risk register should have been published. How many more Ministers and coalition MPs do not agree with the Cabinet’s decision?

Most worrying, however, is the confusion over freedom of information policy. The Secretary of State, in his statement earlier this week, said:

“If such risk registers were regularly disclosed, it is likely that their form and content would change”.

But later in the same statement he said that this was an “exceptional case”. Which is it? Do the Government now have a blanket ban on the publication of any risk register, even if ordered to do so by a judge, or was this an exceptional case? If it was the latter, how did it meet the exceptional criteria that Government rules require? We need answers, as again this Government are breaking the precedent set by the last Government. Following a ruling from the Information Commissioner, we released the Heathrow third runway risk register. We never called for the publication of all risk registers, but said that each case should be judged on its merits. Inconveniently for the Minister and the Conservative party, that ruling makes a clear differentiation between the strategic risk register on the one hand and the transition risk register on the other, as I have argued all the way through this discussion.

The Secretary of State’s argument today hinges on the “safe space” argument—he says that if we did not have a safe space, it may change future risk registers. Is he aware that the tribunal considered that point in detail but concluded that there was no evidence presented to us that the release of the Heathrow risk register had a chilling effect on their use by Government? Was the Secretary of State’s argument not tested in court and did it not fail in court? Is he not now showing a blatant disregard for the law? He said today that it “is a matter of principle and not a matter of law”, but it is a matter of principle and of law—freedom of information is the principle and the Freedom of Information Act is the law. He should be following the law that enacts that principle, but he has taken a step away from it today.

The Treasury website still has this statement on risk policy:

“Government will make available its assessments of risks that affect the public, how it has reached its decisions, and how it will handle the risk. It will also do so where the development of new policies poses a potential risk to the public.”

I ask again: if that is no longer the Government’s policy on risk management, when will it be removed from the Treasury’s website?

In conclusion, the Government are in disarray on many fronts. The NHS belongs to the people of this country, not Ministers. If Ministers cannot be open about the risks that they are taking with the NHS, they should not be taking those risks. That is a simple principle.

The truth is that this has been a cowardly decision from a Government on the run who are now too frightened to face up to the consequences of their own incompetence. The real reason for the veto is that publication would have shown that the warnings from doctors, nurses, midwives and patients were echoed in private by civil servants but the Government just ignored them. This is a Cabinet cover-up of epic proportions—a Government closing ranks and covering each other’s backs because they know that the public would never forgive them if they could see the scale of the risks that the Government are taking with the national health service.

Rare Disease Strategy

Simon Burns Excerpts

Monday 30th April 2012 Commons Chamber

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

May I begin by congratulating my hon. Friend the Member for Crewe and Nantwich (Mr Timpson) on securing this debate on what is a most important topic for a great number of people, and on the sensitive way in which he outlined his concerns, particularly those that affect his family? May I also congratulate him on running the London marathon an hour and a half quicker than the shadow Chancellor?

As we have heard, anybody, at any stage in life, can be affected by a rare disease, which can range from manageable conditions that do not affect daily living to debilitating conditions that have a significant impact on one’s quality and length of life. The Government are committed to providing the best quality of care to people with rare conditions, and the importance that we attach to services for people with rare conditions is clearly demonstrated in the reforms we set out in the Health and Social Care Act 2012. Through the Act, specialised services, which are currently provided at both national and regional level through a range of NHS organisations, will be brought together under one roof. From April 2013, the new NHS Commissioning Board will directly commission services for people with rare diseases on a national basis.

My hon. Friend asks for an explanation of how the NHS Commissioning Board will operate to ensure cluster-type service delivery in respect of rare diseases. Moving to a national standard system of commissioning but maintaining a regional focus gives the geographical and speciality oversight that he describes. National specifications will lead to services being defined once for England, allowing clear planning to take place across the country.

[Mr David Anderson (Blaydon) (Lab)]

I congratulate the hon. Member for Crewe and Nantwich (Mr Timpson) on a fine speech. As the chair of the all-party parliamentary group on muscular dystrophy, may I ask the Minister about two connected points in respect of what he has just said? There has been a great development within neuro-muscular services and work by the House and the Department. Will the Minister meet the all-party group and the muscular dystrophy campaign to discuss the progress of the national neuro-muscular work plan? Will he also give us an assurance on the positive advantages in the south-west region—he mentioned regional development—and confirm whether there will be strategic clinical networks for neuro-muscular services across the country?

[Mr Burns]

I am grateful to the hon. Gentleman. I recognise the tremendous work he does in this area of health care and congratulate him on his efforts. With regard to a meeting, I will pass on his comments to my noble Friend the Earl Howe, who has responsibility for this area of health care. On the hon. Gentleman’s second point, I am more than happy to give him the assurances he seeks.

The proposed operating model for specialised commissioning links national service knowledge and expertise with local contract knowledge of providers and pathways of care, cementing the new system together in the interests of patients. The benefits to patients with rare conditions are clear: a single national commissioning policy and better planning and co-ordination will result in improved consistency across the country.

My hon. Friend asked me to set out the Government’s thinking on the suggestion from the former chief medical officer for a national clinical director for rare diseases. I can assure him that there will be a director within the NHS Commissioning Board with lead responsibility for specialised services for people with rare conditions. The board will also consider the most suitable form of clinical advice covering the domains of the NHS outcomes framework. Rare diseases come under domain 2: long-term conditions.

Our commitment to people with rare conditions is demonstrated through our recently published, “A UK Plan for Rare Diseases”. The consultation was launched on 29 February—Rare Disease day—and was produced jointly by the four nations of the United Kingdom. The consultation will continue until 25 May and is an important step on the way to producing the final plan. I urge everyone with an interest in this area of health care to contribute to the consultation process.

This will be the first time that the UK has developed a plan to tackle rare diseases, and the consultation represents collaboration across the four nations of the UK. It brings together a number of recommendations designed to improve the co-ordination of care and to lead to better outcomes for people with rare diseases. We suggest that improvements can be made through earlier diagnosis, better co-ordination of services, stronger research and better engagement with patients and their families. Many of these recommendations will be of direct benefit to patients and can help the NHS to be more efficient and co-ordinated and to save money.

Earlier diagnosis through clear care pathways to expert centres can prevent disability, and in some cases save lives, by allowing an earlier start for effective treatment. It will also save money by avoiding more intensive or emergency treatment. More co-ordinated care saves patients’ time, money and stress by avoiding multiple visits to various clinics. As many rare diseases are of genetic origin, we must also embrace advances in genetics and genomic medicine and ensure that the NHS is ready to support and take full advantage of these developments.

My hon. Friend has already mentioned that people with rare diseases need to be able to access orphan medicines. Our priority is to give NHS patients better access to the innovative and effective drugs that their doctors recommend for them, including those designated as “orphan drugs”. The new system of value-based pricing will bring the price the NHS pays for drugs more in line with the value it delivers. Notwithstanding this, we know that there may be instances where an individual medicine should not be assessed under value-based pricing. We will keep the situation under review. If, as we begin to implement value-based pricing, it becomes clear that some treatments would be better dealt with through separate arrangements, we will explore alternative options.

The consultation document sets out a coherent approach to tackling rare diseases. It recognises existing developments while setting out a number of further developments, such as on better information for patients to help them manage their condition. My hon. Friend asked for reassurance that we are putting steps in place in preparation for the introduction of the international classification of diseases—ICD-11. I can assure him that the NHS is moving towards widespread use of systematized nomenclature of medicine clinical terms—Snomed CT—in preparation for the introduction of ICD-11.

The consultation will inform the final UK plan for rare diseases. We hope that the final plan will offer a framework for managing rare diseases wherever they occur. Each nation of the UK will then take forward implementation of the plan in accordance with its own priorities and patterns of service. In England, much of the implementation of the final plan will be for the new NHS Commissioning Board to take forward, in close dialogue with Public Health England.

As my hon. Friend will appreciate from my comments in this relatively short but important debate, he has raised an extremely important issue that all too often is forgotten in the mainstream of the NHS, where people concentrate on more acute services, rather than this highly specialised area. My hon. Friend the Member for Stourbridge (Margot James) mentioned a particular illness or condition. May assure her that following her intervention, I will ask my noble Friend the Earl Howe to write to her about the issue she raised?

In conclusion, the development of the first ever UK plan is an important signal of our continuing commitment to providing good quality services to people with rare conditions. The consultation is aimed at a wide audience, including not just clinicians and NHS specialised commissioners, but patients, their carers and families, support groups, specialist organisations, researchers, academics and colleagues from across social care. I call on all hon. Members to encourage their constituents with an interest in rare diseases to take part in this important consultation.

Question put and agreed to.

EU Working Time Directive (NHS)

Simon Burns Excerpts

Thursday 26th April 2012 Westminster Hall

[Andrea Leadsom]

That is very interesting. Clearly, my hon. Friend’s contractual employment was not correct because she should not have been asked that question at the same time as signing the contract.

I would like to cite a case study of a junior doctor who was employed under the working time directive in foundation training between 2009 and 2011. This is his story:

“When I was on my surgical placement as part of my training, we were told by the hospital to take a mandatory ‘zero hours’ day off every week, as we were working 8 am to 6 pm on the other weekdays, as well as some longer on-call days and on-call weekends at times. The purpose was to keep our average working week within the 48-hour limit.”

That is utterly bizarre.

“We rotated who took the day off among our team, but this meant that on any particular day only one or two doctors would know the patients who had been admitted the day before. However, those particular doctors might not be there the next day, so would have to hand over patient information to a colleague. Unsurprisingly, much information was ‘lost in translation’. Trainee doctors would also not know which registrar, or even consultant, to expect on any particular day, due to the irregular working patterns of these people also caused by the limits on working time.

Furthermore, patients no longer knew who would see them on the ward round. The effect was poor patient experience, as patients were unable to build a rapport with individual doctors. People would be very frustrated that the doctors seeing them did not know what the same medical team had planned/achieved the day before.

There is also much less time for on-the-job training for junior doctors. This was compounded by the fact that we often had to cover for other trainees who were rostered off due to the working time directive, missing our regular teaching sessions. Lack of training time has made it difficult for us to establish a rapport with our seniors, and gain adequate support in terms of mentorship and career advice. In fact, trainee doctors no longer feel that we ‘belong’ to a team, given the new shift patterns that have broken up teams of trainee doctors and their seniors. Morale is certainly lower and junior doctor sickness rates much higher. This is a negative spiral—more doctors off means that when you do turn up, your working day is more hectic and stressful, and you are much more likely to fall ill and take time off yourself.

Diary carding exercises (whereby doctors record the actual hours they work) have shown almost universally high rates of non-compliance with the working time directive. During my general medicine attachment in training, I ended up working 1.5 to to 2 extra hours (unpaid) per day and was consistently non-compliant…Doctors that do opt out of the 48-hour limit on the working week are sometimes not sure whether they will be remunerated appropriately for their time.”

That is interesting and highlights some of the problems faced by doctors who are trying to do the right thing by their patients. Of course, this is not only about doctors but about patients. My right hon. Friend the Minister will be aware of two recent cases where coroners have recorded problems associated with the working time directive. They said that it impacted on the ability of doctors to understand what was going on with patients, and that was one of the factors that caused the untimely death of a patient. The other case involved a patient undergoing a routine operation.

Let me quickly turn to the solutions.

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

It might be helpful if I give my hon. Friend the answer to her question about when one can opt out and whether one gets paid. A doctor can opt out at any time with the agreement of the employer, and the junior doctors are expected to work up to 56 hours because of their contracts. If they work more than 56 hours and it is agreed, they will be paid for those hours.

[Andrea Leadsom]

I am grateful to my right hon. Friend for that important clarification. He will note the experience of the case study that I have just read out. There is an uncertainty about payment for extra hours and the recording of extra hours. That is clearly an issue that needs to be resolved at the sharp end, if not in the principle.

[Mr Burns]

If it is of any help to my hon. Friend, I will re-clarify the matter. Junior doctors will be paid for hours over the 56 hours in their contract, but it is only with the authorisation of the employer that they can work those hours.

[Andrea Leadsom]

I am grateful to my right hon. Friend. As my hon. Friend the Member for Bristol North West pointed out, representatives of doctors and NHS staff do not agree among themselves about whether they support the European working time directive. Certainly, the Royal College of Physicians, NHS Employers and the Royal College of Surgeons are concerned not only that the working time directive causes a problem for doctors and patients, but that it does not do what it sets out to do, which is to deal with the exhaustion of doctors themselves. The Royal College of Surgeons says:

“We know from our members that working in a full shift pattern is more tiring when compared to working using an ‘on-call’ system, and creates a working environment that is impairing to patient safety.”

The British Medical Association believes that the European working time directive is entirely right in all of its manifestations. Patient and doctor representatives need to resolve the question of where they stand, as representatives of health service workers, on the implications of the working time directive.

Turning to the options for change, the Fresh Start project has done a great deal of work on this. Certainly, there are things Britain could do in isolation to try to improve the situation, and we have heard about some of them today. Some doctors in other European Union countries have two contracts, which has been used as a way of getting round the working time directive. We have heard about all sorts of workarounds that Britain does not tend to use, and the Government might want to consider what other countries have done. Certainly, MEPs in Europe have told me that some doctors will take on two 48-hour contracts, which seems to be going back to dangerous practice. Nevertheless, if an impossible situation is created, we end up with people just trying to defeat the problems.

A far more likely scenario is that we negotiate for change with other members that are unhappy with the consequences of the working time directive. We should get together with the 16 other member states that are determined to see change and that have negotiated an opt-out, so that we can get the directive changed specifically in relation to the NHS and make our economy more flexible.

What we are proposing is a concrete option for change. At the time of the European members’ attempt to get their recent fiscal consolidation agreement into the main treaties, there will be an opportunity for Britain to go to the EU Council with its own proposal for change. This is a clear opportunity, which has arisen from the need for fiscal consolidation in other EU countries, for Britain to prepare a list of changes to various elements of the treaties that it would like to see, and to go all out to negotiate those changes when the time comes, in three or four years. In line with the proposal put forward at the all-party parliamentary group for European reform, I recommend a triple lock whereby Britain arranges to opt out.

--- Later in debate ---

[Chris Skidmore]

I agree. I am sure that all hon. Members would echo such a call. We should have complete data. The complete data, if we had them, would show that the situation is far worse and that, instead of the £1 billion a year cost, the hidden cost is, according to the data that I have, perhaps £2 billion. We do not know.

My hon. Friend the Member for Bristol North West, almost like a Cassandra, warned that this would be a problem back in 2010, and started the campaign with no data at all. Two years down the line, we find what she said to be true, in respect of data from individual trusts. We will know more, probably, by the end of this year and there will be more stories in the Sunday papers and it will become an ever bigger issue. That is why it is so important to have this debate now, because when the public and patients who use the NHS ask, “What were you doing about this, as MPs?”, we can say, “We’ve had this debate. Okay, it’s not come up with all the solutions just yet”—we are interested to hear what the Minister says about possible solutions—“but we are on the case.” That is important, because an avalanche of cases will come forward in the near future. It is important to recognise that.

There is a challenge from Nicholson and we need to make those savings. The problem is that this matter is standing in the way of the Nicholson challenge being effectively delivered. Either we have to push harder to gain those efficiency savings—the problem now is that we have inefficiencies of the worst kind and are essentially having to make more efficiencies elsewhere to reinvest in front-line care—or the money will not be reinvested back into front-line care. Working time directive costs are classed as front-line care, when clearly they are not, so money is being removed that could be spent on nurses or on alternative equipment for the NHS that would have benefited patients.

[Mr Simon Burns]

My hon. Friend might find it helpful to know—he is talking about the Nicholson challenge and asking, “What were we doing during this”—and might take some comfort from the fact that, since May 2010, the cost of locums has fallen by 11%.

[Chris Skidmore]

I appreciate that information. I only have pre-coalition data from 2007-08 and 2009-10, although they are not inaccurate. It is interesting to note that, before the coalition came in, the cost of locums was rising enormously, from £384 million to £758 million. The coalition’s inheritance was enormous. It is good to hear that there has been an 11% saving, which is roughly £75 million.

[Mr Burns]

Let me give my hon. Friend the precise figures on the savings. The number of people employed as locums by the NHS has fallen by 11% since May 2010, and the number of doctors in the NHS has increased by about 4,000.

--- Later in debate ---

[Mr Burns]

I really do not want to be a clever clogs. My hon. Friend has accurately described what happens in the Netherlands, but even with the opt-out, weekly hours in that country are limited, in that case to 60 hours.

[Chris Skidmore]

Sixty hours would be a start—65 is what most people seem to be calling for. It is about getting a balance. We do not want to go back to the 80, 90 or 100-hour working week, but nor do we want to face the consequences of the 48 or 56-hour working week. There is a balance to be struck, and I would be very interested to hear what the Minister thinks can be done. This debate is obviously an interesting one because it can go down a European direction, which I know a Health Minister cannot say very much about today. However I would be interested to hear what he has to say about the NHS in his capacity as a Health Minister.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship this afternoon, Mr Howarth. I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie) on securing this debate. Anyone who listened to her speech this afternoon would realise that she is an expert in this area and cares passionately about improving the current situation, which, as it will become clear during the course of my remarks, is a problem for the national health service. I have considerable sympathy with the aim of her contribution—to get improvements and changes that will aid the NHS to help those who work within it.

We have had a particularly high-level and intelligent debate in which there have been some powerful contributions—surprisingly, not from many Opposition Members—from my own hon. Friends and the hon. Member for North Antrim (Ian Paisley). I would like to call him an hon. Friend because of the kind things that he said about me, but protocol forbids me as he is not a paid-up member of the Conservative party. None the less, my thoughts are with him in that respect.

There was an excellent speech by my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who spoke with the authority of someone who was a consultant in a national health service hospital before coming to this place. Another powerful and highly informative speech came from my hon. Friend the Member for Totnes (Dr Wollaston), whose knowledge of the NHS has been gained through direct experience of working within it for many years before coming here.

We had a very interesting contribution from the hon. Member for Vauxhall (Kate Hoey), who cares passionately about this issue. My hon. Friend the Member for Stafford (Jeremy Lefroy) made a customarily well-informed speech based on knowledge gained partly from his experiences as an MP with the Mid Staffordshire NHS Trust in his constituency, and partly from his background interest in all health matters. I congratulate my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) on a very powerful contribution. She rightly holds very strong views on these issues, and they are an important part of the debate. I congratulate my hon. Friends the Members for Hastings and Rye (Amber Rudd) and for Kingswood (Chris Skidmore), who both, in their own way, fight vociferously for their own local health economies in Hastings and in Kingswood, and show an interest in health debates.

All hon. Members are aware that this issue has been simmering, in one way or another, for many years. Recent news has shown us that dealing with the EU never seems simple, regardless of what is being discussed. I can understand the impatience of a number of my hon. Friends, because I, too, am impatient when I want something to be done that I think is sensible and should be done. Sadly, as we all know from our experiences of working within the European Union and of how that organisation works, we cannot always have instant gratification.

[Dr Wollaston]

Does my right hon. Friend think that one of the problems with the EU’s priorities is that it is demanding a 6.8% rise in its budget, rather than dealing with more pressing problems?

[Mr Burns]

I am tempted to go down that path, because I have considerable sympathy with my hon. Friend. However, time is short and I do not want to upset you, Mr Howarth. I will avoid temptation and keep myself on the straight and narrow.

We could not be clearer about how we want things to move forward. In the coalition agreement almost two years ago, the Government resolved to limit the application of the working time directive in the NHS. That position has not changed. We still believe strongly that working people should be able to work the hours they want. That means they should be able to choose to opt out of the directive’s limit on working hours. However, no one wants a situation where tired doctors are working for far too long, and for that reason it is important that doctors who choose to opt out, and their employers, agree working hours that ensure that patients are not at risk. A common thread running through the contribution of every hon. Member was the importance and necessity of not returning to what is known as the bad old days. Nobody on this side of the House, in any shape or form, would want that to happen. However, it is equally viable and intellectually respectable to argue for more flexibility, as the current situation —as highlighted in many speeches—is causing problems for the NHS. That has to be done in an ordered way. We cannot unilaterally take any action that would compromise the legality of how the European Union works, our contribution and how we operate within the EU.

[Andrea Leadsom]

Does my right hon. Friend recognise that Sweden agreed legally to join the euro and has failed to do so, and so our inability to implement all our commitments might be seen by some as trivial in comparison?

[Mr Burns]

My hon. Friend makes an interesting point that could tempt me, but I will not be tempted. Each member state of the European Union is answerable for its decisions and behaviour. I believe that if one is a member of an organisation and has signed up and committed oneself to certain procedures and legal ways to do business, it is only right that the British Government—

[George Eustice]

Will the Minister give way?

[Mr Burns]

I will not, if my hon. Friend will forgive me, simply because I have only seven more minutes. I was hoping to address some of the points raised by my hon. Friend the Member for Bristol North West.

We have to abide by the legalities. Otherwise, chaos will ensue and we will not in the longer term achieve what we are hoping to, even if we might on that narrow issue. Until the negotiations in Europe come to a successful end we are obliged to comply with the European Court of Justice and we cannot unilaterally go against it. The Department of Health and the Department for Business, Innovation and Skills are working very closely together on how the WTD will apply to the UK health care sector. Both Departments agree that we need to keep the opt-out and it would be a grave error to surrender it or to abandon it for other concessions. That is a red line for us. We have to keep the opt-out.

We also want to solve the issue of flexible on-call time and compensatory rest that allows the NHS to work within the current constraints of the working time directive. Those are both very important issues to the Government and to the NHS, but as I said, the bottom line is that the opt-out must stay. European social partners have opened negotiations to amend the WTD. At this stage, as hon. Members will know, it is not national Governments directly who are conducting these negotiations; they are being done through what is known as the social partners. In our case, it is NHS Employers and the Local Government Association with regard to local government and the knock-on effect for social care; that is an important part of the delivery of NHS services and social care.

That process is autonomous, and operates independently of the Commission and Council. The social partners have nine months at most to reach an agreement. That takes us up to September 2012. If an agreement is reached, it would be submitted to the Council for approval. But if an agreement cannot be reached, it will be up to the Commission to issue a proposal to change the directive. The Government have made it patently clear to everyone that long-term, sustainable growth must be the EU’s key priority. Every decision the EU makes must be geared towards that. So we will carry on working with our partners to make sure that EU measures support labour market flexibility and do not impose unfair costs on member states or businesses, or services like the NHS, that could hold back our economy and the delivery of services.

For the NHS specifically we are keen to ensure that an amended directive provides more flexibility, particularly in the areas of on-call time and compensatory rest, provided that a workable opt-out can be maintained. Responding to concerns about how the directive is being applied, particularly with regard to medical training—an issue raised by a number of hon. Members—Medical Education England, the Government’s independent advisory body on medical education, commissioned an independent review chaired by Professor Sir John Temple. My right hon. Friend the Secretary of State for Health has asked Medical Education England to help improve our training practices in line with Sir John’s recommendations.

In response, Medical Education England has set up a programme known as Better Training Better Care, which will improve patient care by increasing the presence of consultants and by ensuring that service delivery supports training. It includes two important components: identifying, piloting, evaluating and sharing good education and training practice; and improving the curriculum so that training leads directly to safe, effective patient care. From an education and training perspective, handovers present an excellent opportunity for training. The Better Training Better Care programme includes pilots that will hopefully show how education and training practice can improve in that area and take advantage of those opportunities.

NHS trusts in England have responded very positively to this programme: 96 trusts applied for part of the £1 million available for NHS pilots in 2012-13. Following that competitive process, last month 16 projects with 16 NHS trusts were awarded funding for those pilots. I look forward to seeing what developments they come up with.

As I am running out of time, I say to my hon. Friend the Member for Bristol North West, who wants to make a contribution to end the debate, that I will write to her with answers to a number of important issues that she raised. However, I will deal briefly with two issues now.

First, my hon. Friend asked what will happen in emergency situations such as a flu pandemic. I hope I can give some reassurance on that point. In such circumstances, as long as health and safety are protected in the round and the employer has correctly judged that the circumstances are exceptional, the rest requirements of the directive can be suspended.

Secondly, my hon. Friend the Member for Kingswood and other Members raised the vital issue of locums, including the cost of locums and their number. I share the concern of my hon. Friends about the use of locums. They play an important role when there are short-term staff shortages, or when there is illness or holidays, and there may be a limited impact of the EWTD that means that trusts will be employing locums when they might not otherwise do so. However, the evidence about the extent of that practice is not as extensive and meaningful as we would like it to be; we would like to get a fuller picture. Nevertheless, whatever the reason for the use of locums, we are concerned across the board about their extensive use and the add-on costs that brings to the NHS. That is why we are working through our training programmes and through the Quality, Innovation, Productivity and Prevention programme to seek to minimise unnecessary use of locums and to bring down the number employed, thereby reducing costs. As I said to my hon. Friend the Member for Kingswood, there has been an 11% reduction in the employment of locums, and at the same time there has been an increase in doctors.

In conclusion, I also hope I can give some reassurance to my hon. Friends about staffing levels, particularly in specialised areas, because the situation is slightly more encouraging than they may have feared. For example, if we take the current year and general surgery—

[Mr George Howarth (in the Chair)]

Order. I call Charlotte Leslie.

Mental Health Care (Hampshire)

Simon Burns Excerpts

Wednesday 18th April 2012 Westminster Hall

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

It is a pleasure, yet again, to attend a debate under your chairmanship, Dr McCrea.

The commitment of my hon. Friend the Member for New Forest East (Dr Lewis) is quite evident, because not only is this the second debate on the issue in the past five months but he has had ministerial meetings. He has championed the interests of his constituents, as expected of an assiduous Member of the House. I also congratulate my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) on her speech and on how she represented the views and concerns of her constituents on a difficult and sensitive issue. My hon. Friend the Member for Burton (Andrew Griffiths) and the hon. Member for Strangford (Jim Shannon) managed, intriguingly, to merge Burton and Strangford into the southern county of Hampshire. To do so took political skill—debating skill—but they achieved it and made some interesting points that were a valuable contribution to the debate.

I have to say, however, that I am not quite sure what more I can say in response to my hon. Friend the Member for New Forest East following our meeting of 26 March, when we discussed the matter. My hon. Friend has campaigned vigorously since the autumn of last year against Southern Health NHS Foundation Trust’s proposed redesign of acute adult mental health services in Hampshire, and in particular against the withdrawal of the adult in-patient mental health ward at Woodhaven hospital in his constituency. Nevertheless, in the course of my remarks, I will seek to explain and to lay out the policy towards the provision of mental health care in Hampshire and the knock-on effects elsewhere.

The debate also gives me the opportunity to thank all the NHS staff who work in the field of mental health and, in particular, the staff at Southern Health NHS Foundation Trust, who do a fantastic job, day in, day out, looking after some of the most vulnerable and frail members of our society with complex medical problems. Locking into the valid point made by the hon. Member for Denton and Reddish (Andrew Gwynne), the staff must also combat the stigma associated with mental health issues. The hon. Gentleman is absolutely right to congratulate Stephen Fry, Mind, Rethink and others who work continuously to break down such barriers. I will be a little more generous politically, because the Major Government in the mid-1990s and the previous Labour Governments of Tony Blair and the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown) did a tremendous amount of work to help bring down barriers and reduce stigma. The trouble is that there is still a long way to go and none of us can relax in fighting that battle.

If one suffers from an acute medical problem, people are all too willing to make hospital visits, to ring up and to inquire after someone’s general well-being, but it is a disgrace that if one’s mental health is suffering, people still too often do not want to find out or are frightened to ask. Even worse, the family and friends of people who suffer from mental illness want to ignore it or hush it up. The patients themselves are often too scared to allude to their medical problems because they are fearful of the response that they might get from family—less often—or friends and, generally, from people in the community. That is our challenge, and that is why I am so full of admiration for people in the NHS and elsewhere in the charitable and voluntary sector who do so much work, not only to look after people at a particularly vulnerable time in their lives but as ambassadors in seeking to break down the barriers and the stigma.

As I explained to my hon. Friend the Member for New Forest East when we met recently, the reconfiguration of local health services is exactly that—a matter for the local NHS. Although he is calling for a halt to the closure of beds at Woodhaven, Ministers cannot and should not be seen to interfere. My hon. Friend, who is generous and courteous, tried to tempt me —he slightly sugared the pill by suggesting that, if not today, perhaps upon reflection—to send out a message, almost like the white smoke that appears from the Vatican when a new Pope is elected, to the trust, and if not to the trust, certainly to the Hampshire HOSC, saying how much I would welcome a referral to my right hon. Friend the Secretary of State.

[Dr Lewis]

Do it.

[Mr Burns]

I know that nothing would give my hon. Friend greater pleasure, but I must warn him that I have been here too long to fall into that pit. It would completely compromise the independence of local government. I am sure he agrees that all too often, Governments of different political parties have been criticised for interfering too much in local government, and that local councillors are elected to local authorities to make decisions about matters that they, because of their representation of their constituents, are most familiar with. It would not be the way forward for a heavy-handed Minister at 79 Whitehall to issue messages of welcome for things. It would compromise the ethos and independence of local democracy, and the way in which local people elect local councillors to represent their views. Therefore, I must disappoint my hon. Friend.

[Andrew Griffiths]

I am a fan of localism, and I completely support what the Minister says, but does he not recognise that there is a massive lack of democratic accountability in how PCTs operate? No one elects them. They make decisions, and they are accountable only to themselves and ultimately to the Minister.

[Mr Burns]

My hon. Friend makes a valid point, and I have total sympathy with it. It is precisely why we are abolishing PCTs on 1 April next year, and why we are creating the clinical commissioning groups under the Health and Social Care Act 2012. Those groups will consist of GPs, who are most familiar with their patients’ needs and requirements, and will commission care for their patients, and create the health and wellbeing boards which will, for the first time in a generation, have democratic accountability because they will include locally elected councillors and will have responsibility under the Act and the reforms to look out for and to ensure that the needs of the local health economy are being met in local communities. That is a positive and straightforward step in addressing the very problem that my hon. Friend raised.

In response to my hon. Friend the Member for New Forest East, decisions on reconfiguration of services will be made by the local health economy, not Ministers in Whitehall. He will be aware that planned changes to in-patient mental health beds in Hampshire have been the subject of local discussions since 2009-10. However, to reiterate the clinical case for change, it will allow investment in better alternatives to in-patient care by increasing home treatment, and developing other measures to support people outside hospital in Hampshire. The number of in-patient beds will decrease by 58, from the current total of 165, to 107. That addresses the question asked by my hon. Friend the Member for Romsey and Southampton North about how many beds were involved from the start to the finish of the process. The change will also enable growth in community reablement services in the New Forest to help and support people with longer-term mental health needs, allowing them to live a more independent and fulfilling life when that is clinically appropriate.

Doctors and other professionals, the public and service users have all been involved in this process in Hampshire from the outset, and their views have always been taken into account, even when they were not supportive of the proposals and the proposals were not radically changed or abandoned.

[Dr Lewis]

It is true that there has been public consultation. It is also true that soon afterwards an analysis of the responses listed concern about this, that and the other. If I remember correctly, the consultation ended in October last year, and it took me until March to get the trust to admit that the heavy majority of people who responded to the consultation were against the bed closures. It consults, and then carries on as though nothing has happened.

[Mr Burns]

I appreciate that point, and I will come to it.

I must reiterate that decisions on the reconfiguration of services are, as with all reconfiguration, for the local health economy to make, led by local people, local GPs and local clinicians. I have been assured that the proposed changes are supported by the majority of GPs, most but not all clinicians and the clinical commissioning group in the New Forest, as well as the Hampshire HOSC. I listened to the procedures and activities of the Hampshire HOSC and what happened at its meetings, but my hon. Friend will appreciate that those decisions do not come within Ministers’ responsibilities.

The Hampshire HOSC consists of elected county councillors who are responsible for and accountable to their local communities, and they made the decision not to refer the matter to my right hon. Friend the Secretary of State. I am sure that my hon. Friend accepts that I cannot dictate—I would not seek to, because it would be inappropriate—what an HOSC should do. It is an independent body with democratic accountability, and it will consider the sort of complaints that my hon. Friend and others have raised to see whether, on balance, it believes that they could lead to its deciding that the proposed reconfiguration is inappropriate and that it should be referred to my right hon. Friend with a request that it is then sent to the independent reconfiguration panel.

The problem for my hon. Friend and others who oppose the proposal is that that body, which has the power to seek a referral, has so far refused to do so. I am sure that my hon. Friend will accept that not only do I have no right or power to do that, but it would be totally inappropriate for me as a Minister to seek to interfere with the working of that local government committee and its decisions.

[Dr Lewis]

I fully respect and accept the Minister’s point. Will he reiterate the point that he made at our previous meeting that even now, if it chose to do so, the HOSC could make that referral to the Secretary of State?

[Mr Burns]

I can reiterate that if the HOSC decides—my hon. Friend said during his eloquent speech that there will be a further meeting in May—that there is new evidence, or whatever, and that it wants to reverse that decision, nothing in the rules and procedures prevents it from doing so. However, it has had two meetings and has heard the evidence and arguments, and the pros and cons, and has not decided so far to take that decision. It has decided not to make a referral to my right hon. Friend. I do not know whether it will change its mind at the meeting in May, and it is not for me to speculate, or to try to influence it. However, in theory, if it wished to make that referral, it could.

I understand that the trust is investing more than £1.3 million in community services and developing alternative patient care in Hampshire. For example, four new specialist liaison staff will help service users to move more easily from in-patient care to the community, and crisis funds will help service users who may struggle to pay things such as deposits on accommodation and household items, or electricity and gas charge cards. As my hon. Friend will accept, it is important to have plans and measures in place so that those people for whom treatment is more appropriate in the home or the community have the structures to help them ensure that that happens. Mental health services are no different from those for acute care, and no one wants to be in hospital for a day longer than they have to be. If it is more appropriate to care for someone in a home setting, with proper support and access to services, or in the community, that is better for the patient. However, such care must be based on a clinical decision about what is most appropriate.

More than 50 staff will form part of hospital-at-home teams, providing intensive support to people where they live and helping them to remain or return to their homes. They will also help to prevent readmission to hospital. In the west of Hampshire, three members of staff will work to support service users who have more complex mental health needs and to help them to gain emotional and vocational skills that will support their recovery and health.

The launch of those services, which are still in their early days, has shown that service users are able to re-establish links with their community and gain the confidence to adapt to home and family life. As a result of the investment, the trust has seen people staying in hospital for a shorter period of time because they receive more intensive support both before they leave hospital and afterwards in the community.

Independent service user and carer groups—for example, the west Hants area service user involvement project or the Princess Royal Trust for Carers—have worked closely with the trust to develop plans, and they have been supportive of the changes. The service user-led recovery philosophy for mental health services has underpinned many of those proposed changes.

As I said earlier, the proposed changes have had throughout the full support of GPs, most clinicians, service users and the HOSC, thereby demonstrating the importance of locally led change at the heart of our NHS. As my hon. Friend alluded to, the Hampshire HOSC last met on 27 March, and its chair wrote to Katrina Percy, the chief executive at the Southern Health NHS Foundation Trust, advising her that pausing the proposed changes would not be in the best interests of local people who were affected by them.

Of course, the HOSC recognises that local people are worried about the changes, and that is why it has agreed to set up a small task and finish group to discuss the concerns raised at the meeting on 27 March. The group will report its findings at the HOSC meeting scheduled for 22 May 2012. In the meantime, let me say that the changes proposed in Hampshire are not unusual—we got a flavour of that from my hon. Friend the Member for Burton, who I know has conducted a vigorous campaign about elements of the proposals in his county that he considers to be deeply flawed.

[Dr Lewis]

On a slightly lighter note, the Minister may be interested to know that the Southern Health NHS Foundation Trust appears to think that what it has been doing is a suitable model and template for the whole country. It has applied for NHS funding because it wants to design a

“comprehensive, independent service evaluation...to inform day-to-day operational business context”

and

“future modelling of service changes.”

Instead of giving the trust more NHS money, perhaps the Minister should provide it with a link to today’s debate, which will show everyone exactly how such trusts go about their reconfigurations.

[Mr Burns]

That is an interesting point that gives one side of the argument. I do not want to labour the point, but unfortunately the other side of the argument suggests that most GPs and clinicians, together with many service users and the HOSC, have so far not shared that view because in various ways they have been supportive of what the trust is doing. That is a serious problem for my hon. Friend, because the nub of the argument is that the democratically elected overview and scrutiny committee has so far refused, or felt it unnecessary, to decide that the trust’s proposals should be referred to the Secretary of State and then to the independent reconfiguration panel. That is the mountain that my hon. Friend has to climb, and as with most arguments there are two views about the effectiveness, efficiency and correctness of the proposals. So far, he is on the losing side within the rules and the way that things are done locally.

Hampshire is not unusual, but the important point is to achieve the best possible outcomes for people in mental health crisis. Significant changes have been made to community and hospital services, so that they become more responsive to people’s needs and more attentive to the physical environments in which care is received.

Other mental health trusts in England have already reduced the number of in-patient beds, so that more support can be given to people in familiar and appropriate surroundings, such as their own homes. Local changes are in line with the “no health without mental health” strategy that was launched on 2 February 2011. As my hon. Friend will know, that is a cross-governmental mental health outcomes strategy for people of all ages, with the twin aims of improving the population’s mental health and improving mental health services. The strategy takes a life course approach and sends the message that prevention and early intervention are key priorities. It also stresses the interdependence of mental and physical health—a point raised by the hon. Member for Denton and Reddish.

The bulk of the strategy will be delivered locally—as it should be—by experts on the ground working with service users and their families and carers. At national level, our early years policies, including health visitors and the pupil premium, are about helping children and young families to get the best start. We expect that investment to save the NHS £272 million, which will then be available to doctors and nurses for reinvestment in front-line services. That will save the public sector £704 million over the next six years—again, that money can be reinvested in front-line services, which I am sure all hon. Members would agree is where it should go.

As the Department of Health completes the nationwide roll-out of psychological therapy services for adults who suffer from depression or anxiety disorders, we will pay particular attention to ensuring appropriate access for people over 65 years of age. We have also committed an extra £7.2 million for mental health services for veterans—a key point given what is happening in that area of mental health.

Many patients who suffer from long-term conditions do not expect a long stay in hospital. They expect to be treated promptly and then discharged, so that they can go home and continue to recover with proper support and access to proper care and treatment. That is the most important thing. Patients in my hon. Friend’s constituency, those of all Hampshire MPs or, indeed, throughout the country who suffer from mental health problems must receive appropriate and swift care and be looked after to the highest standards and in the most appropriate setting. That lies at the heart of the problems highlighted by my hon. Friend.

In conclusion, my hon. Friend should continue his discussions not with a Minister with a heavy-handed approach who dictates things from Whitehall, but with democratically elected councillors and others on the ground in his constituency and in Hampshire.

Oral Answers to Questions

Simon Burns Excerpts

Tuesday 27th March 2012 Commons Chamber

[Gavin Shuker (Luton South) (Lab/Co-op)]

7. What his most recent estimate is of the cost of NHS reorganisation.

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

The cost of the NHS modernisation is estimated to be between £1.2 billion and £1.3 billion. It will save £4.5 billion over the rest of this Parliament and £1.5 billion a year to 2020. We will reinvest every penny saved in the NHS in front-line services.

[Mr Crausby]

The Bolton clinical commissioning group estimates that its budget will be about £25 per Bolton resident, or £100 for a couple with two children. Is that not too much, considering that they will get no medical treatment at all from that money, just administration money paid to doctors who should really be treating patients and not sat in the back office?

[Mr Burns]

No, I do not believe it is. The administration figure that has been announced for CCGs throughout the country is £25 a patient, but if a CCG is more effective and efficient in providing administration and bureaucracy and makes savings, those savings can be transferred and reinvested in funding the care of their patients. That is an incentive for them to be streamlined and to ensure that that happens.

[Gavin Shuker]

The Minister speaks of reinvesting every single penny in the NHS budget. How does that fit with the £500 million raid on the NHS budget spoken of this week?

[Mr Burns]

If I could explain this to the hon. Gentleman, the £500 million that he is talking about was part of the savings made through renegotiating the IT contract. It is a perfectly normal procedure, because as the right hon. Member for Leigh (Andy Burnham) will know, the average figure for previous years was £850 million, and one year when he was a Minister at the Department of Health, it was £2.3 billion.

[David Tredinnick (Bosworth) (Con)]

As part of the reorganisation, my right hon. Friend the Secretary of State has decided—rightly in my view—that the Health Professions Council will regulate Chinese medical practitioners, but there is widespread concern in the community that these practitioners will not have protection of title. Will he please ensure that they do when he finishes his consultation?

[Mr Burns]

I am extremely grateful to my hon. Friend and, as his question suggested, there is a consultation process. I can give him an assurance that the point that he has made will be fully considered as part of that consultation process.

[Robert Halfon (Harlow) (Con)]

Is my hon. Friend aware that the NHS reorganisation will abolish the strategic health authority in the eastern region, which will save £46 million a year—money that will be spent on front-line services in Harlow and elsewhere?

[Mr Burns]

I am extremely grateful to my hon. Friend for pointing that out. It is crucial that we slim down the bureaucracy and management of the NHS so that we can make savings, so that they can go where they should—to provide more care for patients in the NHS.

[Andy Burnham (Leigh) (Lab)]

Last week in the emergency debate, the Secretary of State said:

“Risk registers…are not a prediction of the future. They set out a worst-case scenario”.—[Official Report, 20 March 2012; Vol. 542, c. 676.]

I now have an early version of the risk register that civil servants gave him in September 2010. Risk No. 7 of his reorganisation was that “Financial control is lost.” That was red rated and, according to the document, likely to happen with major consequences. Is it not clear that last week the Secretary of State gave an inaccurate description of the risk registers he saw, and should he not now come to the Dispatch Box to correct the record?

[Mr Burns]

May I reassure you, Mr Speaker, if not so much the right hon. Gentleman, that my right hon. Friend did not mislead anyone? The answer to the right hon. Gentleman’s question is the same as he and his predecessors pursued under the last Labour Government—and was pursued under the Thatcher and Major Governments—which is that Ministers do not comment on leaked documents.

[Andy Burnham]

The rest of the world is, and we would be interested to hear the Government’s views on it. Here we have it in full colour. It is not the worst-case scenario, as the Secretary of State claimed, but 43 very real and predictable risks, 21 of which are red rated and 14 likely to happen with major consequences. They include:

“Emergencies…less well managed…more failures…GP consortia go bust or have to cut services…performance dips and key staff lost”.

Is it not now clear for all to see that the Secretary of State and his Ministers have knowingly taken major risks with the national health service, ignored warnings from civil servants and kept those risks secret from Parliament in order to get their unnecessary Bill through?

[Mr Burns]

I am not quite sure which word in my last answer the right hon. Gentleman did not understand, so I will repeat it. Like previous Governments, we do not comment on leaked documents. Instead of coming to the Dispatch Box and talking down the fantastic work that nurses and doctors do day in and day out, why does he not read the quarter, the latest copy of which is full of facts about how the NHS is improving its performance and delivering better quality care for patients throughout England?

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

3. What assessment he has made of progress in tackling tuberculosis in England.

--- Later in debate ---

[Stephen Barclay (North East Cambridgeshire) (Con)]

9. What steps his Department is taking to develop more effective performance management of GPs.

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

As set out in the Health and Social Care Bill, performance management of general practice will become the responsibility of the new NHS Commissioning Board from April 2013. This will enable, for the first time, a single, consistent approach to be developed for the assessment and management of general practice.

[Stephen Barclay]

As with any profession, the performance of GPs varies widely. As more power is devolved to GPs, does my right hon. Friend recognise the importance of independent performance management of GPs, in order to identify outliers and improve patient care?

[Mr Burns]

I am extremely grateful to my hon. Friend, given his past association as a constituency MP with this subject, because of the problems in his constituency. I believe that we have a strong system of general practice in this country, but I am afraid that more can be done to address variations in aspects of the quality of provision by some general practitioners. As I have said, the NHS Commissioning Board will adopt a single, consistent approach, allowing an overview of performance, which is not currently possible, and ensuring that interventions occur at an early stage. I think that will go a considerable way towards helping with the problems that have been experienced.

[Jim Shannon (Strangford) (DUP)]

As an elected representative for a great many years, I have often been made aware of issues relating to GPs and patient lists. Does the Minister agree that there should be greater co-operation between the Health Department and GPs with regard to their patient lists, and specifically with regard to the transfer of patients?

[Mr Burns]

With regard to the transfer of patients, we are seeking to give greater choice to patients under the modernisation programme so that they can move from one GP, or one GP practice, to another in a way that they cannot do at the moment. That will help to enhance the power of patients to get the GP of their choice and preference.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I am sure that the Minister would agree with me about the importance of addressing alcohol misuse through the alcohol strategy announced last week. On the performance management of GPs, however, does he agree that we need to do more than just monitor how much people drink, and that we need to ensure that GPs are incentivised to tackle the problem drinkers who attend their surgeries?

[Mr Burns]

Yes, my hon. Friend raises an important issue. We must ensure that every contact counts, and that there is greater working between GPs and patients to help to deal with what is a significant problem among certain sections of the community.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The first step that the Government should take is to start listening to doctors. Is it not the case that some senior GPs are now spending as little as one day a week seeing patients because they are too busy working on the Government’s massive NHS upheaval? It is costing the NHS up to £124,000 a year to replace each of those GPs with a locum. That is why the Department’s leaked transition risk register warns that GP leaders are not sufficiently developed to run consortia, and that they might be drawn into managerial processes that drive clinical behaviour, rather than the other way round. The risk rating for that is that it is likely to happen, with major consequences. When is the Minister going to get his head out of the sand and start listening?

[Mr Burns]

Well, that interesting rant bore little relation to the facts—[Interruption.] If the hon. Member for Copeland (Mr Reed) would just button it for a minute, he will get the answer. The answer is that we are constantly listening to GPs, nurses, consultants and others within the NHS health economy. As we showed during the progress of the Health and Social Care Bill, we listened and we accepted a number of recommendations from the Future Forum and from a number of others, which strengthened and improved the Bill. I have to say that the hon. Member for Denton and Reddish (Andrew Gwynne) just does not get it.

--- Later in debate ---

[Neil Carmichael (Stroud) (Con)]

15. What assessment he has made of the provision of vision screening for children.

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

The Department of Health has made no assessment of the provision of vision screening for children. However, the UK National Screening Committee, which advises Ministers and the NHS on all aspects of screening, has commissioned a national mapping exercise to look at how many primary care trusts offer vision screening.

[Neil Carmichael]

There is some evidence of variance across the country, with some PCTs not conforming to current arrangements. What thought has been given to how to improve the situation and iron out the variance?

[Mr Burns]

As my hon. Friend will be aware, the National Screening Committee recommends screening for visual impairment for children between the ages of four and five, and encourages all PCTs to follow those recommendations and ensure that children are screened. However, the Government are aware that, as my hon. Friend says, there are variations in the commissioning of vision screening across PCTs, and it welcomes the review that is being undertaken. We await its recommendations as regards those variations, but we hope that under the new arrangements, after the abolition of PCTs, there will be a far more uniform approach to commissioning and screening.

--- Later in debate ---

[Jeremy Lefroy (Stafford) (Con)]

T8. Could my right hon. Friend indicate how he proposes to use his welcome new duty to reduce health inequalities under the Health and Social Care Bill?

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

I am extremely grateful to my hon. Friend for that question. As he will be aware from his time on the Bill Committee this Government have for the first time in the 64 years of the NHS put into legislation a duty to reduce health inequalities. That will be done through the NHS Commissioning Board and clinical commissioning groups, each being under a duty to have regard to the need to reduce inequalities in access to and the outcomes of health care. The Secretary of State will also have a wider duty to have regard to the need to reduce inequalities relating to the health service. That will include his duties for both the NHS and public health. It is a great step forward and I am surprised that the previous Government did not think of doing it during their 13 years.

[Rosie Cooper (West Lancashire) (Lab)]

T4. At a time of major upheaval in the national health service, the people of west Lancashire and other areas of Lancashire are being failed by the chief executive of the Lancashire primary care trust cluster. Living in Yorkshire and working from Lancaster, Janet Soo-Chung has failed to meet with me or other colleagues, including my hon. Friend the Member for Chorley (Mr Hoyle). Can the Secretary of State assure me that the necessary time and development is being invested in health services in west Lancashire to ensure that authorisation takes place in a timely way without conditions and that the health services provided to my constituents are good?

[Stuart Andrew (Pudsey) (Con)]

Currently, there is a review into paediatric cardiac services going on. I recognise that that is independent of Government, but we now have the independent analysis of patient flows, which says exactly what we have been saying—that patients in south and west Yorkshire will not go to Newcastle. Does my right hon. Friend agree that this is an important development and that the options should reflect that because this is a serious problem for heart services in the north of England?

[Mr Simon Burns]

I congratulate my hon. Friend on his persistent championing of his constituents, but sadly I cannot be drawn into a discussion about evidence, facts and figures that might come up around this issue, because as he will appreciate it is an independent review which is divorced from Ministers.

[Chris Ruane (Vale of Clwyd) (Lab)]

T5. Mindfulness-based meditation techniques have been deemed by the National Institute for Health and Clinical Excellence to be more effective than drug-based therapy in the treatment of recurring depression in many circumstances. Will the Minister tell the House his views on mindfulness-based techniques and say what other conditions and diseases he thinks would benefit from such therapy?

--- Later in debate ---

[Mr Simon Burns]

I hope I can reassure my hon. Friend. PCTs carrying legacy debt into 2012-13 must clear it. Clinical commissioning groups will not be responsible for resolving primary care trust legacy debt that arose prior to 2011-12. It is expected that aspirant CCGs will continue to work closely with primary care trusts and primary care trust clusters in 2012-13 to ensure that no PCT ends 2012-13 in a deficit position.

[Bill Esterson (Sefton Central) (Lab)]

One NHS consultant told me that

“NHS reorganisation could mean that you are forced to spend around 10% of your income on private health care insurance.”

Does the Secretary of State accept that the doctor is right to say that people will either wait longer for care or they will have to pay for it?

--- Later in debate ---

[Mr Speaker]

Order. The hon. Gentleman should resume his seat. I do not wish to be unkind, but topical questions are about short questions, and that was not. I am very sorry. The Minister may give a brief reply if he wishes.

[Mr Simon Burns]

The industrial action to which my hon. Friend refers showed both the best and the worst sides of industrial relations in this country. On the one hand, it showed the worst excesses of union militancy and intransigence in failing to put effective contingency plans in place ahead of strike day, and then in refusing to call off the strike. On the other hand, it showed the best traditions of public services when the Metropolitan police, St John Ambulance and many out-of-hour providers came to the aid of the London ambulance service. Were it not for their help, the situation could have been even more serious.

[Mr Speaker]

The Minister’s power to anticipate what will be said to him is extremely impressive, and I congratulate him immensely warmly.

Health and Social Care Bill

Simon Burns Excerpts

Tuesday 20th March 2012 Commons Chamber

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

I beg to move, That this House agrees with Lords amendment 1.

[Mr Speaker]

With this we will consider the following:

Lords amendments 2 to 10 and 13 to 30.

Lords amendment 31, and amendment (a) thereto.

Lords amendments 32 to 42, 54 to 60, 74, 242, 246, 248, 252, 287, 292 to 294, 299 to 326, 328 to 332 and 335 to 342.

[Mr Burns]

The aim of this Bill is to secure a national health service that achieves results that are among the best in the world. Through it, the Government reaffirm their commitment to the values and principles of the NHS: a comprehensive service, available to all, free at the point of use and based on need, not ability to pay. However, we have always been prepared to listen and make changes to improve the Bill, and we have continued to do so in another place. The Lords amendments in this group fall within five main areas.

First, we recognised that concerns had been expressed about the Secretary of State’s accountability for the health service. Although it was never our intention in any way to undermine that responsibility, we have worked with Members of another place and the House of Lords Constitution Committee to agree Lords amendments 2 to 5, 17, 18, 24, 39, 40, 74, 246, 287 and 292. Those amendments put beyond doubt ministerial accountability to Parliament for the health service. In addition, they amend the autonomy duties on the Secretary of State and the NHS Commissioning Board, to make it explicit that the interests of the health service must always take priority. They also amend the intervention powers of the Secretary of State and the board, to clarify that they can intervene if they think a body is significantly failing to exercise its functions consistently with the interests of the health service. Finally, a new provision will make it explicit that the Secretary of State must have regard to the NHS constitution in exercising his functions in relation to the health service.

Although clinical commissioning groups will have autonomy in their individual decisions, Lords amendment 9 clarifies that CCGs must commission services consistently with the discharge by the Secretary of State and the board of their duty to promote a comprehensive health service, and with the objectives and requirements in the board’s mandate.

The Government also tabled amendments in response to the recommendations of the House of Lords Select Committee on Delegated Powers and Regulatory Reform, all of which we have accepted. Amendments 15 and 16 ensure that the requirements set out in the mandate, and any revisions to those requirements, must now be given effect by regulations.

Commissioning will be led by GPs, who know patients best. However, with that responsibility must come accountability. Therefore, further to the amendments made in the House requiring CCGs to have governing bodies, the other place has strengthened requirements in relation to CCGs’ management of conflicts of interest. We recognised how important it is to ensure the highest standards of probity in CCGs and accepted amendments 31, 300, 301 and 302, which were tabled by the noble Baroness Barker, and which require CCGs to make arrangements to ensure that members and employees of CCGs, members of the governing body, and members of their committees and sub-committees, declare their interests in publicly accessible registers.

The amendments also require CCGs to make arrangements for managing conflicts of interest and potential conflicts of interest in such a way as to ensure that they do not, and do not appear to, affect the integrity of the board’s decision-making processes. The board must issue statutory guidance on conflicts of interest, to which CCGs must have regard.

Taken together, those amendments provide certainty that there will be clear and transparent lines of accountability in the reformed NHS. However, I cannot support Opposition amendment (a) to Lords amendment 31. The Bill is clear that CCGs must manage conflicts of interest in a way that secures maximum transparency and probity. In most cases, that would mean that a conflicted individual withdraws from the decision-making process, but that might not always be possible, for instance when a CCG is commissioning for local community-based alternatives to hospital services, and determines that the most effective and appropriate way to secure them is to get them from all local GP providers within its geographic area. In that event, it would not be possible for every GP to withdraw from the decision-making process. We cannot, therefore, agree to a blanket ban.

[Andrew George (St Ives) (LD)]

Will the Minister clarify something in view of what he has just said about the conflict that all members of the board and the CCG will have with regard to decisions on the provision of new services? Does he share my fear that the structure of CCGs results in bodies that will continue to be conflicted? Does that continuing conflict not undermine that important structure within the health service?

[Mr Burns]

I appreciate the hon. Gentleman’s intervention, but I am afraid I do not share that view. I hope that what I shall go on to say will help to give him additional reassurance on that.

There will be additional safeguards in the Bill to ensure that those processes are transparent, including the regulations that Monitor will enforce on procurement practices and its accompanying guidance. In addition, the board must publish guidance for CCGs on their duties in relation to the management of conflicts of interest. Of course, the CCGs' commissioning intentions will have been set out in its commissioning plan, which is subject to consultation with both the public and the health and wellbeing boards.

The second area in which the other place has strengthened the Bill relates to the duties placed on commissioners to ensure a patient-focused NHS. It has always been the Government’s intention to put in place reforms that support the simple principle, “No decision about me without me.” To achieve that, commissioners will for the first time have a duty in relation to patient involvement in decisions. The House strengthened those duties following the listening exercise, and they were further improved by amendments 19, 32 and 33 in the other place, to make it explicit that the duty means promoting the involvement of patients in decisions relating to their own care or treatment.

Another core principle of the White Paper was the need to eliminate discrimination and reduce inequalities in care. The Bill will for the first time in the history of the NHS place specific duties on the Secretary of State and commissioners to have regard to the need to reduce health inequalities.

To reinforce that further, the other place agreed amendments 22, 23, 36, 37, 38 and 60. These ensure that the Secretary of State, the board and CCGs will be better held to account for the exercise of these duties through their annual reports, the board’s business plan and, in the case of CCGs, their commissioning plans and annual performance assessment by the board. However, improvements in quality, outcomes, and reduced inequalities will not happen unless we better integrate services for patients. That is why we placed duties on commissioners, again for the first time, to promote integration in new sections 13M and 14Y, and made clear, following the listening exercise, that competition will not take priority over integration.

[Mr Robert Walter (North Dorset) (Con)]

I met GPs and consultants in Tavistock in west Devon the other day. One of the great concerns that consultants have, particularly in the field of paediatrics, is the integration of children’s services. A great deal of work has gone into that. In dealing with these amendments, what assurance can my right hon. Friend give that the integration of children’s services will be particularly emphasised in these changes?

[Mr Burns]

I hope that my hon. Friend will be reassured by two points. First, the Bill contains far greater duties and responsibilities for integration over the whole provision of care within the NHS, and that will obviously include children’s services. Secondly and more precisely on the narrow issue that he raised, the children’s health outcomes strategy, published some time ago, will ensure that commissioners provide services to improve integration and that there is greater working together between the NHS, public health bodies and commissioners in securing an improved pathway of care and greater integration.

Lords amendment 320 ensures that the NHS continues to provide funds to local government for investment in community services at the interface between health and social care.

Thirdly, amendments in the other place have placed a greater emphasis on the duties of the Secretary of State and commissioners with regard to system-wide issues, such as education, training and research. Amendment 7 ensures that the Secretary of State will remain responsible for securing an effective system of education and training. Amendments 21, 26, 35 and 42 will place duties on the board and CCGs to have regard to the need to promote education and training, and the Government supported the noble Lord Patel’s amendment to ensure that providers of health services were required to participate in the planning, commissioning and delivery of education and training.

The Government have also listened further to concerns that the strength of the research duties on the Secretary of State, the board and CCGs did not properly reflect the importance of the NHS as a world leader in supporting research. Amendments 6, 20 and 34 have strengthened these to a more direct duty to promote research.

Fourthly, concerns were expressed in the other place about the treatment of charities, other voluntary sector organisations and social enterprises that provide or want to provide NHS services. We are committed to a fair playing field for all providers of NHS services, regardless of their size or organisational form. We see voluntary organisations and social enterprises as key to this vision. For example, they can play a key role in understanding the needs of local communities and delivering tailored services.

Amendment 8 commits the Secretary of State to undertake a thorough and impartial statutory review of the whole of the fair playing field for NHS-funded services. I can confirm that it will cover all types and sizes of provider, including charities, social enterprises, mutuals and smaller providers. It will consider the full range of issues that can act as barriers for providers, including access to and cost of capital, access to appropriate insurance and indemnity cover, taxation and access to the NHS pension fund. The Secretary of State will be required to keep consideration of these issues under review. As my noble Friend Earl Howe set out in another place, during preparation of the report there will be full engagement with all provider types, commissioners and other interested stakeholders to ensure their concerns are looked at.

Finally, I turn to the amendments relating to mental health services. I would like to thank my noble Friend Lord Mackay for his work in developing amendment 1, which inserts the words “physical and mental” into clause 1 in order to promote “parity of esteem” between physical and mental health services. In response to the Royal College of Psychiatrists’ concerns, I would like to offer the reassurance that the definition of “illness” in section 275 of the National Health Service Act 2006 would continue to apply to section 1, meaning, for example, that learning disabilities, mental disorders and physical disabilities would continue to be covered by the comprehensive health service.

Although our view is that the most important work in achieving genuine parity of esteem will be non-legislative—for example, through our recent mental health strategy, “No Health without Mental Health”—we recognise the symbolic significance of including these words in clause 1. Mental health is a priority for this Government, so I commit to considering further the role that the mandate, the NHS and public health outcomes frameworks can play in driving improvements in mental health services. Similarly, we decided not to oppose amendment 54 by the noble Lord Patel of Bradford relating to mental health aftercare services provided under section 117 of the Mental Health Act 1983, and tabled a number of consequential technical amendments.

I am grateful for the scrutiny that the Bill has received in another place. There is no doubt that it has been strengthened and improved as a result. It will help to ensure that the Secretary of State will remain accountable overall for the health service and provide a robust framework for holding commissioners to account. I urge hon. Friends and hon. Members to agree to the Lords amendments in this group, but to reject Opposition amendment (a) to Lords amendment 31.

[Liz Kendall (Leicester West) (Lab)]

There have been 1,000 Government amendments to this disastrous Health and Social Care Bill—374 in the other place alone—and it is unacceptable that elected Members in this House have been given so little time to debate amendments that will affect patients and the public in every constituency in England.

It is essential that we reach the second group of amendments, on parts 3 and 4 of the Bill, which deal with Monitor, foundation trusts and the Government’s plans to raise to 49% the private patient cap in foundation trusts, but I want to start with the Lords amendments to the Secretary of State’s duty to ensure a comprehensive service in the NHS. I will remind hon. Members where this all began.

On 10 February last year, my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) challenged the Secretary of State, in his evidence to the Commons Bill Committee, over why he was removing the Secretary of State’s responsibility to provide a comprehensive service in the NHS. He said:

“I have not... It is in the original language. It is reproduced the same way.”––[Official Report, Health and Social Care Public Bill Committee, 10 February 2011; c. 166, Q402 and 404.]

On 15 February, my hon. Friend the Member for Halton (Derek Twigg) challenged the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) about the removal of the Secretary of State’s duty to provide comprehensive NHS services. Again, this was categorically denied. The Minister said:

“Clause 1 retains the overarching…duty which dates from the original 1946 Act”.––[Official Report, Health and Social Care Public Bill Committee, 15 February 2011; c. 178.]

He also said that any amendments to the clause were “unnecessary”. Today the Government are being forced to eat their words.

For the record, it was the determination of Labour Members in the other place, not Liberal Democrat Members, that forced the Government to place the clauses relating to the Secretary of State’ duties on promoting a comprehensive service and on autonomy within the remit of the Lords Constitution Committee, chaired by the noble Baroness Jay of Paddington. The result of the Committee’s deliberations are the amendments before us today. The amendments do not deliver exactly the same duty as the National Health Service Act 2006, but they are a significant improvement. Pressed on this issue by Labour Members in both Houses and at every stage of the Bill, the Government have been forced to concede.

A similar thing has happened on education and training, which is the subject of Lords amendments 7, 21, 26, 35 and 42.

--- Later in debate ---

[Grahame M. Morris]

I am grateful for that intervention and I share the hon. Gentleman’s concern that this amendment, which deals with the Secretary of State’s powers, and, indeed, the whole thrust of the Bill, are likely to lead to a fragmented service, when what we all want to see is co-operation and integration. I am concerned about the direction of travel in that respect.

The point about autonomy is relevant, because Lords amendment 2 reiterates that

“The Secretary of State retains ministerial responsibility to Parliament for the provision of”

health services. Lords amendments 4 and 17 would further amend clauses 4 and 20 in order to downgrade the duty to promote autonomy even more, through the idea that the Secretary of State must only

“have regard to the desirability of securing”

autonomy instead. When it comes to ministerial accountability for the Secretary of State, we have a yearly mandate to the NHS Commissioning Board, which will remove the Secretary of State—and therefore Parliament—from being involved in or interfering in the running of the NHS. In that case, I ask the Minister: what would be the point of Health questions? As private health care interests take over the provision of health services, they will not be subjected to freedom of information requests or other forms of accountability to which NHS providers are subjected.

[Mr Simon Burns]

Will the hon. Gentleman give way?

[Grahame M. Morris]

I will in a moment, but I want to pose a few questions first. The Secretary of State clearly cannot answer for private companies that are exempt from FOI requests. He cannot answer for GP commissioning groups, which are essentially independent contractors and private bodies. Surely, it is clear that the Secretary of State is handing over a big chunk of the NHS budget to private GP commissioning groups, cutting himself and Parliament out of the loop. I therefore believe that it is a fantasy to say that the Secretary of State will remain accountable.

[Mr Burns]

There is almost—no, there is—an air of déjà vu to this part of the hon. Gentleman’s speech, as there always is. We discussed this in Committee, and I am a bit frustrated that he cannot quite get it. The fact is that at the moment there is virtually no transparency and no real accountability as to what a Secretary of State does with regard to the provision of health services. The fact is that the mandate will be published; it can be debated in this House either on a motion from the Government or from the Opposition; there will still be Question Time at which hon. Members will be able to ask questions; there will still be an opportunity for Adjournment debates, urgent questions and statements. There will be accountability.

[Grahame M. Morris]

Well, as Aneurin Bevan said, “You give your version of the truth, and I will give mine.” In my assessment, yes, there will certainly be a mandate, but this House’s power to scrutinise and hold Ministers to account will be severely diminished under the new arrangements. Writing down that the Secretary of State has the duty

“to exercise functions to secure the provision of services”

is thus rather perverse—one might even say ridiculous—when the rest of the Bill hands over those duties to other bodies, often private bodies outside the NHS such as the clinical commissioning groups. Indeed, the National Commissioning Board—the world’s biggest quango—will also secure provision through clinical commissioning groups, which will not be done through the Secretary of State. [Interruption.] I think the Minister is being extremely disrespectful, Madam Deputy Speaker, in the way he is gesticulating when I am trying to make my points.

In effect, the Secretary of State’s only duty seems to be to pass over the money or the resource and write one letter a year—this mandate—to the National Commissioning Board.

On the issue of the duty to promote a comprehensive health service and secure the provision of services as opposed to any duty to promote autonomy, this surely remains a conundrum, as they are virtually mutually exclusive. How the Secretary of State thought that those two competing principles could sit side by side or that he could balance the two is beyond me. This is the problem with the Bill as a whole. No matter how much tweaking is done to clauses 2, 4 or 20 by these amendments, we cannot escape this dilemma. That brings me back to my key point that this Bill’s driving ideological purpose remains to commercialise and privatise each and every service in the NHS.

Finally, let me return to the definition of autonomy—[Interruption.]—for the information of Conservative Members, who are shouting across the Chamber. According to the dictionary, autonomy means

“the condition of being autonomous; self-government or the right of self-government; independence”.

What we are talking about here is being autonomous or independent of the Secretary of State. My contention is that only central planning can deliver a comprehensive service. Otherwise, we will have postcode lotteries—identified in the risk registers we have discussed, such as the one from the Faculty of Public Health—and unprofitable services being cut back. Once the private sector is too big to control, what then?

[Mr Burns]

rose—

[Grahame M. Morris]

I have concluded my remarks, so perhaps the Minister can address those points in his summing up.

--- Later in debate ---

[Liz Kendall]

The fundamental difference is that under the Bill only two lay people will be appointed as members of clinical commissioning groups, and no independence will be involved. Under the old system, lay members of primary care trusts were independently appointed. The degree of independence that provided checks and balances has gone.

[Mr Simon Burns]

rose—

[Dr Poulter]

I thank the hon. Lady for her intervention, but I will give way to my right hon. Friend the Minister before I respond to it.

[Mr Burns]

The hon. Lady may not fully appreciate this, but the regulations refer to a minimum of two lay members. There is nothing to stop a clinical commissioning group from appointing more than two.

--- Later in debate ---

[Mr Simon Burns]

No.

[John Pugh]

The Minister says “No”, but I tabled a question recently in which I asked him whether he had taken advice from the European Commission. He told me that he had not. [Interruption.] We are talking about European law—

--- Later in debate ---

[Grahame M. Morris]

Will the Minister give way?

[Mr Simon Burns]

Sit down.

[Madam Deputy Speaker (Dawn Primarolo)]

Order. Minister Burns, I will chair the debate in this Chamber. You will not. Unless you want to sit here and allow me to take—

[Mr Burns]

indicated dissent.

[Madam Deputy Speaker]

No? In that case, be quiet.

--- Later in debate ---

[Andy Burnham]

It is not rubbish. They can earn 49% of their income, according to this Bill, from the treatment of private patients. That is a fact, and why the hon. Lady shouts “rubbish” I have no idea.

[Mr Burns]

Will the right hon. Gentleman just confirm that when his Government brought in controls on foundation trusts, they allowed non-foundation trusts, which were the majority of trusts at the time, to have a 100% cap?

[Andy Burnham]

Non-foundation trusts were managed by the Department, and the Department’s policy, during our time in government, was to have a tight cap—[Interruption]. There was a tight cap on the income that trusts could earn, so the very fact of foundation trusts’ creation gave rise to the question of whether there should be a cap. The Minister is effectively abolishing that cap with his Bill.

[Mr Simon Burns]

Answer the question.

[Andy Burnham]

I have answered the right hon. Gentleman’s question. It was an entirely different situation altogether.

On the suggestion that we are setting our face against reform, we have not said that, and I as Secretary of State initiated a review of the private patient cap, because the issue came up before the election. I was prepared to allow a modest relaxation of the cap if it could be demonstrated to benefit private patients, but I was talking about single percentage points: 1% or 2% becoming 2% or 3%. I was not in any way conceiving the possibility that 49% of a trust’s income might be made from the treatment of private patients—that half their theatre time, beds and car parking spaces could be turned over to the treatment of private patients.

--- Later in debate ---

[Mr Simon Burns]

No.

[Ms Abbott]

She will, you know. Does she agree that it is apparent over the years that it is one thing to see an intention built into a Bill, but quite another to see it implemented on the ground? It is the contention of Opposition Members that, worthwhile as the statements in the Bill are, in the context of this particular car crash of a Bill, some of those intentions around public health will be dead on arrival.

[Liz Kendall]

I thank my hon. Friend for her, as always, powerful and eloquent description of the realities of the Bill.

[Mr Burns]

Will the hon. Lady give way?

[Liz Kendall]

No, I am not giving way to the Minister.

Although I have said that a number of amendments in the group make minor improvements regarding NICE and the functioning of the information centre, they are overwhelmingly—

[Mr Burns]

Will the hon. Lady give way?

[Liz Kendall]

I have told the Minister that I am not giving way to him.

These amendments are overwhelmingly outweighed by the huge change put forward by the Government in abolishing an effective statutory model for healthwatch bodies locally, which was supposed to give patients and the public a strong and independent voice in the NHS. Labour Members cannot accept the Government’s removal of that statutory body, which they promised and have now betrayed. The amendments make a mockery of the Deputy Prime Minister’s claim in the letter he wrote with Baroness Williams to Liberal Democrat Members that the Bill will ensure “proper accountability” to the public. It makes a mockery, too, of the claims made by the Secretary of State and the Prime Minister that this Bill will put real power into the hands of patients and the public, and that there will be “No decision about me without me.” And, as the national body that represents patients and public involvement in the NHS has said, it is

“a betrayal of public trust”.

This is what has happened throughout the proceedings on a Bill for which the Government—Conservatives and Liberal Democrats—have no mandate, and for which they know they have no mandate. They promised that there would be no top-down reorganisation, but did not present any proposals for an independent regulator on the basis of the system that exists in the privatised utilities because they were worried about what people would say. Above all, on this fundamental issue, which concerns the say that the public and patients have in the NHS, the Government have—as the National Association of LINks Members said—betrayed people’s trust in what they promised, and for that reason we will not support the amendments.

Health and Social Care Bill

Simon Burns Excerpts

Tuesday 13th March 2012 Commons Chamber

[Andy Burnham]

Dr Chand is not an adviser to the Labour party, and the Secretary of State, in seeking to inject that party political note so early on in today’s debate and to claim that the petition of 170,000 people is a political petition, continues, it suggests to me, to misread the mood of this country on his unnecessary Bill.

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

Will the right hon. Gentleman give way?

[Andy Burnham]

No, I will not.

We have arrived at a dangerous moment, not only for the NHS but for our democracy. To recap, this is a Bill for which nobody voted at the general election and which does not have a mandate, a Bill ruled out by the coalition agreement, and a Bill that has been so heavily amended in another place that in effect the unelected Chamber has written a new legal structure for the national health service that we are being asked to rubber-stamp. Yet despite all that, it could be rammed through this House in just seven days’ time, in defiance of an outstanding legal ruling from the Information Tribunal and in the teeth of overwhelming professional and public opposition.

This is an intolerable situation, and it is no way to treat our country’s most valued institution. Far-ranging changes to the NHS of the kind proposed by the Secretary of State can be made only by public consent and professional consensus, and it is plain for all to see that the Government have achieved neither of those things.

--- Later in debate ---

[Joan Walley]

No, I will not.

I agree with the right hon. Member for Charnwood (Mr Dorrell), who chairs the Health Committee, that some aspects of the Bill are very worthy, particularly those on public health, and we do not want to lose them, but four issues need urgent clarification, and I hope the Minister will address them when he replies.

First, why are my constituents not entitled to know what is on the risk register? What is there to hide? Why can we not have it laid before us when we are making important decisions about the future of the NHS? I am quite content for there to be service changes, but not structural, top-down reform, which the Prime Minister himself, in one of his commitments before the general election, said he was not going to introduce.

The key issue for the House is whether the NHS will be subject to the full force of domestic and EU competition law, and that has not yet been clarified. The Government maintain that it will not, but the changes brought about by the Bill make certain that it will. In any event, it is not in the Government’s gift to decide, because the issue will be decided in the courts, so I genuinely believe that we are entitled to clarification on that issue—[Interruption.] I will not give way on that point. It is absolutely essential that the Government, not the law courts of this country, determine NHS policy.

Secondly, what safeguards are there against private companies using loss leaders to replace NHS services and then, once the NHS service has been eliminated, maximising profits by reducing quality? We have heard from the Secretary of State on that, but once the service is eliminated, the private companies that come in will surely have a free hand. The Government say that there will be no competition on price, but private companies will still be able to use loss-leader tactics by overloading a bid with quality for the specified price, so we must have regard to the real concerns about that.

Thirdly, how will the Government stop cherry-picking in practice? If they attempt to exclude private companies from bidding for a particular contract, will they not face court action, and in those circumstances will not services be put on hold while the courts deal with how NHS care is to be provided?

Finally, again when the Minister replies—

[Mr Simon Burns]

In 10 minutes?

[Joan Walley]

Yes, in 10 minutes, because we need time to sort out the NHS. What will the Government do about foundation trusts once they become unsustainable—once they have been undermined by cherry-picking and by loss leaders?

There are huge issues, our constituents’ health is at stake, and this is an important debate, one in which the Government need to take account of what we are saying so that Parliament can have a say in how the NHS goes forward.

--- Later in debate ---

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

I will speak in favour of the Government dropping this truly awful piece of legislation.

Before I do so, I will say a few words about my constituent, Dr Kailash Chand, who began the e-petition against the Bill, which has reached 174,000 signatures. Kailash has been a GP in my area for 27 years. He has been awarded an OBE for his work and in 2009 he was named north-west GP of the year. He has dedicated his life to public health. At times he has spoken out against Government policy, whoever has been in charge. His motivation in creating the e-petition was solely his love for and belief in the NHS. We should be grateful for such public servants. I am delighted that he is here to listen to this debate.

[Mr Simon Burns]

So that everyone fully understands the background, will the hon. Gentleman confirm that this same doctor wants to be a Labour MP, has been appointed by the leader of the Labour party to review Labour party policy on older people, and has worked for the right hon. Member for Wentworth and Dearne (John Healey) in a research capacity?

[Jonathan Reynolds]

The Government are just not willing to listen to the people who will be affected by the Bill. Kailash is not alone in opposing it. If I read out the name of every organisation that opposes the Bill, I would run out of time.

[Mr Burns]

Will the hon. Gentleman give way?

[Jonathan Reynolds]

No, sit down and listen for once.

It is clear that the majority of non-biased, objective opinion is against the Bill proceeding. Never in the field of public policy have so many opposed so much and been listened to so little.

Should the Government not be asking themselves this: if the Health Secretary cannot convince the people who he wants to devolve power to, and if the Deputy Prime Minister cannot convince his own party members to support the Bill, maybe—just maybe—there is not that much going for it? The Health Secretary cannot even visit an NHS hospital, so low has his reputation sunk.

As has been said, the people who oppose the Bill, whether the royal colleges or Opposition Members, do not oppose all reform. Of course, NHS services will have to change over time, particularly in the provision of specialist services. The Labour Government introduced reforms, which used the private sector to the advantage of the NHS. The Bill does the opposite and uses the NHS for the benefit of the private sector. The problem is not reform, but these reforms. To say that anyone who opposes the Bill is against all reform is crass and simplistic.

Let us please put an end to the nonsense that the reforms are just an evolutionary approach following what has happened in the past. If that were the case, would there be an unprecedented groundswell of opinion against them? Once the Bill is passed, the primary care trusts and the strategic health authorities will be gone, and clinical commissioning consortia will be responsible for the whole NHS budget. Local authorities will take public health, and Monitor and the NHS Commissioning Board, not the Department of Health, will be responsible for the health system. That is a fundamental, top-down restructuring of the NHS, and no one wants it.

To justify that revolution, the Government started by rubbishing the success of the NHS. It began with the cancer survival rates and carried on from there, and every time the Government’s case has been knocked down. The King’s Fund, the respected health think-tank, in its review of NHS performance since 1997, clearly showed dramatic falls in waiting times; lower infant mortality; increased life expectancy across every social group; cancer deaths steadily declining; infection rates down, and in mental health services, access to specialist help, which is considered among the best in Europe. Again, I put it to the Government that they have no justification for the revolution that the Bill brings about.

The Government’s other justification has been that the NHS has too many managers, yet their reforms create a structure so confusing that, when an organogram of the new structure was published, it became a viral hit on the internet because it looked so ludicrous. What do the experts in the King’s Fund say about this? The myths section about the Bill on its website says:

“If anything, our analysis seems to suggest that the NHS, particularly given the complexity of health care, is under-rather than over-managed”.

--- Later in debate ---

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

I agree with my hon. Friend the Member for Witham (Priti Patel), who observed in her vigorous and punchy speech that there was an element of déjà vu in the debate.

I was delighted to listen to the speech of the right hon. Member for South Shields (David Miliband). As I listened to it, and to the speech of the right hon. Member for Leigh (Andy Burnham), I reflected on how odd changes in political fortunes are. Those two were the über-Blair reformers, but it was clear from their speeches—both thoughtful in their different ways—that they had turned away from their reforming zeal. I can only put that down to “what a difference a leadership election makes”.

I congratulate my right hon. Friend the Member for Charnwood (Mr Dorrell) on another good and compelling contribution. I also congratulate my hon. Friends the Members for Kingswood (Chris Skidmore), for South West Bedfordshire (Andrew Selous), for Loughborough (Nicky Morgan) and for Witham, as well as the hon. Member for Burnley (Gordon Birtwistle). It seems that in his part of the world they call a spade a spade.

I must also mention the speech of the hon. Member for Walsall South (Valerie Vaz), which was at times fanciful, that of the hon. Member for Stoke-on-Trent North (Joan Walley), that of the right hon. Member for Manchester, Gorton (Sir Gerald Kaufman), which was passionate but, I fear, misguided, and that of the hon. Member for Stallybridge—[Hon. Members: “Stalybridge!”] I mean the hon. Member for Stalybridge and Hyde (Jonathan Reynolds). I am afraid that I am from the south. I was disappointed that the hon. Gentleman did not answer my question about the political allegiance of Dr Chand, whom he prayed in aid, given that Dr Chand has had aspirations to become a Labour candidate. Indeed, I think he even had aspirations to fight the seat that the hon. Gentleman fought, so it was very generous of the hon. Gentleman to mention him.

Let me make clear to the House that no party has a monopoly on caring for the NHS. We all care for the NHS passionately, and I find it distressing when Opposition Members seek to misrepresent the position by accusing us of trying to privatise it. Let me tell them that this party, my party—this Government, the coalition Government—will never privatise the NHS, and let me tell my hon. Friends to reinforce that message. Clause 1 of the Bill gives the Secretary of State a duty to provide a comprehensive health service, and subsection (3) gives a commitment—just as Nye Bevan did in his original Act—that it will be free at the point of use.

Let me tell Opposition Members that what they are saying is scaremongering, that it is unfair, and that it is a gross distortion of the facts. Let me also tell them that shroud-waving does not do them any credit. Pulling out examples that have no basis in proof and are simply intended to misguide and mislead the public is a disgrace—

[Andy Burnham]

Will the Minister give way?

[Mr Burns]

No, because I have no time.

I urge hon. Members to reflect—

[Andy Burnham]

Will the hon. Gentleman give way?

[Mr Burns]

No, because I have no time. I have only five minutes.

The right hon. Gentleman was seductive in his speech. He came across as trying to be eminently reasonable by saying that he did not want this to be a party political football. I must say to him, however, that it is he and his friends who have turned the NHS into a party political football, and I must say to them that the NHS is too precious to be turned into a party political football simply for the purpose of trying to gain votes.

Our reforms will help to prepare the NHS for the future, making it more balanced and better suited to the demands of the 21st century so that it has a long and healthy life based on its founding principles. First, our reforms will give patients more choice, enabling them to choose where to go, see who they want to see, and influence the kind of services that they want in their communities. Secondly, they will give doctors more freedom to commission care for their patients, so that they can shape the NHS around the needs of their local communities. Thirdly, they will reduce bureaucracy so that money—£4.5 billion of it between now and 2015—can be saved and reinvested in front-line services. Those are the basic premises and that is the basic ethos of the Bill.

Not once during the speech of the shadow Secretary of State, and not once during the speeches of any of his right hon. and hon. Friends, did we hear a single answer to the question of what they would do. I do not know how many Members saw the right hon. Gentleman being interviewed on “Newsnight” by Jeremy Paxman two weeks ago. Some of us live in fear of that experience, while some of us come to enjoy it. Five times during that brief one-to-one interview, Mr Paxman asked the right hon. Gentleman “What would you do?” and answer came there none. That was because the right hon. Gentleman is prepared to criticise and try to scare people in order to win votes, but he is not prepared to confront, in a realistic and meaningful way, the challenges facing the NHS and the way in which it must move forward.

What we need is less carping, less criticism, and more constructive engagement. When the right hon. Gentleman says in his flowery way that he is prepared to engage in all-party discussions there is a hollowness in his claim, because he has no policies to discuss, and can identify no positive way in which to resolve the problems of the NHS and enable it to evolve to meet the pressures to which it is subject.

This Bill, which has been discussed at length in this House and in another place, is the Bill that will move the NHS forward and enable it to meet the challenges of an ageing population and an escalating drugs spend. I urge my hon. Friends to reject the motion and to reject the Liberal Democrats’ amendment if it is pressed to a vote, because neither is in the interests of the health service or those of the country.

Question put, That the amendment be made.

Adult Social Care

Simon Burns Excerpts

Thursday 8th March 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I, too, congratulate the hon. Member for Truro and Falmouth (Sarah Newton) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on bringing this important debate to the House. They make an impressive and persuasive double act for this most important of causes, and are right to challenge both Front-Bench teams as this is without doubt the biggest unresolved public policy challenge facing the country. So far, between us, Parliament has failed to face up to it, and as others have said the result is a developing care crisis in England.

We must all bear our share of the responsibility for allowing that to happen, but the best response is to resolve to find lasting solutions. This century of the ageing society demands it, and the earlier we do it, the better. If we do not, to Beveridge’s five giants of the last century we might add a sixth for the 21st century: fear of old age. We cannot let that happen, and people are looking to us all to put point scoring aside and to work constructively to find a solution. In that spirit, I welcome much of what the Minister said.

I commit the Opposition to doing the same, and as a sign of our intent, the Leader of the Opposition has appointed a member of the shadow Cabinet with specific responsibility for these matters. I refer to my hon. Friend the Member for Leicester West (Liz Kendall). The House might have noticed that she is not here today. I send her apologies. [Interruption.] The Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), is absolutely right. She has a good excuse: she is in Leicester with Her Majesty the Queen at the commencement of the diamond jubilee celebrations; otherwise of course she would have been here. I hope that I am an acceptable substitute.

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

You are.

[Andy Burnham]

Thank you.

I wish to demonstrate today Labour’s commitment to this issue. The House might remember, as my hon. Friend the Member for Worsley and Eccles South said, that I made reforming social care my top priority as Health Secretary, and I did that for a very personal reason: I have never forgotten my grandmother’s dispiriting journey through England’s care system and the battles that my mum fought to preserve her dignity. The day I visited her in a nursing home near where I lived to find that her engagement ring had been wrenched off her finger and stolen was the day that I knew something was seriously amiss with how we looked after our older people.

We all have our own personal experiences, and we all know that we have to do much better. Looking after other people’s relatives, particularly the most vulnerable in our society, should be one of the most highly valued and respected callings there is, but sadly the reverse is the case. England’s care provision is too often low status and low wage, with about 70% of the work force having no qualifications and many earning at or around the national minimum wage.

With every year that passes and every year that we do not achieve a lasting and better solution to the funding of adult social care, the cruel unfairness in the system gets worse and the quality of service diminishes even further. People are paying higher charges, and the most vulnerable, as the Minister said, are losing everything. Families are being wiped out physically, emotionally and financially by the situation, carers are under intolerable pressure and councils are struggling to cope with the demographic pressures.

But there is hope. I did not think that the White Paper and cross-party talks that I led before the election achieved as much as they might, but perhaps I was wrong, because they might have prompted the Government to establish the Dilnot commission, on which we congratulate them. We also congratulate Andrew Dilnot and his commission on the intelligent way they addressed their brief and delivered a solution that politicians on all sides can work with. It provides a basis for progress, and we should take it.

Since then, we have also had the Health Select Committee’s excellent report on social care, which made a persuasive case for integration. At present, the social care debate is happening in isolation from the debate about NHS reform, which is unhelpful. We are looking at a Bill called the Health and Social Care Bill, but there is not much about social care in it. Indeed, it is slightly odd that a Bill of this name is going through Parliament, yet a social care White Paper is not due until May, as my hon. Friend the Member for Worsley and Eccles South said. It is essential that we start viewing reform of social care and the NHS as two sides of the same challenge—how to provide integrated, people-centred and preventive care in the century of the ageing society.

The Committee’s recommendation of a single commissioner for older people was an important one, and I was pleased to hear the hon. Member for Truro and Falmouth endorse it. I do, too, not least because it was precisely what I would have done had I returned to the Department of Health as Health Secretary had we secured a different result at the general election. However, I am worried that this vision, which we share, is made more difficult by the Health and Social Care Bill and the new landscape that is developing.

Those are the issues that the Government need to address in the White Paper. We are grateful for the opportunity that the Minister and the Secretary of State have extended to us to take part in cross-party talks and to influence that debate, as well as the crucial issue of how to fund the Dilnot proposals. Speaking for the Opposition, I can assure the House that we will play a constructive and responsible role in those talks. However, I would also like to take this opportunity to place three caveats on the table. First, we need to make it clear to people that although the Dilnot package is an important step forward, it is only that. It is not the whole answer to the challenges that the country faces. Its introduction would make the system fairer than it is today and would deal with the catastrophic costs of care that the most vulnerable people face. However, people would still be liable for high charges, with the vulnerable paying the most.

Secondly, there has to be a recognition from all parties in the House that progress will come only with difficult decisions and nettles being grasped. We need to have a mature discussion with the public about those difficult options, rather than using them for point-scoring purposes. What stands in the way of progress is not the complexity of the issues—they are not over-complex—but the political will to advance a difficult argument. That is what has prevented us from making more progress than we should have. To push things along and give our talks some impetus, it would help if the Government committed to introduce legislation in this Parliament to implement whatever has been agreed. That would bring a useful focus to the cross-party talks. Thirdly, we believe that there is a genuine danger that the debate might focus only on funding the Dilnot recommendations, and not on the existing pressures in the system. That must be avoided at all costs, as my hon. Friend the Member for Worsley and Eccles South said. As one care charity told me yesterday,

“We can’t have jam tomorrow if we have no bread today”.

I, too, was concerned by the comments that the Minister made before the Select Committee on Health, specifically when he said:

“We don’t accept the position that there is a gap. We have closed that gap in the spending review. On the issue of unmet need, I am yet to find any agreement among academics on a definition of unmet need.”

Many councils would struggle to reconcile that statement with the reality of what is happening on the ground. Council budgets are being cut by more than a third over the course of this Parliament, and as we know, adult social care makes up the largest part of those budgets, at around 40%.

The Prime Minister is fond of quoting me on health funding at Prime Minister’s questions, but he only ever uses the bits that suit his purpose. If I may, I would like to give the House the full version of that quotation today, because what I was warning of was the danger of taking an unbalanced approach to public spending. Before the election, the Conservatives were saying that they would give the health service real-terms increases, over and above inflation—which have not, in fact, materialised—within a much reduced overall public spending envelope. My worry was that taking such an unbalanced approach could damage other public services, including those that are intrinsically linked to the health service. What I actually said was:

“It is irresponsible to increase NHS spending in real terms within the overall financial envelope that he, as chancellor, is setting. The effect is that he is damaging, in a serious way, the ability of other public services to cope: he will visit real damage on other services that are intimately linked to the NHS,”

such as social care. I believe that this is what we are seeing right now.

Veterans (Mental Health)

Simon Burns Excerpts

Wednesday 7th March 2012 Westminster Hall

[John Pugh]

I defer to the hon. Gentleman’s experience, and he is probably right in advocating that solution. The question is who will secure that proper mix.

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

Will the hon. Gentleman give way?

[John Pugh]

The Minister is going to tell us.

[Mr Burns]

I am grateful to the hon. Gentleman. Given that I will not have very much time to speak, can I deal with the question of who will commission veterans’ mental health services? It will be the responsibility of the NHS Commissioning Board.

[John Pugh]

I am relieved that it is placed within an appropriate body, although the board has an awful lot else to do.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Dobbin. I am delighted that the House once again has the opportunity to debate an important issue, although it is sad that we are holding this debate against the backdrop of tragic news from Afghanistan. We await the final details of what has happened over there, but we must give full consideration to the families and friends who might be suffering at this terrible time.

I congratulate my hon. Friend the Member for York Outer (Julian Sturdy) on securing this debate. I also thank the other hon. Members who have taken part. The number of hon. Members in the Chamber for a Westminster Hall debate shows how important it is and why a debate is justified after we had one only three months ago.

I congratulate my hon. Friends the Members for Hexham (Guy Opperman), for Rugby (Mark Pawsey) and for Brigg and Goole (Andrew Percy) on their contributions, and I thank the hon. Members for Newport West (Paul Flynn) and for Southport (John Pugh) for theirs, but I particularly congratulate my hon. Friend the Member for York Outer on the measured, informed and caring way in which he introduced the subject. It became clear as I listened to him that it is important to him as both a constituency Member of Parliament and as an individual. That came through during the course of his remarks.

As hon. Members will be more than aware, members of the armed forces put their lives on the line for their country, but it is we as parliamentarians who send them into combat. It is therefore incumbent on us to do everything that we can to protect their health and well-being, that of their families and that of veterans. There is no issue of greater importance for this Government, and I am pleased that my right hon. Friend the Prime Minister has made it one of his priorities.

It is crucial and universally accepted that the health care provided by the Defence Medical Services to serving members of our armed forces is second to none. It is equally important that services are provided for our veterans for the rest of their lives when their health is affected as a result of their service, and that those services should be second to none. That is why I am pleased that in recent years, great strides have been made. I was particularly delighted to see in the Chamber a former Minister who had responsibility for veteran affairs during the previous Administration: the hon. Member for Halton (Derek Twigg), who was here to listen to and participate in this debate. While he served in that post, he had a record of which he could be justifiably proud.

Several Members, including my hon. Friend the Member for York Outer, raised the question of funding. Real-terms funding for the NHS as a whole is increasing, as we all know, but we have invested more than £7 million of funding in veterans’ mental health over the spending review period. I reassure hon. Members that we will continue to fund veterans’ mental health initiatives for the lifetime of this Parliament.

The focus of this debate is on raising awareness of veterans’ mental health. I feel strongly that we are now tackling the issue from a far more informed position than we once did. Thanks to charities such as Help for Heroes, the Royal British Legion, Combat Stress and the Soldiers, Sailors, Airmen and Families Association, awareness of the well-being of the military community is high both in Parliament and, fortunately, among the general public.

I highlight the work of my hon. Friend the Member for South West Wiltshire (Dr Murrison), to whom many hon. Members referred. The report that he produced will push forward the agenda to improve and enhance veterans’ health. My right hon. Friend the Prime Minister asked my hon. Friend to conduct a study on the relationship between the NHS and the armed forces, including former service personnel, in terms of mental health. The result was the report “Fighting Fit”, which I commend to those who have not already read or seen it, although, judging from my hon. Friends’ speeches, a disproportionate number of hon. Members in the Chamber have read it.

I am proud to say that both the Department of Health and the Ministry of Defence have been working on the report’s implementation ever since it was published, which represents a milestone in the effort to improve mental health care for ex-service personnel. For me, one of the strongest themes of the report, and a factor that is particularly relevant to the topic of this debate, is the effect that service care can have on the mental health and well-being of those who have served. Some obvious themes emerged from the findings of my hon. Friend the Member for South West Wiltshire, echoed in research by some of our partner organisations, in particular our strategic partner, Combat Stress. Its research shows that the average ex-serviceperson can take up to 14 years to seek help for anxiety and depression that has developed as a result of their service in the armed forces. Combat Stress put it vividly, and said that

“those veterans suffer terribly in silence, often for years, before seeking help”,

a fact that was echoed in hon. Members’ speeches.

We must keep that in mind when services are designed. The help that we offer must be accessible throughout veterans’ lives, not just when they return from duty. We must also remember that today, we may just as well be designing and delivering care for Falklands veterans as for those who have served bravely in Iraq or Afghanistan. We owe it to all groups of veterans to get things right, to understand that mental health issues can come into an ex-serviceperson’s life long after they have been discharged, and to communicate that message to the public. It should be a key part of any awareness campaign.

“Fighting Fit” makes it clear that some veterans can never bring themselves to seek help—those who will not admit, even to themselves, that they have a problem, and who must rely on close family members and friends to help them move forward. In partnership with Combat Stress, we have launched a 24-hour veterans’ mental health support line run by a charity, Rethink. The helpline is based on the principle of lifelong care and offers support to veterans of any age and at any stage in their lives. Families may also contact the helpline, both for themselves and to talk about a loved one. It allows both groups to receive targeted support from people trained and experienced in dealing with often complex mental health needs.

Both my hon. Friend the Member for York Outer and the hon. Member for Denton and Reddish (Andrew Gwynne) raised the issue of funding the helpline and its future funding. I am extremely pleased to announce that the total number of calls taken by the helpline is now upwards of 5,000. Hon. Members may be aware that we initially launched the helpline as a one-year pilot, which expired at the end of February this year. However, I am pleased to announce today that we are continuing to fund it for the next year and will consider future funding after that. Working closely with Combat Stress and other partner organisations, it will continue.

We are also working to introduce a veterans’ information service over the next two months or so. It will routinely contact service leavers 12 months after they are discharged to establish whether they have any health needs that require attention. The “Fighting Fit” report refers to the service as something of a safety net to help veterans once the support structures available to them during their service lives are no longer readily accessible. To get it right, it is essential that we are able easily to identify veterans, so we are working with the Ministry of Defence to ensure that a veteran’s status is properly recorded on his or her records. However, we must equally recognise that some who leave do not wish to have their veteran’s status recorded, and it is right to respect those wishes.

Returning to the issue of the safety net, there is another key point when it comes to an awareness of mental health issues of any sort. Perceived isolation can have a bad effect on mental health problems. The problem is bad enough anyway, but among ex-service personnel, it is often particularly bad, because the camaraderie that exists within a forces setting is so pronounced. It makes sense that once the institutional support network goes, an ex-serviceperson might feel alone, adrift or isolated. Support services should not necessarily try to recreate that camaraderie. It is often more beneficial in the long term to help veterans come to terms with their change in circumstances. By creating services that are easily accessible and trustworthy, we are going some way towards building an environment in which an ex-serviceperson feels accepted and understood, and in which recovery is more likely.

At the heart of easily accessible services should be a requirement to make them readily available in each local area. Having a service in each area, especially if it has a high military profile, goes a long way towards raising awareness of veterans’ mental health issues in the country as a whole. I am particularly proud of the effort that the Department of Health and my officials have made to spearhead the set-up of armed forces networks in each of the old strategic health authority areas. The networks are groups of representatives from the national health service, service charities and the armed forces who can represent the health and well-being interests of serving personnel, their families and veterans in the local area.

As part of meeting the “Fighting Fit” recommendations, integrated veterans’ mental health services are now being set up in each network area by the local NHS working in conjunction with Combat Stress. The services are at different stages of development, but I can tell my hon. Friend the Member for York Outer, who specifically asked about this, that six of the 10 are already up and running and the remaining four will come online shortly.

We have also increased the number of mental health professionals providing services to veterans, not by the 30 recommended in the Murrison report, but by 50. My hon. Friend will be aware that the recommendation was 30, but we have been able to exceed that, and there are now 50 in place, which will considerably help to provide support and assistance to veterans.

[Gemma Doyle]

Will the Minister give way?

[Mr Burns]

No, I will not, because I am almost running out of time.

The partnership with Combat Stress and the innovative solutions delivered by the NHS at a local level is to be applauded. Regarding effectiveness, we are still in early days, but initial feedback has been positive, with more veterans being identified in the mental health care system and receiving the treatment that they need and deserve.

I want to point to an example of what is happening in the constituency of my hon. Friend the Member for York Outer. The work of Andy Wright with the vulnerable veterans and adult dependants project is particularly noteworthy and warrants praise. I am delighted to report that the project has delivered high levels of patient satisfaction, with 85% being very satisfied with their therapist. It is an excellent example of collaboration, which can only serve to raise further the profile of veterans’ issues more generally.

There is a final and vital aspect of veterans’ mental health and care that I would like to explore, which hon. Members have mentioned, and that is stigma. The title “Fighting Fit”

“recognises the importance of stigma and of making interventions acceptable to a population accustomed to viewing itself as mentally and physically robust.”

Stigma is a big barrier standing in the way of ex-service people getting help, and it is vital that we do everything we can to reduce it. Many Members on both sides of the House will be aware of the “Big White Wall”, an online well-being network for serving personnel, their families, veterans and the general public. It is a social network that allows people with mental health problems from every walk of life to engage with others who have similar problems. The anonymity of the network allows for a free and frank exchange of experiences, with a view to generating a wider sense of support, and it is staffed by professional counsellors. The Department of Health and the MOD are funding a one-year pilot for service personnel, their families and veterans on the “Big White Wall”. I am pleased to say that it has had excellent take-up. Up to 1 March, 2,019 places of the original 2,400 provided in the pilot have been filled. Of those, veterans represent 40%, with 38% being serving personnel and 22% family members.

Launched on the same day as the “Big White Wall”, and in conjunction with the Royal College of General Practitioners, an online e-learning package aims to educate civilian GPs about the conditions from which veterans often suffer. The idea is to reduce the stigma attached and increase the likelihood that GPs will be able to give veterans effective and suitable care. That has been successful with its target audience; the package has had almost 14,000 hits since its launch.

I believe that there is a consensus on both sides of the House that much is being done, but much more remains to be done. The more we as Government can engage with veterans, the public and the media, the more likely mental health issues will be understood more widely. I hope that hon. Members on both sides of the House will continue to work together to help the services reach their full potential, so that no ex-serviceperson ever has anything less than all the support that they need of the highest quality.