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.

Pharmaceutical Price Regulation Scheme

Simon Burns Excerpts

Thursday 23rd February 2012 Written Statements

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

“The Pharmaceutical Price Regulation Scheme—11th Report to Parliament” has been published today.

The Department published the first report on the “Pharmaceutical Price Regulation Scheme” (PPRS) in 1996 following a comment by the Health Committee that the “Department of Health should introduce greater transparency into the PPRS”. Since then, the Department has published a report to Parliament on the operation and management of the scheme most years, the last report being December 2009. This latest report covers an update on the operation of the 2009 scheme, and other developments on PPRS since the last report. In addition, an update has been provided on innovation provisions under the 2009 scheme, Government support for the life science industry and an update on international price comparisons.



A copy has been placed in the Library. Copies are available for hon. Members from the Vote office and for noble Lords from the Printed Paper Office.

National Health Service Charges

Simon Burns Excerpts

Thursday 23rd February 2012 Written Statements

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

Regulations will be laid before Parliament shortly to increase certain National health service charges in England from 1 April 2012.

There will be an increase in the prescription charge of 25p from £7.40 to £7.65 for each quantity of a drug or appliance dispensed.

The cost of a prescription prepayment certificate (PPC) will remain at £29.10 for a three-month certificate. The cost of the annual certificate will remain at £104.

PPCs offer savings for those needing four or more items in three months or 14 or more items in one year.

Regulations will also be laid to increase NHS dental charges from 1 April 2012. The dental charge payable for a band 1 course of treatment will increase by 50p from £17 to £17.50. The dental charge for a band 2 course of treatment will increase by £1 from £47 to £48. The charge for a band 3 course of treatment will increase by £5 from £204 to £209.

Dental charges represent an important contribution to the overall cost of dental services. The exact amount raised will be dependent upon the level and type of primary dental care services commissioned by primary care trusts and the proportion of charge-paying patients who attend dentists and the level of treatment they require.

Charges for elastic stockings and tights, wigs and fabric supports supplied by hospitals will also be increased.

The range of NHS optical vouchers available to children, people on low incomes and individuals with complex sight problems are also being increased in value. In order to continue to provide help with the cost of spectacles and contact lenses, optical voucher values will rise by an overall 2.5%.

Details of the revised charges are in the following tables.

NHS Risk Register

Simon Burns Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Andy Burnham]

Those on the Government Front Bench are laughing. They will not be laughing when I have finished my speech.

More than 150 experts in child health wrote to a newspaper last week to say that health inequalities among children will widen as a result of the Bill. Are Ministers listening? No. It is disgraceful that they behave as they do.

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

Will the Secretary of State confirm—sorry, the shadow Secretary of State—that in clause 3 of the Health and Social Care Bill for the first time in the history of the NHS reductions in inequalities in health have been put on the face of a Bill as a duty to achieve?

[Andy Burnham]

I confirm to the Minister that I am the shadow of my former self, but it sounds as though he would like to have me back. Expert opinion says that health inequalities will widen. Is he listening to that opinion? That is the question he should answer today.

--- Later in debate ---

[Valerie Vaz (Walsall South) (Lab)]

It is always a pleasure to follow my hon. Friend the Member for St Ives (Andrew George), a fellow member of the Select Committee on Health.

[Mr Simon Burns]

Friend?

[Valerie Vaz]

I thank the Minister for making his sedentary intervention.

Obviously, I rise to speak in favour of the motion and I humbly request the Secretary of State for Health to publish the risk register, as recommended by the Information Commissioner. I thank my right hon. Friends the Members for Wentworth and Dearne (John Healey) and for Leigh (Andy Burnham) for taking up this issue. As most people will know from their e-mail inbox and their postbag, and from letters that have gone into various newspapers, the professionals are behind us, as are the public.

I have an image of the Cabinet sitting round the table singing the classic Irving Berlin song, “Anything you can do, I can do better”, as each Secretary of State tries to please the Prime Minister by showing how far they can go beyond what was agreed in the manifesto and the coalition agreement. The Secretary of State for Health, who obviously does not want to hear a good argument, is not so much nudging the NHS—to use his favourite phrase—but giving the NHS a great big shove off the end of the cliff; this is more about the chaos theory than the nudging theory. There is a fundamental flaw at the heart of his reasons not to publish the risk register, which is that it contains the information that the public need to see whether the decision that he has reached in the Bill is without risk to the NHS. The Information Commissioner has deemed this to be in the public interest but the Secretary of State chooses to hide it from the public. The public have a right to know that when a decision is taken in their name the relevant considerations have been taken into account. If this reorganisation goes wrong, as it is doing—the good people in the NHS who are working hard are leaving now—could that possibly amount to misfeasance in public office?

In the Health Committee, we have seen what can be done with co-operation. We visited Torbay and saw public sector leadership at its best. I have absolutely no idea who the staff there voted for—nor do I particularly care—but I know that they saw a system for elderly people that was not working, and they worked hard, not thinking about their pensions or asking for overtime, to devise a system in which there was one point of contact for elderly people. Under the system, the risk is shared, 50% with the NHS and 50% with the local authority. They devised a system with consistency of leadership and long-standing good relations across the system. A care package that might take eight months to deliver elsewhere can now be delivered in two hours. By spending £l million on community care, they saved the hospital £3 million. A seven-step referral is now down to two steps. All of that is at risk, however. The NHS and local authorities could learn from that good practice and evolve in that way.

Some people say that, as a result of the Bill, the people around the table will be the same; they will just have different titles. People need to know that the risk is not just about getting rid of managers. The Secretary of State might say that he is reducing the number of managers by making them redundant, but the NHS still needs some managers—so step forward McKinsey and KPMG to help the GPs who do not have, or might not want, management skills. Members of the public need to know the risk associated with the loss of expertise that has stayed in the public sector for the common good, but which will now be lost by the dismantling of structures.

--- Later in debate ---

[John Healey]

There is the precedent of releasing a programme risk register connected with the third runway at Heathrow, but the principle of the Freedom of Information Act is that each case is different—every risk register is different. The reason why this case is important and exceptional and why the Information Commissioner has, on balance, required the Government to disclose rather than withhold the risk register is that the Government’s health reforms are the biggest ever reorganisation in NHS history; that the legislation is the longest in NHS history; and that it has been introduced at a time of unprecedented financial pressure.

[Mr Simon Burns]

Will the right hon. Gentleman confirm for the House that, on behalf of Lord Boateng, he refused to release a risk register when he was a junior Treasury Minister?

[John Healey]

I do not think that the Minister was listening to the point that I just made: on the Freedom of Information Act, the decisions that Ministers make—I hope—as we did, and the decisions that the Information Commissioner would make on a challenge, depend on the specific information and, in this case, the risk register at stake. This case is unprecedented and exceptional and the Information Commissioner has come to this view because we are faced with such huge upheaval. It involves the biggest reorganisation and the longest legislation, at a time of the tightest financial squeeze for 50 years. Furthermore, this reorganisation was explicitly ruled out in the Conservative manifesto and in the coalition agreement. That is why, less than two months later, the huge upheaval of the White Paper was so unexpected, and why the NHS and the civil service were so unprepared for what they are now being forced to implement.

--- Later in debate ---

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

We have had an interesting debate. The number of right hon. and hon. Members taking part has shown the interest in it. I congratulate Opposition Members who have made speeches—unfortunately, so many spoke that I cannot go through all their speeches—on sticking meticulously to the line in the parliamentary Labour party briefing. They repeated meticulously the mistakes and wrong information in it.

I have a degree of sympathy for the right hon. Member for Leigh (Andy Burnham), because very early in the debate his predecessor as Secretary of State for Health, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), seemed to hole his argument below the line when he came out with what was a rather surprising statement at the time, although having listened to the winding-up speech of the hon. Member for Leicester West (Liz Kendall) it does not seem that surprising. He said that the risk register was a second-order issue. Given that the debate is about the risk register, that struck me as rather odd.

I congratulate my hon. Friend the Member for Finchley and Golders Green (Mike Freer) on an excellent speech. As we listened to more Opposition speeches, his speech began to strike a strong chord that risk registers could be misinterpreted and become a charter for shroud-waving.

I congratulate my hon. Friend the Member for Kingswood (Chris Skidmore), who with great logic and clarity argued an overwhelming case, and I was delighted to hear yet again a speech from the hon. Member for Easington (Grahame M. Morris). A health debate without a contribution from him would be a severe loss. No doubt the news editor of the Morning Star will be fascinated with his comments. I also congratulate my hon. Friends the Members for Boston and Skegness (Mark Simmonds) and for Gillingham and Rainham (Rehman Chishti).

I am disappointed that the right hon. Member for Leigh has decided to politicise a topic that, at its core, is not really about health. The question of publishing risk registers has implications that will be felt across the Government. For the reasons I shall outline, risk registers have implications for the successful running of a parliamentary democracy.

The right hon. Gentleman knows that by heart already, but let me tell him again, in plain English, one last time. The reason why risk registers are not released is the same now as it was when he was in government: if their contents are taken out of context, they could be misleading for parliament and the public.

As many hon. Members have mentioned, the right hon. Gentleman cleared the line in a letter sent from the Department of Health on 1 October 2009, when refusing to publish a departmental risk register. He rightly said that there was a

“public interest in preserving the ability of officials to engage in discussions of policy options and risks without apprehension that suggested courses of action may be held up to public or media scrutiny before they have been fully developed.”

Releasing the risk register is directly contrary to the public interest he described. As he knows, risk registers outline any conceivable situation, however improbable, on the subject they are evaluating. Any risk at all, even the most minuscule or unlikely thing, is included. They help the Department to see the possible pitfalls and to ensure that they do not happen.

This case has implications not only for the Department and Whitehall, but across all levels of government. As hon. Members will know from the debate, risk registers are essential because they are records of frank discussions between Ministers and civil servants on policy formulation. If a precedent were set for those records to be made public, it follows that such discussions and conversations would be a lot less open and a lot more guarded. That would mean that policies might develop with a lot less candid thought and debate than they do now. That might have been the argument under the previous Government, but the reason prevails and the argument is the same today.

The right hon. Gentleman understood that argument when he was Secretary of State for Health. Similarly, the right hon. Member for Wentworth and Dearne (John Healey), who made an interesting speech, understands it. That is why, regardless of what he said in interventions today, during his time in the Treasury—

[Kerry McCarthy (Bristol East) (Lab)]

Will the Minister give way?

--- Later in debate ---

[Mr Burns]

I will not give way. I am afraid I do not have time.

As a Treasury Minister, the right hon. Member for Wentworth and Dearne wrote to Mark Oaten, the then MP for Winchester, upholding the Chief Secretary to the Treasury’s refusal to disclose information about gateway reviews and the identity cards scheme.

Tony Blair—a name that is not often heard with joy on the Opposition Benches now—understood that too. In his memoirs, he calls himself a fool, a nincompoop and an imbecile for introducing the Freedom of Information Act, because, in his words, Governments need to be able to discuss issues

“with a reasonable level of confidentiality”.

He said:

“If you are trying to take a difficult decision and you’re weighing up the pros and cons, you have frank conversations…And if those conversations then are put out in a published form that afterwards are liable to be highlighted in particular ways, you are going to be very cautious. That’s why it’s not a sensible thing.”

Several hon. Members asked about the strategic health authorities that published their risk registers. I would like to clarify this point, because there seems to be considerable confusion about it, particularly among Opposition Members. The purpose of the Department of Health’s risk registers is to allow civil servants to advise Ministers properly about the potential risks of a policy. SHAs, on the other hand, are further removed from Ministers, and are more concerned with operational issues—not policy formulation—and the more day-to-day business of health care. They are not concerned with providing objective guidance to politicians. Their risk registers are routinely published every quarter, and are written with publication in mind. That is evidently not the case with Department of Health registers, which, to remain useful, must be confidential.

Risks are inherent in any programme of change, and we have been open about them, having published a vast amount of detailed information, including the original impact assessment, in January 2011, and the revised impact assessment last September. In addition, the Public Accounts Committee’s health landscape report was published in January 2011, and there has also been the annual NHS operating framework, and the oral and written evidence presented to the Health Select Committee and the PAC. The risks must be scrutinised, we have supported that scrutiny and the risks have been scrutinised. The Bill received 40 sittings and two stages in Committee, and as one hon. Member mentioned, there have been 100 divisions. Even the lead shadow spokesman said, on conclusion of the Committee stage, that the Bill had been thoroughly scrutinised. To claim otherwise is ludicrous.

[Julie Hilling (Bolton West) (Lab)]

I wanted to ask the Secretary of State this question earlier because I was rather confused. The Information Commissioner has said that the risk register should be released. If the Government lose the appeal, will they publish it, given that it would be the right thing to do?

[Mr Burns]

I am grateful for this opportunity to clarify the situation. The hon. Lady is right that the Information Commissioner has taken a view, and under legislation my right hon. Friend the Secretary of State has the right to appeal to the tribunal. That appeal, which he lodged some time ago, will be heard on 5 and 6 March and a decision will be made according to a timetable set by the tribunal—we have no control over the timing.

Of all the topics that the Opposition could have chosen to debate for the past six hours, this is probably one of the most pointless. The tribunal for publishing the risk register sits in a fortnight’s time, as I have just told the hon. Lady, so why not wait for it to report back and use this opportunity to talk about something more useful? Since they have chosen to race down this particular dead-end, however, all I can say to them is this: wait until after the tribunal. There is nothing to add until then. We have explained which areas the risk register covers; we have subjected the Bill to unprecedented scrutiny and consultation; we have debated it for countless hours, and yet still the Opposition bleat that we have not been open. My advice to them is this: change the record. What they are doing is cynical, opportunistic and shallow. I urge my hon. Friends to vote against the motion.

Question put.

Oral Answers to Questions

Simon Burns Excerpts

Tuesday 21st February 2012 Commons Chamber

[David Wright (Telford) (Lab)]

2. What recent assessment he has made of the potential risks of NHS reorganisation.

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

The Department monitors risks associated with the implementation of the health and social care reform programme on an ongoing basis.

[David Wright]

“An open, transparent NHS is a safer NHS”: not my words, but those of the Secretary of State for Health. Is it not amazing that Ministers do not want to release documentation relating to the reorganisation of the NHS? Is it not an absolute scandal that they will not publish the documentation? Is it not the fact that the reorganisation of the NHS is looking a bit like the Norwegian blue? Should it not shuffle off the perch?

[Mr Burns]

No, the hon. Gentleman is wrong. As he, or certainly the right hon. Member for Leigh (Andy Burnham), will know, the risk register is an ongoing document—discussions between Ministers and civil servants on the formulation, implementation and transition of policies—and it would be wrong, in my opinion, for it to be published. That is why my right hon. Friend the Secretary of State appealed to the tribunal following the decision of the Information Commissioner, in line with the precedent adopted by Secretaries of State in the Labour Government in both the Department of Health and the Treasury.

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

Does the Minister agree that the risk of not reorganising would be the longer waiting lists, longer waits for ambulances and lower access to life-prolonging drugs that we currently see in socialist-dominated Wales under the Assembly?

[Mr Burns]

My hon. Friend is absolutely right, and of course he speaks from the authority of living in a country that has a Labour Administration, where we see spending cut, waiting times and lists rising, and utter chaos in the quality of care for patients.

[Hywel Williams (Arfon) (PC)]

The Minister will know that large numbers of people from Wales, particularly north Wales, access treatment in England. What assessment has he made of the risks to such treatment if the legislation goes through?

[Mr Burns]

If the hon. Gentleman is trying to tease out of me what is in the risk register, I am afraid he will be unsuccessful, but if it is of any reassurance I can tell him that for people living close to the border there have been arrangements between Wales and the English NHS and they will continue. Those people will benefit if treated in England, because waiting times are falling in this country, unlike Wales where they are increasing.

[Mr Jamie Reed (Copeland) (Lab)]

What a pleasure it is to see the Secretary of State here today; he managed to make his way in.

I am afraid I have to describe the Minister of State’s answer as codswallop. Let me give him an example of one risk to the NHS that we already know about. The number of NHS nurses has fallen by 3,500 since the general election, and that figure could be at least 6,000 by the end of this Parliament. The Bill is damaging front-line services in the NHS right now. Why does the Minister not put patients before his, the Secretary of State’s and the Prime Minister’s pride, drop this unwanted Bill, and use some of the money it would save to protect those 6,000 nursing posts?

[Mr Burns]

I have to say that, unfortunately, notwithstanding what the hon. Gentleman thought was a rather clever way of describing my answers, his figures are factually incorrect. As Jim Callaghan once said, an inaccuracy can be halfway round the world before truth gets its boots on. The facts are these: there are 896—[Interruption.] If the hon. Gentleman would listen to the answer he asked for, he might learn something and stop making misrepresentations. There are 86 more midwives working in the NHS—[Hon. Members: “86?”]—896, which is an increase of 4%. There are 4,175 more doctors working in the NHS: an increase of 4%. There are 15,104 fewer administrators working in the NHS—a decrease of 7.4%—and 5,833 fewer managers. There are more doctors. There are more midwives. There are fewer administrators.

[Jessica Morden (Newport East) (Lab)]

3. What recent assessment he has made of the future of private health care.

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

13. What assessment he has made of the involvement of the private health care sector in the NHS.

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

The Department has made no assessment of the future of private health care. This is not the role of the Department of Health. The private sector has always provided services to the NHS and the Department monitors trends where it does so—for example, the number of NHS patients choosing a private provider under patient choice.

[Jessica Morden]

Given that the Prime Minister said there would be no top-down reorganisation of the NHS, the coalition agreement ruled it out and nobody voted for it, what exactly is the Secretary of State’s mandate for turning the NHS into a “fantastic business”, as the Prime Minister has said?

[Mr Burns]

I am extremely sorry if the hon. Lady really believes the mantra that she has just spewed out. If she had read pages 45 and 46 of our manifesto, she would have seen that it says that we would introduce clinical commissioning groups, take away political micro-management from Whitehall, free up the NHS and cut bureaucracy, as we are doing, which will save £4.5 billion to reinvest in the health service. Our coalition colleagues, the Liberal Democrats, had in their manifesto the abolition of SHAs. So I have to tell the hon. Lady that she is wrong. The test of what is going on and what is a success is the fact that if one meets GPs around the country, they support commissioning for their patients.

[Teresa Pearce]

On the BBC’s “Newsnight”, the Minister of State stated that the Health and Social Care Bill would turn the NHS into a “genuine market”. How does this belief fit in with the NHS founding principle that access should be based on need, not market forces?

[Mr Burns]

I am sorry—the hon. Lady has obviously not listened properly to me. It has been my guiding principle and my core belief from the day I entered politics that we should have a national health service free at the point of use for all those eligible to use it. In no shape or form does the Bill, or any actions by this Government, compromise that core belief of mine.

[Mr Brown]

The Minister is aware that funding for the health service in Wales and Scotland is through the Barnett formula. For every pound saved by the Government—in other words, for every pound less spent per person in England—there is a knock-on consequence for the budgets in Wales and Scotland. What assessment has he made of the fact that he will be funding NHS provision from private patient fees, rather than the public purse?

[Mr Burns]

As the hon. Gentleman knows better than I do, the running of the NHS in Scotland and Wales is a matter for the devolved authorities. I speak for the English NHS, and I can tell him that that we have guaranteed that the budget of the NHS in England will be a protected one for this Parliament in which there will be real-terms increases, albeit more modest than in the past. But we have seen in Wales in particular a fall of just over 8% in funding. That is the decision of a Labour Welsh Government. The moneys that are saved in the health service in England through cutting out bureaucracy and through greater effectiveness in delivering care will be totally reinvested—100%—in the NHS in England.

[Sir Paul Beresford (Mole Valley) (Con)]

I may have an interest—a remote one—in this question. I expect my right hon. Friend would agree that every patient who chooses to have private health care rather than national health service care, for whatever reason, is one less case on the national health cost and care bases. Does my right hon. Friend agree that it may be appropriate for the Treasury to do a cost-benefit analysis so as to consider a tax encouragement for individuals, especially those over 65, to take out private health insurance?

[Mr Burns]

I do not want to disappoint my hon. Friend, but I am afraid I do not agree with that. What the Government have to concentrate on is giving the maximum amount of resources within the protected budget to the provision of health care in this country, to ensure, enhance and improve the quality of care for patients in England. That is the priority, not providing tax relief in any shape or form for people who use their choice for private health care.

[Margot James (Stourbridge) (Con)]

Professionals working in the NHS told the Health and Social Care Bill Committee that income from private patients was important to the development and improvement of NHS services. What steps will my right hon. Friend take to ensure that that income benefits NHS patients?

[Mr Burns]

I am grateful to my hon. Friend for her question, because it might clarify some of the misinformation being bandied around on the Opposition Benches. Any money generated by private patients or by the private sector within the NHS must be spent on NHS patients, so it will benefit NHS patients and the NHS, and that is to be welcomed.

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

Does my right hon. Friend agree that collaboration between the NHS and the independent sector can deliver real benefits for both patients and the taxpayer?

[Mr Burns]

My hon. Friend is absolutely right, because we need to drive up the quality of care. What we are doing with the Health and Social Care Bill is closing a loophole so that there can be no favouritism towards the private sector, so the travesty introduced under the previous Government, including the right hon. Member for Leigh (Andy Burnham), whereby independent treatment centres had an advantage that put the NHS at a disadvantage in providing care, and were paid more than the NHS, will stop, because it is unacceptable.

[Mr Kevin Barron (Rother Valley) (Lab)]

Part 3 of the Health and Social Care Bill will introduce competition policy to the NHS by law for the first time in its history. Does the Minister think that that is likely to lead to more private care in this country or less?

[Mr Burns]

I am sorry, but the right hon. Gentleman, who always asks this question, is wrong. We have not introduced competition into the NHS; it was there under the previous Administration.

[Andy Burnham (Leigh) (Lab)]

indicated dissent.

[Mr Burns]

It is a bit rich for the former Secretary of State to bleat about that. What I want is the finest health care for patients so that they are treated more effectively and quickly and their long-term conditions are managed in a way that enhances the patient experience.

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

4. What steps he is taking to address underperforming hospital management teams.

--- Later in debate ---

[Andrew George (St Ives) (LD)]

11. If he will withdraw the Health and Social Care Bill.

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

No, Sir.

[Andrew George]

I respect the Minister, but massive opposition to the Bill is mounting at the same time as its meagre support is ebbing away. Any more rational process would have resulted in the dignified withdrawal of the Bill long ago. Is there anything that would persuade the Secretary of State—frankly, he should be answering this question—to change his mind?

[Mr Burns]

The straightforward answer is no, because everyone, including the right hon. Member for Leigh (Andy Burnham), accepts that the NHS has to evolve to keep up and meet its challenges. What matters to patients is not who delivers their care but the quality of the care that they receive, their experience of that care and the dignity and respect with which they are treated at all times. Cutting bureaucracy by a third to reinvest £4.5 billion in front-line services between now and 2015 is the way forward. Frankly, if one goes and talks to doctors around the country, one finds that they wish that Labour’s party political squabbling would stop so that they can get on with implementing the modernisation programme.

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

The Minister talks about party politics. Is he not aware that not a day goes past without an organisation representing doctors and nurses coming out against his Bill? Most recently, the Royal College of Physicians is having to hold an extraordinary general meeting because of pressure from its members. The Royal College of Paediatrics and Child Health is consulting its members. Why should anyone in this House support a Bill to which the men and women who work in the health service are so opposed and which even Tory Cabinet Ministers are briefing against?

[Mr Burns]

I suspect that the hon. Lady does not get out and about much to meet doctors who are beginning to commission care for their patients. If she did, she would know that the mantra she is repeating from organisations that are not representative of doctors in this country—[Interruption.]

[Mr Speaker]

Order. The Minister of State is such an emollient fellow that I cannot imagine why people are getting so worked up, but they are getting very worked up, and they must calm themselves. We are only on Tuesday; we have got some time to go. Let us hear the Minister.

[Mr Burns]

Very briefly, Mr Speaker, I can say to the hon. Lady that a number of the organisations that she mentions are trade unions that do not represent the views of GPs up and down the country who are actually engaged in implementing the modernisation by commissioning care for their patients.

[Lorely Burt (Solihull) (LD)]

12. What steps he is taking to improve the standard of dementia care in hospitals.

--- Later in debate ---

[Mr Philip Hollobone (Kettering) (Con)]

T7. Northamptonshire residents are rightly concerned that in the county in the last four months of 2011 the East Midlands ambulance service reached fewer than 69% of category A calls within eight minutes. The target is 75%. What hope can my right hon. Friend offer to local residents that this poor performance will rapidly improve?

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

I hope that I can give some reassurance to my hon. Friend by telling him that East Midlands ambulance service is working with commissioners, hospital trusts, community health services and social care services in taking measures to address its response time performance. NHS Milton Keynes and NHS Northamptonshire have received £1.7 million in additional funding, and NHS Midlands and East advices me that some of that has been used to fund further measures to help improve EMAS response times, including through the provision of additional ambulance crews and the deployment of hospital-ambulance liaison officers in each accident and emergency department to improve handover and turnaround times.

[Mrs Madeleine Moon (Bridgend) (Lab)]

T3. The Secretary of State says he acts on advice. May I advise him to read the horrendous report from Mencap that details the death of 74 people with learning disabilities due to a lack of basic care and a lack of understanding of the health care needs of people with learning disabilities? Will he follow the advice of Mencap and ensure that the undergraduate and postgraduate training of doctors and nurses includes intensive training in the needs of people with learning disabilities, so that there will be no further unnecessary deaths of people with learning disabilities due to neglect in NHS hospitals?

084 Telephone Numbers (NHS)

Simon Burns Excerpts

Tuesday 24th January 2012 Westminster Hall

[Mr Ainsworth]

If my hon. Friend can wait, I will try to give way later. A number of Members want to intervene.

The GPs argue that they have entered into contracts that give them enhanced telephony solutions, and that they cannot get out of them. That is the kind of thing that they say to justify their non-compliance, but none of it is true. All the arguments are flawed, and there is the simple solution of migrating to an 034 number, which provides the same supposedly enhanced telephony services. As an aside, I will say that what we mean by such services is call queuing and call diversion options. When in the middle ages people fell foul of the inquisition, they were shown the instruments of torture but not made to pay for them, but people are now being made to pay for these supposedly enhanced telephony solutions.

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

Will the right hon. Gentleman give way?

--- Later in debate ---

[Mr Ainsworth]

We can do that only if the Department of Health is determined, right up to ministerial level, to enforce the contract. The terms of the contract are clear, as I hope the Minister will say when he responds. No one should pay enhanced charges to access their GP.

[Mr Simon Burns]

indicated assent.

[Mr Ainsworth]

The Minister is nodding. Let us hope that he says that and that, for heaven’s sake, we do not have non-Government and that, having made a decision, they make sure that it is complied with across the board. I look forward to hearing the Minister’s response.

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

I congratulate the right hon. Member for Coventry North East (Mr Ainsworth) on securing this debate on the use of 084 telephone numbers in the NHS. The Government’s position is extremely clear—when patients contact their GP or anyone else in the NHS, they should not be charged more than they would be to call their next-door neighbour’s landline. Those are the rules. That is why we have retained the previous Government’s directions, published in December 2009, and regulations, passed in April 2010, which make it a contractual requirement for GP surgeries to ensure that that is the case.

Under the directions and the amendments to the general medical services and primary medical services regulations, it became compulsory for GP practices and NHS bodies to review how much it cost patients to call them. If they found that patients were being charged more than a standard local landline call, they had one year to take all reasonable steps, which could include varying the terms of their telephony contract, cancelling the contract, or offering an alternative number to call, such as an 03 number, which charges callers at a local rate. GP practices should not, in any case, enter into, extend or renew their contracts with their telephone supplier if patients are being charged more than a local call.

This legislation was the result of a lengthy consultation by the Department in 2009, to which there were about 3,000 responses. The vast majority agreed that patients should not be charged additional costs to contact their GP. However, many also valued the enhanced services they receive when calling their GP, such as queuing and additional booking options, but we are clear that that should not cost patients any more than a local landline call.

[Mr Andrew Smith]

Will the Minister give way?

[Mr Burns]

I will not at the moment, because I do not have much time to answer all the points raised by the right hon. Member for Coventry North East. [Interruption.] I might give way in a moment, although hon. Members should remember that the right hon. Gentleman did not give way to me either.

We must also be clear that the additional services can also be offered on other number ranges—such as 01, 02 and 03—and GP practices should feel able to choose the number that is most suitable for their patients, provided that it does not cost them any more to call.

Many people ask why we do not simply ban 084 numbers outright. I fear that that would not solve the real problem, which is that some patients continue to be, or believe that they are being, charged too much to contact their GP.

[Mr Andrew Smith]

Given that the Minister has said that practices should not charge more than the cost of a landline call to a neighbour, if a patient can demonstrate from their bill that they have been so charged, will they be able to get the money back, and how would they go about that?

[Mr Burns]

The right hon. Gentleman has anticipated something that I will deal with shortly, namely the 1,300 GP practices mentioned by his right hon. Friend the Member for Coventry North East that have allegedly been abusing the system.

As I have said, I fear that banning 084 numbers would not be the panacea that Opposition Members might believe it to be. The Department, to its credit, banned the use of premium-rate telephone numbers beginning 087 and 09 in 2005, but new number ranges with additional costs began to appear. Although it seems to be a simple solution, I do not think that it will be over the medium and longer term, because people will seek to avoid it. That is why it is crucial that the previous Government rightly sought to tackle the problem at source and why we have continued the policy that they introduced in the dying days of their regime. The 2010 regulations make it clear that patients must not be charged more to contact their GP than they would be if they called a local number.

Since the rules came into force, I understand that there has been confusion in the NHS about what the regulations and the directions include. I am grateful for this opportunity to clarify some of those misconceptions in the NHS and elsewhere. There have been claims that mobile phones are not covered by the 2010 regulations, but that is not true. The regulations cover landlines, mobiles and payphones equally. The legislation is absolutely clear that if a person calls a GP surgery with an 084 number from a mobile, landline or payphone, they should not pay more than they would if they called a local landline number from the same phone.

That is very important, because more and more people now use mobile phones as their primary form of communication, as has been mentioned by the right hon. Member for Coventry North East. That is particularly true of the less well-off—the right hon. Gentleman also made this point—where 25% of households only have access to mobile phones, and for young people, where a third of people under 25 only use mobile phones for communications purposes. In 2011, for the first time, the majority of call minutes originated from mobile phones.

Questions have also been raised about how a patient can challenge their GP practice or PCT if they believe that they are being charged more than the cost of an equivalent local call. Any action taken should be on the basis of robust evidence. GP practices and their PCTs should look at evidence of call costs to determine whether their patients are being charged more than they should be. Such evidence could include cost-per-call information from providers, such as O2, Vodafone and BT. A suitable sample should be considered, bearing in mind the different contracts that patients can choose to sign up to.

A practice can also look at cost-per-call information that is provided by patients. Using that information, it would be possible to compare directly the cost of calling a GP practice’s 084 number with the cost of calling a local land-line number. If the evidence suggests that using a specific number is not costing patients more than it should, the GP practice should be free to continue using 084 numbers. If patients are being charged more than they should be, they should take the steps that I have already mentioned to rectify the situation.

[Mr Ainsworth]

Although I welcome a lot of what the Minister has said, I am not at all sure that we can afford to leave this problem to the individual. There is deference towards doctors and people are loth to offend or upset their doctor. The Department and the local PCT must be prepared to take action to ensure compliance, and they should not expect individual patients to do so.

[Mr Burns]

The right hon. Gentleman anticipates a point that I was about to make. As a preface to that point, however, I must say that patients can be extremely helpful in providing evidence that can help to prove if this practice of overcharging, which is in defiance of the regulations and directions, is going on.

I now come on to the point that the right hon. Gentleman made about the figure that is in the public domain and that is used a lot, namely that there are 1,300 GP practices that are—in effect—defying the regulations and charging patients more than they should. I have made inquiries and I can find no evidence to support that figure. People say that there are 1,300 GP practices that charge more than they should; what they do not say is which practices they are, and they do not provide the robust proof that overcharging is happening.

I say to the right hon. Gentleman, and to anyone else who has an interest in this important subject, “Please send us the evidence”, because we cannot find concrete evidence that overcharging is going on. If it is going on, we want to see the evidence and we want to see which GP practices are engaged in it, so that the PCTs, which enforce these regulations, can take action. I assure the right hon. Gentleman that if we get the evidence and if it is proven that overcharging is happening, the PCTs and—after the modernisation of the NHS—the NHS Commissioning Board, which will have responsibility in this area, will also vigorously pursue the matter because, like his Government, we believe that such overcharging is unacceptable.

However, I must reiterate that we need the evidence. We do not need anecdote or the “friend of a friend”, who has said this or that. We need precise, concrete evidence, to be able to pursue this matter.

As I have said, PCTs are currently responsible for ensuring that GP practices meet the terms of their contracts, including ensuring compliance with these regulations. The Department will soon clarify the existing guidance, which I hope will help GP practices and PCTs to understand this issue more fully and to dispel some of the myths and misunderstandings about the use of 084 numbers.

This Government are committed to creating a patient-focused NHS, as the right hon. Gentleman said we were planning to do; I can confirm that he was accurate when he said that. One of the key elements of that process is ensuring that patients find it easy to access the services they need, when they need them. Using an 084 number can help a GP practice to offer additional services that improve patients’ access to care. It is right that GPs remain responsible for their own access arrangements, including their telephone number, opening hours and booking arrangements. Those arrangements will be different for different practices, and the ability of GPs to be locally responsive is something that we know patients value. Primary care is the cornerstone of the NHS. Around 90% of patient contact with the NHS takes place in a primary care setting, with around 300 million consultations per year, so it is essential that patients can easily access care, and have a choice about how to do so.

One way that we are improving access to care is through the roll-out of the NHS 111 service, which will be available to everyone in England by April 2013. That service will give the public a phone number that is easy to remember and free to call when they need help urgently but do not know where to turn. Callers will be quickly assessed, and sent to the right service on the first point of contact. The primary aim of NHS 111 is to ensure that patients get to the right service, and quickly, at any time of the day or night. In most areas, patients can also expect to be able to see their out-of-hours GP through NHS 111, which will simplify how patients access NHS services and improve patient experiences.

NHS 111 will replace NHS Direct’s 0845 4647 service, which obviously uses an 084 number. NHS Direct was exempted by the last Government from the directions and regulations, and rightly so. That is because the Department had already begun considering plans to implement NHS 111, and it would have been confusing to the public to change NHS Direct’s number shortly before introducing a new number for patients to call that will be free to the user.

By April 2013, there will be a simple system in place, whereby patients can access care quickly and easily. If there is an emergency they should dial 999, but if people do not know where to go they should dial 111, and otherwise they should continue to use their GP as usual.

I give an assurance that we take these directions and regulations very seriously indeed. We expect them to be adhered to and obeyed. I can assure Opposition Members who raised this issue that PCTs carefully monitor the situation to ensure that, when there are complaints about 084 numbers, GP practices are adhering to the regulations and not costing patients more than they should. The PCTs vigorously enforce the regulations. I also reconfirm that we are issuing clarification guidance to GPs, which I hope addresses another point that the right hon. Gentleman made.

I cannot emphasise strongly enough, however, that despite the numbers that are bandied around—as I said earlier, 1,300 is the number that is most commonly used to describe the number of GP practices that are not adhering to the regulations—we cannot find any evidence to establish the accuracy of that figure. Nevertheless, we are anxious that the regulations are enforced. So, if there is any concrete information, proof or evidence that GPs are abusing the system and not abiding by the regulations, it is important that that it is provided to the PCT, which acts as the enforcement officer. If the right hon. Gentleman himself has concrete evidence— following the research that he has conducted to secure this debate and then take part in it—and wants to send it to me, I would be more than happy to accept it and I will direct it to the appropriate body, whichever PCT it is, so that the allegation can be investigated.

In conclusion, the use of 084 numbers is controversial but we are very clear that patients should not be charged more than they would be to make an equivalent call to a local number. That is the belief and principle that underlies the policy, one that we are continuing from the last Government’s term in office. However, we also believe that we should not restrict the freedom that GPs have to improve access arrangements for their patients, provided that they are complying with the regulations. I hope that this debate has not only clarified the situation but has set a challenge to the right hon. Gentleman and others to provide evidence if they have it or come across it, so that if there are any abuses we can put an end to them.

NHS (Private Sector)

Simon Burns Excerpts

Monday 16th January 2012 Commons Chamber

[Andy Burnham]

No, I would not agree. I shall explain the policy that our Government adopted on the private sector and how different it was from that of the Government whom the right hon. Gentleman supports. In making our argument we will expose the terrifying gap between the Prime Minister’s rhetoric on the NHS and what he is doing in reality. People will recall the efforts that went into rebranding the nasty party. The Conservatives were at great pains to tell us that they would be pro-environment, a bit less tough on crime and pro-NHS going forward. Many photo calls were arranged to send those messages to the public, but it was poor old NHS staff who featured far more than huskies or hoodies in being brought in to promote hastily made political promises. We were told there would be real-terms increases for the NHS, a moratorium on accident and emergency department closures, thousands more midwives and, famously, no top-down reorganisation—four promises made in opposition: four promises broken in government. I still have not worked out how a Prime Minister can go from agreeing there should be no top-down reorganisation with his coalition partners after the election to bringing forward just weeks later the biggest top-down reorganisation ever in the history of the NHS. How does that work? Perhaps Lib Dem Members will enlighten us this evening.

Our evasive Prime Minister is the master of making statements that sound good at the time only to turn out to be meaningless in practice. Tonight we will focus on his most outrageous yet. On Monday 16 May last year, under pressure to reassure people about the Health and Social Care Bill and in the middle of the enforced pause, the Prime Minister said, in a speech:

“That’s why, when I think about what our NHS will look like in five years time, I don’t picture some space-age institution, a million miles away from what we have now. Let me make clear: there will be no privatisation”.

Those were his words—“no privatisation”.

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

indicated assent.

[Andy Burnham]

The Minister of State says that is right, and he is free at any point to get up and challenge what I say or to prove how he can make that statement. I will give him the opportunity to do so soon.

The Prime Minister could not have been clearer—“no privatisation”. Similar statements were made during the pause by the Deputy Prime Minister. On the Marr programme on 8 May, he promised that safeguards would be brought forward in the health Bill. He said:

“What you will see in this legislation are clear guarantees that you are not going to have back-door privatisation of the NHS.”

He followed that up on 14 June with this promise:

“Patients, doctors and nurses have spoken. We have listened. Now we are improving our plans for the NHS. Yes to patient choice. No to privatisation. Yes to giving nurses, hospital doctors and family doctors more say in your care. No to the free market dogma that can fragment the NHS.”

Those statements from the Prime Minister and the Deputy Prime Minister were significant for two reasons. First, they revealed an understanding at the top of Government about how, more than anything else, fears about privatisation and the market in the NHS were driving professional disquiet about the Health and Social Care Bill—a Bill that was sold as putting doctors in charge but that had a hidden agenda of breaking up the structures of the national planned health system to allow a free market in health. Secondly, they implied that major changes to address those concerns would be made to the Bill and that there would be a return to the existing policy of the managed use of the private sector within a planned and publicly accountable health system.

Let me be clear. As our motion states, we believe that there is a role for the private sector in helping the NHS to deliver the best possible services to NHS patients, and that was the policy we pursued in government. Without the contribution of private providers, we would never have delivered NHS waiting lists and times at historically low levels, but let us put this in its proper context. Our policy was to use the private sector at the margins to support the public NHS. So, in 2009-10, 2.14% of all operations carried out in the NHS were carried out in the independent sector and spend in the private sector accounted for 7.4% of the total NHS budget. I would defend those figures, because that helped us to deliver the best health care to the people of this country.

Furthermore, we supported a system allowing foundation trusts to generate income at the margins of their activity from treating private patients but with a clearly defined cap to protect the interests of NHS patients at all times.

--- Later in debate ---

[Mr Dorrell]

rose—

[Mr Simon Burns]

rose—

[Andy Burnham]

I shall give way to the Chairman of the Select Committee on Health once more and then to the Minister.

--- Later in debate ---

[Andy Burnham]

That is not what I said. I understand that the preferred policy was to have no caps or limits, but even if a generous and liberal cap was introduced there would be a major risk that hospitals under financial pressure would give beds, theatre time and appointments to private patients, enabling them to jump the queue and giving a much worse deal to NHS patients. That is the risk that the cap was designed to mitigate and that is why we support it.

[Mr Simon Burns]

Could the right hon. Gentleman explain the logic, under his Government, of having a cap on a minority of trusts—foundation trusts—while he as the Secretary of State and his Government did not impose a cap on the majority of trusts that were not foundation trusts?

[Andy Burnham]

There is a simple explanation. The right hon. Gentleman will remember, as I do, the debate on the foundation trust legislation. There were worries that if hospitals were made more independent and were not directly managed by the Department they would put the treatment of private patients before that of NHS patients. The cap was introduced to mitigate that risk. He will know that we had a policy that all trusts should become foundation trusts in time—a policy that his Government have adopted—so that the cap would apply to all NHS hospitals in time. I think that answers his question.

[Mr Burns]

If that is the case, rather than that it being forced on the Labour party by a rebellion of Back-Bench MPs in 2002, why did the right hon. Gentleman’s election manifesto in 2010 say that Labour would remove the cap?

[Andy Burnham]

It did not, and I would expect a Minister not to make misleading statements like that in a debate of this kind. It did not propose the removal of the cap: it said that more freedom would be given to NHS hospitals with a modest loosening of the cap. That was my policy as Health Secretary. We did not propose removal of the private patient cap.

--- Later in debate ---

[Andy Burnham]

I remind the Health Secretary that he is the Secretary of State, not me. It is for him to bring forward proposals. Forty-nine per cent: in that proposal he is saying that NHS hospitals can give equal priority to the treatment of private patients—that it can be as legitimate an objective for an NHS facility, paid for by the taxpayers, to be used equally for the treatment of private and NHS patients. I put it to the hon. Member for Kingswood (Chris Skidmore) that I am not prepared to accept a cap on that scale. It could lead to an explosion of private sector work in NHS facilities and I do not think that is in the best interests of NHS patients. I would be prepared to accept the Government’s bringing forward proposals that fulfilled a modest loosening of the cap, to give the NHS more freedom at this difficult time, but I am talking in single figures. I am not talking about a doubt-digit, 50% cap—a recommendation that hospitals devote half their resources to private patients.

[Mr Simon Burns]

Will the shadow Secretary of State kindly answer the questions put by my right hon. and hon. Friends about what modest means? [Interruption.] If I might read it out, the 2010 Labour manifesto says:

“Foundation Trusts will be given the freedom to expand their provision into primary and community care, and to increase their private services—where these are consistent with NHS values, and provided they generate surpluses that are invested directly into the NHS.”

There was no mention of a modest increase; it was open-ended.

[Andy Burnham]

The Minister is not listening. I answered his question. I proposed a small increase in the cap—in single figures; a couple of per cent, as I am on record saying at the time, to give NHS hospitals more freedom to generate more income, to be put back into improving standards for NHS patients. Can the Minister honestly look me in the eye and tell me that 49% is not a world away from the NHS that he inherited from our Government?

--- Later in debate ---

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

To begin on a conciliatory note, I congratulate the hon. Member for Copeland (Mr Reed) on his first speech from the Front Bench as a junior shadow Health spokesman. I did not agree with a single word that he said, but I congratulate him on the way in which he spoke.

I have no idea what new year resolutions the Labour party has made, but perhaps I could suggest one: to get their facts right. Having listened to the endearing speech of the right hon. Member for Holborn and St Pancras (Frank Dobson), the same speech that I have heard on many occasions from the hon. Member for Easington (Grahame M. Morris), the slightly bizarre speech of the hon. Member for Blaydon (Mr Anderson) and the speech from the hon. Member for West Lancashire (Rosie Cooper), I have to say that they really have got it wrong. It is wrong to seek to misrepresent by repeating a fallacy.

I congratulate my right hon. Friend the Member for Charnwood (Mr Dorrell) on his lucid exposé of the contradictions in the arguments of the right hon. Member for Leigh (Andy Burnham). I thank my hon. Friends the Members for Central Suffolk and North Ipswich (Dr Poulter), for Crawley (Henry Smith) and for Battersea (Jane Ellison) for their thoughtful contributions. I listened carefully and with great interest to the speech by the hon. Member for Southport (John Pugh) but, to be honest and frank, I was not carried by the strength of his argument on the issues.

I fear that many of the contributions of Opposition Members that my hon. Friends and I have had to listen to have given a series of misrepresentations and misinformation. I remind them that for 36 years, just over half the 64 years of the national health service, it has been under the stewardship of the Conservative party. We have never sought to privatise the health service and we never will privatise the health service.

[Frank Dobson]

Will the Minister give way?

[Mr Burns]

Because of the time, I will give way to the right hon. Gentleman, but to no one thereafter.

[Frank Dobson]

The Minister suggested that I had used figures that were not factual. If they are not, he should know that they all came from parliamentary answers signed by him.

--- Later in debate ---

[Mr Burns]

I did not in any shape or form suggest that the right hon. Gentleman’s figures were wrong. I argued that his arguments and his philosophy were wrong. They are based in a time that is pre-Blair, let alone Blair, which I know is now anathema to the Labour party. Ironically, one might say, as I think did my right hon. Friend the Member for Charnwood, that Government Members, in this respect, are all Blairites now.

Rather than pour scorn on an invented problem, the Opposition should welcome the healthy relationship between the national health service and private providers—a relationship that is mutually beneficial, that has existed since 1948, that is better for patients and, I hesitate to remind the right hon. Member for Leigh, that flourished under his Government. The previous Labour Government expanded the involvement of the private sector in the provision of NHS care in a way that no previous Conservative Government had done. Labour’s general election manifesto of 2010, which was written by the current Leader of the Opposition, said:

“We will support an active role for the independent sector working alongside the NHS in the provision of care”.

Rather more surprisingly, given the nature of today’s debate, the Labour manifesto also stated:

“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality at NHS costs.”

To reinforce that, it went on to promise to remove the private patient cap on foundation trusts. In addition, on 8 February 2010—at No. 10 Downing street, no less—the now Leader of the Opposition and the right hon. Member for Dulwich and West Norwood (Tessa Jowell), who I believe is a close personal friend of the right hon. Member for Leigh, hosted a meeting with non-NHS providers to examine their future role in delivering NHS services, among other public services. There is a certain irony and nerve in Labour’s bringing this motion before the House tonight.

I remind Members of the benefits of extra income to the NHS, which are so clear as to be self-evident. Any and all money made by the NHS is returned straight into care, not to the Treasury. The principal purpose of NHS providers has always been to serve NHS patients, and that will not change. In fact, trusts say that changing the cap will help them do that better than ever. The Labour party knows that. In 2009, the then Health Minister, Mike O’Brien, said that to cap the number of private patients would be nothing but a sop to militant Labour MPs. It now seems, though, that they are all militant Labour MPs.

I know that he has not been the flavour of the month for a while now, but as none other than Tony Blair once said, the private sector

“has got a valuable role to play in delivering NHS services.”

Even the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown) called for greater use of the private sector.

I wish to take a second to look at the last Government’s record on using the private sector. Through choose and book and through giving patients the right of the choice of provider, the number of patients treated as NHS patients in the private sector escalated. Under choose and book alone, the number of procedures increased from only 11 in 2000-01 to more than 208,000 10 years later. By May 2010, more than 7% of all NHS-funded first out-patient appointments were booked with independent sector providers. In monetary terms, between 2006 and 2010, £12.6 billion was spent in the private sector on NHS health care.

Let us pick an example at random—say, independent sector treatment centre contracts. “Wonderful things”, said Labour. “Cutting waiting times”, it said. What happened? Private companies were paid even when they had not treated any patients; hundreds of millions of pounds were taken from the public purse and wasted; and the NHS was barred from competing with private companies, even if it could offer a better service. What is more, seven of those ISTC contracts were signed while the right hon. Member for Leigh was a junior Minister at the Department of Health—hardly a glorious record.

My hon. Friends and I had a while in opposition, and I know how uncomfortable the Benches on that side of the House are. They make people itch—itch to disagree with everything that is said by Government Members. However, I say to the right hon. Gentleman that it is wrong to scaremonger about the role of the private sector in the NHS. As he found out in government, because his Government greatly expanded that role, there is a responsible role for the private sector not at the expense of the NHS but working with it. On that basis, I urge my right hon. and hon. Friends to vote against the motion.

Question put.

Oral Answers to Questions

Simon Burns Excerpts

Tuesday 10th January 2012 Commons Chamber

[Jason McCartney (Colne Valley) (Con)]

3. If he will take steps to ensure that the safe and sustainable review of paediatric cardiac services is fully inclusive.

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

The review of children’s congenital heart services is a clinically led NHS review, independent of Government. In conducting it, the Joint Committee of Primary Care Trusts has aimed to be as inclusive as possible in relation to all issues.

[Jason McCartney]

The Minister will be aware that the review has been called into question because the consultation has not encompassed other medical conditions such as respiratory problems. Will he intervene so that a consensus approach can now be taken?

[Mr Burns]

As I have said, the review is clinically led and independent of Government, and I am afraid that it would not be appropriate for me, or my colleagues, to intervene. Moreover, the review is the subject of legal proceedings. It will be for the Joint Committee of Primary Care Trusts, on behalf of local commissioners, to decide the future pattern of children’s heart services on the basis of the best available evidence.

[Greg Mulholland (Leeds North West) (LD)]

It seems nonsensical to deal with the provision of surgical services for adult and child congenital cardiac patients in separate reviews. Given the delay in the review of children’s services, does the Minister not agree that it is time to consider including them in the forthcoming review of adult services?

[Mr Burns]

I am grateful to the hon. Gentleman for his suggestion, but I am afraid that I do not share his view. As he knows, there will be a review of adult services, but it has always been considered most appropriate to deal with paediatric cardiac services before adult care, and that is what we will continue to do.

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

Although the paediatric heart unit at Southampton general hospital is rated the best in the country outside London, it was included in only one of four options under the review. In the past, the Minister has helpfully hinted he might not be confined to considering only those four options. Can he expand on that?

[Mr Burns]

I can expand on it by saying that it will not be me who considers the options. As I have told my hon. Friend before, this is an independent review. However, as he suggests, the JCPCT may decide on four, six or seven possible sites. It all depends on what the consultation produces, and the clinical decision on what is the most appropriate number of sites, which will happen eventually.

I congratulate my hon. Friend on his championing of Southampton general hospital as the local Member of Parliament.

[Mr David Evennett (Bexleyheath and Crayford) (Con)]

4. What recent representations he has received on access to the cancer drugs fund; and if he will make a statement.

--- Later in debate ---

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

10. What recent estimate he has made of the cost to the public purse 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. That will save £4.5 billion over this Parliament, and £1.5 billion per year thereafter. We will reinvest every penny saved in front-line services.

[Steve McCabe]

I am grateful for that answer. The Minister will be aware that the figure he has given is about half what the primary care trusts believe they are required to keep back to fund the reorganisation: they put it at £3.4 billion. Given his answer today, will he write to South Birmingham primary care trust to tell it that it no longer has to hold back £25 million for that purpose and that it can use that money to cut the 18-week waiting list, which has risen by 36% since he assumed office?

[Mr Burns]

May I say, in the nicest possible way, that I think the hon. Gentleman is a tiny bit confused? I think he is confusing the one-off costs of the modernisation with the 2% hold-back figures used by the PCTs, which put aside money—a process instigated by the right hon. Member for Leigh (Andy Burnham), which we carried on—that can be used if a PCT gets into financial problems. If it does not get into financial problems, it can then use the money to invest in front-line services.

[Mr Peter Bone (Wellingborough) (Con)]

The Conservative-led coalition should be congratulated on introducing a measure that will get rid of red tape and bureaucracy by getting rid of strategic health authorities and primary care trusts. Do the Labour Opposition not look like dinosaurs when they try to defend those bodies?

[Mr Burns]

I am very grateful to my hon. Friend and I am always reassured when he congratulates the coalition Government, as it suggests to me that we are getting something right. My hon. Friend is absolutely right. As everyone who understands health policy in this country recognises, the NHS must evolve to meet changing needs and we are improving effectiveness and efficiency and saving money by cutting out administration and bureaucracy so that we can reinvest in front-line services to look after the health interests of all our constituents.

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

Figures revealed to the Opposition under freedom of information procedures show that GPs will receive up to £115 an hour for commissioning health care services on top of their existing salary. It makes no sense at all to take GPs away from patient care to become part-time accountants. When the NHS needs every penny it can get, patients will be astounded to hear that the Government plan to pay GPs twice. This comes at a time when 48,000 nursing posts are being axed and £3.5 billion is being set aside for the Minister’s bureaucratic upheaval. Will he now accept that the NHS can ill afford for money to be wasted on a top-down reorganisation that few want? Is it not now time for him to scrap the Bill?

[Mr Burns]

It is nice that the hon. Gentleman got the mantra in at the end—I have been expecting it all through this Question Time. He is wrong; what is important and what this modernisation has at its heart is the need for GPs to commission care for patients, because GPs are best equipped to know the needs of their patients. That is the way forward. Also, we are cutting bureaucracy and administration by 45% so that we can reinvest that money in front-line services. We want to spend money on health care and on improving outcomes, not on managers and bureaucracy.

[John Pugh (Southport) (LD)]

May I congratulate the Secretary of State and the Prime Minister on the productive ward initiative? The NHS document “Top Tips for spreading The Productive Ward” says:

“Set a realistic time scale. Take your time and do not rush. Take small steps and complete them before moving on to the next.”

Is this advice generally applicable to NHS reform?

[Mr Burns]

As the hon. Gentleman recognised at the beginning of his question, this is important and excellent advice for nurses and other health care professionals to give care, consideration and attention to all patients so that they can be looked after in an appropriate and caring way. That is the way forward to making the health service more responsive to the needs of patients and to the improvement of health outcomes.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

What assessment has the Minister made of the impact of the NHS reorganisation on waiting times?

[Mr Burns]

The hon. Lady raises an extremely important point. The whole purpose of the modernisation of the NHS is to enable it to meet the challenges of an ageing population, an increased drugs bill and new medical procedures, so that we can ensure that patients get their treatments, within the responsibilities of the NHS constitution, and do not have to wait undue lengths of time for treatment.

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

11. What recent representations he has received on the Health and Social Care Bill.

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

The Government have listened to representations throughout the passage of the Health and Social Care Bill. In addition to the consultation on the White Paper, the NHS Future Forum has undertaken two engagement exercises. The first involved 6,700 people directly and received more than 28,000 comments and e-mails, and the second involved more than 12,000 people at more than 300 events. Ministers have also continued to meet and to receive representations from a range of interested parties on a regular basis, and we will continue to do so.

[Chris Ruane]

I thank the Minister for that response. May I ask what specific representations he has had on children’s well-being? Is he aware that the Children’s Society will this Thursday publish its 2012 “Good Childhood” report, which will include a specific report on how central and local government could improve and promote positive well-being among children? Will the Minister and the Secretary of State meet the Children’s Society to discuss that important report?

[Mr Burns]

Throughout the consultation process there have been comments and responses to proposals across the whole of the health area, including on children’s health and well-being. Obviously, I cannot comment on a report that will not be published until later this week, but I or one of my ministerial colleagues would be more than happy to meet the Children’s Society once the report has been published if the society thinks that a meeting to discuss the report’s contents would be worth while.

[Mr Stephen Dorrell (Charnwood) (Con)]

Against the background of the recommendation of the NHS Future Forum that a key priority for the future is greater integration between health care and social care—a priority that was explicitly endorsed last week by the Prime Minister—does my right hon. Friend agree that the key opportunity in the Bill, through the health and wellbeing boards, is to drive that agenda, which has been much talked about for many, many years now, and actually to start to deliver on that rhetoric?

[Mr Burns]

My right hon. Friend is absolutely right; of course, when he was Secretary of State he did a considerable amount of work to lay the ground rules for the move towards greater integration, because that is the way forward. My right hon. Friend makes a very valid point: it is the way forward and we fully recognise that. We are deeply committed to achieving that aim, and that is why my right hon. Friend the Secretary of State has added an extra £150 million to the existing £300 million, to facilitate progress towards it.

[Andy Burnham (Leigh) (Lab)]

May I tell the Secretary of State and the Minister that he will receive more representations on his Bill later this week from two hospital doctors who, early this morning, began a 160 mile run to protest against his Bill, from Bevan’s statue in Cardiff to his Department? [Interruption.] The Secretary of State should listen. Let me remind him why people are so angry. Nobody voted for the Bill. It was ruled out by the coalition agreement, and it is now the unelected House deciding the future of the NHS, passing amendments that he was too scared to table in this House.

Will the Minister today have the courage to admit that it is now the Government’s intention to allow NHS hospitals to make 49% of their income, effectively devoting half of their beds, from the treatment of private patients?

[Mr Burns]

May I say a happy new year to the right hon. Gentleman as well? I believe that his analysis of the support for the Bill is flawed, because there are a number of areas where a number of organisations warmly welcome its contents. For example, the BMA voted in favour of GP commissioning at its special general meeting last year.

On the question of 49%, the shadow Secretary of State has been uncharacteristically forgetful, because of course he will appreciate that the cap applies only to foundation trusts, not to non-foundation trusts, and that is no different today from what it will be after the modernisation—and it was a policy that his Government brought in.

[Andy Burnham]

No, it was not. That policy would never, ever have come forward under a Labour Government—and I know that the right hon. Gentleman has not denied it. We, the Opposition, will now make it our business to tell every single patient in England about his plans for the NHS. People can finally see the Bill for what it is: a privatisation plan for the NHS. England’s hospitals will never be the same again if the Bill gets through: an explosion of private work; longer waits for NHS patients; profits before patient care. Will not the only choice on offer for patients be the old Tory choice in the NHS: wait longer or pay to go private?

[Mr Burns]

I am afraid that the shadow Secretary of State is just totally wrong. This Government have no intention to and will not privatise the national health service. We want to improve patient outcomes and the patient experience. The right hon. Gentleman should look again at the 49% that he talks about, because we are not changing the situation, particularly because it does not apply to trusts at the moment; it is only for foundation trusts.

[Andy Burnham]

That is garbage.

[Mr Burns]

The right hon. Gentleman says it is garbage. I think that is confusing from him, because I remind him that of course it was in the Labour party manifesto at the last general election to remove the private patient cap.

[Guy Opperman (Hexham) (Con)]

12. What steps he has taken to implement a flexiscope bowel cancer screening test.

--- Later in debate ---

[Mr Frank Field (Birkenhead) (Lab)]

13. What estimate he has made of the cost to the public purse of NHS reorganisation in (a) Birkenhead constituency and (b) England.

[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. That will save £4.5 billion over this Parliament, and a further £1.5 billion each year thereafter. [Hon. Members: “It is a different question.”] It is the same question. We do not have a local breakdown of these figures, as that will depend on local decisions.

[Mr Field]

Perhaps the right hon. Gentleman will ask the House of Commons Library for the answer so that he can give it to me next time, and also look at the increase in the number of managers in Wirral over the past five years. The number has gone up by more than a quarter. With that size increase, why are those staff not being used to pilot his reorganisation?

[Mr Burns]

The right hon. Gentleman is absolutely right. There was a significant increase in managers in the NHS in the last two or three years of his Government. Since we came to power, there are just under 15,000 fewer managers and administrators, and 3,700 extra doctors.

[Patrick Mercer (Newark) (Con)]

The Minister is well aware of the reforms to the NHS in my English constituency, but many of my constituents question whether they are getting value for money in view of the expansion of population in Newark over the next couple of years. Will he look again, please, at the Newark health care review?

[Mr Burns]

If my hon. Friend would be kind enough to write to me with specifics on the situation in Newark, I would be more than happy to look into it in detail and respond to him.

[John Mann (Bassetlaw) (Lab)]

14. How many (a) accident and emergency departments and (b) maternity units he expects will be (i) downgraded and (ii) closed between May 2010 and May 2015.

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

The reconfiguration of local health services, including A and E and maternity services, is and will remain a fundamentally local process. What matters is that decisions about service changes are clinically driven, and that patients and the public are involved in those changes to ensure that they get the highest quality care.

[John Mann]

I refer to the answer that the Minister just gave to the hon. Member for Newark (Patrick Mercer). The buck stops with the Minister. Would he like to congratulate the SOS Save Our Services group in Bassetlaw, which in the past two months has overturned the proposals to downgrade A and E and maternity services at Bassetlaw hospital? Is that not a good example of the real big society?

[Mr Burns]

As the hon. Gentleman knows, on 20 May 2010 my right hon. Friend the Secretary of State brought in the four conditions that had to be met for reconfiguration, which included paying attention to the views of local stakeholders and the medical profession. So, as the hon. Gentleman rightly says, the decision has been taken not to proceed with the changes at Bassetlaw hospital. No doubt he also welcomes the £900,000 that is being invested to expand and improve Bassetlaw hospital’s A and E facility.

[Mr Jamie Reed (Copeland) (Lab)]

The whole House will note that the moratorium on hospital and ward closures has clearly ended, but as my hon. Friend the Member for Bassetlaw (John Mann) rightly said, the NHS risk registers held by regional and local health boards around the country clearly showed the risks associated with closures and the downgrading of hospital wards. The Government’s Health and Social Care Bill poses risks to the safety and quality of services, yet the Secretary of State has appealed against the Information Commissioner’s ruling that the NHS national risk register should be published. Members of both Houses may be denied the opportunity to scrutinise the real risks that the Bill poses to the NHS before they are asked to vote on it for a final time. Will the Minister give a binding commitment that the risk register produced by his Department will be published in full before the Bill returns from the Lords?

[Mr Burns]

The right hon. Member for Leigh (Andy Burnham) did not publish a risk register during his tenure. His predecessor, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), did not publish the risk register on two occasions during his tenure. The bits relevant to the Health and Social Care Bill have been made public, but we will not be publishing the risk register because, as the hon. Gentleman knows, my right hon. Friend the Secretary of State is appealing, as he is entitled to do, against the Information Commissioner’s decision—[Interruption.] We have a right of appeal, which we are exercising, and we will have to wait until a decision has been reached on appeal. Until then, no we will not be publishing the risk register, because it is not necessary or appropriate.

[Mr Graham Allen (Nottingham North) (Lab)]

15. What steps his Department is taking to prevent ill health and its associated costs through early intervention.

--- Later in debate ---

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

The Prime Minister speaks of the “health and safety monster”; does the Minister believe it is right that advertising for personal injury lawyers should be displayed in hospital A and E departments, which many might think would feed the monster and make it bigger?

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

I am very grateful to my hon. Friend for raising that, because it is an important issue. As he might be aware, there are rules and regulations: it is not acceptable for that sort of advertising in NHS hospitals. I would hope that any trusts behaving in that way immediately review their procedures.

[Jim McGovern (Dundee West) (Lab)]

T8. Yesterday, I had a meeting with Patricia Osborne, the chief executive of the Brittle Bone Society, a UK-wide organisation that is headquartered in my constituency. It was made clear to me that given the current funding squeeze across the voluntary sector, the society is concerned about its ability to provide the vital services that it currently provides. Also troubling the society is the lack of support for adult sufferers of osteogenesis imperfecta. What can the Secretary of State tell me about the Government continuing to support that important society, and what more can they do to support adults with that condition?

Low Dose Naltrexone

Simon Burns Excerpts

Thursday 8th December 2011 Commons Chamber

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

I begin by congratulating the hon. Member for Llanelli (Nia Griffith) on securing the debate and hope that by the end of my comments, particularly the last section, she will feel that there is a mechanism and a way forward that she will find helpful. Like her, I am well aware of the interest in the subject from those who feel that LDN is a suitable treatment for a number of conditions, including multiple sclerosis, HIV and various cancers. I am grateful to her for the opportunity to clarify the Government’s position.

I will begin by talking about the process for licensing drugs in general. An unlicensed medicine is not necessarily illegal in the way an unlicensed driver is; it just means that the regulator has not yet been given the evidence it requires to support a routine place in the market. The Medicines and Healthcare products Regulatory Agency is responsible for the regulation of medicines used in the UK, which includes authorising applications for clinical trials and granting licences for medicines. MHRA gives licences for medicines only after evidence has been submitted to demonstrate the quality, safety and efficacy of the product for the conditions it is intended to treat. That system, whereby licences follow evidence, protects patients and means that there is always a robust, systematic and independent assessment of the safety and suitability of licensed medicines.

In the UK, naltrexone is currently only fully licensed in 50 mg tablet form. That dosage is used to help patients remain free from dependence on heroin, methadone and similar opiates and to help those who are dependent on alcohol, but the drug is not currently licensed at any dose for the treatment of the other conditions that the hon. Lady rightly mentioned, because the evidence necessary for a licence does not exist. However, naltrexone is being prescribed by some doctors in doses of up to 7 mg on an individual patient basis. This is referred to as low-dose naltrexone.

The reason MHRA has not looked into licensing LDN is that it has not received any application or evidence to support it, which means LDN is currently unlicensed. That does not mean that it is necessarily unsafe; it is just that a licence for its use in this country does not exist. The current position is that when a patient needs a medicine an appropriate licensed product should be used. If it is not available, doctors can prescribe a different licensed medicine if they think that it will do the job. If neither of those options is available, an unlicensed medicine may be considered. LDN currently falls into that last bracket. As it involves a significantly lower dose than the licensed form of naltrexone, and as it is untested, it is regarded as an unlicensed medicine.

Legislation supports clinicians when they want to prescribe an unlicensed medicine that they think is necessary to meet a patient’s particular needs. The MHRA checks that the medicine is being manufactured to the right standards, in a safe environment and with suitable materials. Any unlicensed product manufactured in the UK must be manufactured to the specification of the doctor, nurse, dentist or whichever professional prescribed it in the first place. The important point is that the use of an unlicensed medicine is the direct personal responsibility of the professional who prescribed it. They are aware that it is unlicensed, and they prescribe it with that knowledge. The position is reflected in professional guidance, including that of the General Medical Council.

Given that a licensed LDN product is not available in the UK, it can be supplied only as an unlicensed product either manufactured in the UK or imported from somewhere else. Most of the LDN used in this country is manufactured in the UK, but anyone who wants to import it must be authorised by the MHRA. In the UK, manufacturers produce a number of formulations, including LDN capsules, at strengths ranging from 1 mg to 6.5 mg, and these are produced under a “specials” licence.

The importation of any medicinal product not licensed in the UK must be in compliance with the Medicines for Human Use (Manufacturing, Wholesale Dealing and Miscellaneous Amendments) Regulations 2005, which provides for the import of products when a special clinical need exists for individual patients and when the regulatory authority has not objected to the import. Objections may be made on grounds of known safety or quality issues, or if an equivalent UK licensed product is available. In the case of LDN, there is no ban on the import of products of acceptable quality and safety, and I hope that those comments go some way to reassuring the hon. Lady on her point about the fears of some GPs who had been or were not prescribing the drug.

When medicines are unlicensed, such as LDN, the National Institute for Health and Clinical Excellence does not generally assess them, so it has not issued any guidance on the use of LDN in the NHS. When NICE guidance on a particular drug for a particular condition does not exist, it is for local primary care trusts in England to make funding decisions based on their own assessment of the available evidence. On behalf of their patients, doctors can, through an individual funding request, request treatments that are not usually funded, if they feel that there are exceptional clinical circumstances.

In this situation, a special panel that includes clinicians would carefully consider individual cases. They would use the latest available evidence and make a decision on the basis of a patient’s individual circumstances, but we recognise that there is demand from the NHS and from patients for better access to information about drug treatments, particularly when no licensed product is available, so we are keen to explore whether more can be done to support clinicians, NHS commissioners and patients in their own decision-making by giving them easier access to the best available information. That is why the Department of Health asked NICE to provide a service to support the NHS in deciding whether an unlicensed drug can be used to address an unmet need. Under our plans, NICE will commission expert assessments of the evidence that supports—or does not support—the use of unlicensed medicines, including in rarer conditions. That will help clinicians make decisions about effective treatments and address one of the access problems that patients face. As I said earlier, it is important that we preserve the integrity of the medicines licensing scheme, which is so vital to protecting patients. Any information provided will be designed to inform doctors’ decision making and patients’ choices, not to provide a simple yes or no recommendation.

The Medicines and Healthcare products Regulatory Agency is responsible for the enforcement of the advertising regulations—another important area with regard to this subject. There are also self-regulatory controls operated by the industry body—the Prescription Medicines Code of Practice Authority—and general controls on advertising operated by the Advertising Standards Authority. Regulations state that

“no person shall issue an advertisement relating to a relevant medicinal product which is a medicinal product in respect of which no marketing authorisation or traditional herbal registration is in force”.

The regulations apply to any person and are not specific to the pharmaceutical industry. This prohibition does not prevent independent patient charities from providing balanced and factual information about treatment options, including any that are not licensed. The MHRA has published guidance on its website. The MHRA would investigate any complaint about a breach of the legislation, but has not received any complaint about the advertising of low-dose naltrexone. Whether a charity or another third party was promoting a medicine or providing non-promotional information would be decided on the facts of any specific case.

The hon. Lady will no doubt appreciate that it is in everyone’s interest to see a booming medical research industry in the UK that is successful, is meeting its requirements, and is pushing forward our development and use of advanced medicines to help to bring relief to those suffering acute illnesses or long-term conditions and to help them to manage those conditions better.

[Annette Brooke]

The Minister is being very clear in his exposition. The question that my constituents continually ask is why the NHS is not in the least bit interested in a treatment that is so cheap, costing about 50p a day, and appears to defer care costs into the bargain. A constituent of mine has been with their consultant to see the prescribing committee of the local PCT, but we still do not have this drug on NHS prescription.

[Mr Burns]

I am grateful to the hon. Lady for raising that point on behalf of her constituents. The short answer is that it is simply because there have been no clinical trials to assess the drug in its low-dosage levels, and so the conditions of the NHS, under the ways in which we operate in the provision of drugs for patients, have not been fulfilled at this stage. If she will wait for a minute or two, I will get to the nub of the point made by the hon. Member for Llanelli about how we could move forward to seek to address that situation. I hope that the hon. Member for Mid Dorset and North Poole (Annette Brooke) will find the way forward helpful and positive.

The hon. Member for Llanelli will no doubt appreciate that it is in everyone’s interest to see a booming medical research industry in the UK, because that leads to real improvements in the lives of patients, their families and carers, and we are determined to support it. We demonstrated our commitment to health research by increasing spending in real terms up until 2015. In August, my right hon. Friends the Prime Minister and the Secretary of State for Health announced a record £800 million, five-year investment in a series of biomedical research centres and units, which will translate fundamental biomedical research into clinical research that benefits patients and the NHS.

The coalition Government are committed to the promotion and conduct of research as a core function of the health service. The Health and Social Care Bill, which is now passing through another place, will turn this into reality by placing appropriate powers and duties on my right hon. Friend the Secretary of State for Health, NHS organisations, Monitor, and local authorities. We will make sure that the systems and processes for commissioning by the NHS Commissioning Board and by clinical commissioning groups promote, support and fund clinical research. The Government will consult on amending the NHS constitution in order to support patients to have access to novel treatments and to be part of the development of wider patient benefits, so that there is a default assumption, with an ability to opt out; that data collected as part of NHS care can be used for approved research, with appropriate protection for patient confidentiality; and that patients are content to be approached about research studies for which they may be eligible to enable them to decide whether they want a discussion about consenting to be involved in a research study.

The clinical practice research datalink will be introduced by the MHRA in partnership with the National Institute for Health Research, building on the NIHR’s research capability programme. This £60 million investment will offer data services, including providing access to data for researchers, data matching and linkage services, and data validation, to support the clinical trial and observational study work of the life sciences research community.

The NIHR will launch an updated UK clinical trials gateway in spring 2012. That website will enable patients and the public to access information about clinical trials and will be a development of the test site launched in March 2011. To increase the number of patients who can benefit from being involved in trials via the gateway, the NIHR has also developed a free smartphone app, which is available for iPhone users and will shortly be available for Android users. It provides a practical and innovative way for patients to access information about clinical trials.

I will now turn to the question of clinical trials that the hon. Member for Llanelli raised and that the hon. Member for Mid Dorset and North Poole raised, by default, in her intervention. I think that this explanation may provide the hon. Member for Llanelli with the basis for making progress in her quest. Clinical trials are a fundamental part of the drug development process, as she accepts. Trials and health research more generally are funded by a range of groups in the UK, in particular by the NIHR, the Medical Research Council, medical research charities and industry. The NIHR welcomes high-quality funding applications for research into any aspect of human health, including the use of LDN. Such applications are subject to peer review and are judged in open competition, with awards being made on the basis of the scientific quality of the proposals. As she has suggested, a new clinical trial will be required to support a licence for the use of LDN.

The MHRA regulates clinical trials on medicines when they are carried out in the UK. That includes granting approval to conduct a clinical trial and ensuring, through inspection, that the highest possible standards are maintained. However, the MHRA does not initiate clinical trials. A clinical trial needs a sponsor. Sponsors have usually come from industry, the NHS or academia. The hon. Lady is seeking Government funding for a clinical trial to prove the efficacy and safety of LDN. I can tell her that funding is available and that university-based researchers can apply for it.

The efficacy and mechanism evaluation programme is funded by the Medical Research Council and managed by the NIHR. It funds evaluation of the clinical efficacy of treatments. If evidence from such evaluations is promising, larger-scale trials can follow. That is one of the purposes for which the NIHR funds the health technology assessment programme. That programme produces evidence on the effectiveness, cost and broader impact of treatments and other types of health care intervention. In the case of LDN, as with all other novel treatments, I cannot prejudge how successful that pathway of research might be, but I can tell the hon. Lady that a pathway does exist, as I have described.

In addition, the hon. Lady expressed concern about whether the systems in place make provision for patients to say what research they would like to happen. I can assure her that patients can make a suggestion for the efficacy and mechanism evaluation programme to consider. Topics prioritised for funding may be advertised, inviting researchers to submit proposals for clinical trials in those topical areas.

I am grateful to the hon. Lady for raising this subject and giving me the opportunity to explain the background to a matter of considerable interest to many people, not least some of her constituents and those of the hon. Member for Mid Dorset and North Poole. I hope the last part of my speech in particular, in which I have explained an existing avenue that they and others interested in LDN may wish to pursue, will be helpful to them.

[Nia Griffith]

May I take this opportunity to thank the Minister for his very full and helpful reply?

[Mr Burns]

And may I, in the spirit of Christmas, thank the hon. Lady very much for the way in which she presented her case? It was quite clear from listening to her speech that she rightly felt very strongly about the issue on behalf of not only her constituents but people up and down the country who need LDN and who, at the moment, are having to go through the procedures that she described.

Question put and agreed to.

Vascular Services (Warrington)

Simon Burns Excerpts

Monday 28th November 2011 Commons Chamber

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

I congratulate the hon. Member for Warrington North (Helen Jones) on securing this debate, and I totally agree that it is important for patients to have access to high-quality vascular services. I know that she is an active campaigner locally on health issues and a strong supporter of local health services.

The hon. Lady has raised a number of issues about the current review of vascular services in Cheshire and Merseyside. I appreciate that her constituents may be concerned about proposed service changes and want to be assured that they will have access to these services. Due to the shortage of time available, I hope she will forgive me if I do not go into the detail of the background at national level of all that the Government and the NHS are doing on vascular services, health checks, screening and so forth. I would like to address the situation in her constituency that she has raised. If I do not have enough time to provide all the answers to her questions, I assure her that I will write to her.

Currently, the commissioning of complex vascular services varies. In some areas, they are commissioned by regional specialised commissioning groups, but in others they are commissioned by individual primary care trusts. Evidence shows that, in order to maintain the safety and quality of these services, it is better that they are commissioned for larger populations.

There is robust evidence, highlighted by the work of the Vascular Society of Great Britain and Ireland, which shows that patient outcomes are best when complex vascular care is delivered by units that treat higher volumes of patients. In response to that evidence and national screening for abdominal aortic aneurysms, vascular services are being reviewed locally across England.

Reflecting that approach, in June 2010, the NHS in Cheshire and Merseyside embarked on a review of the way in which vascular services are delivered. It deals with non-cardiac vascular services for conditions such as abdominal aortic aneurysms, strokes and mini-strokes. Cardiac services continue, and will continue, to be provided in local hospitals in Cheshire and Merseyside. Vascular services are provided by nine district hospitals across Cheshire and Merseyside, including Warrington hospital in the hon. Lady’s constituency.

The review proposes that local hospitals should work in partnership to deliver the range of vascular services, with arterial complex interventional radiology and emergency surgery being carried out in a small number of arterial centres. Out-patient clinics, initial investigations and follow-up treatment will continue to be provided in local hospitals, including hospitals in Warrington and Halton. Patients with a vascular emergency will be taken to their nearest local hospital—unless the referring GP suggests otherwise—where they will be stabilised. If they require further emergency or arterial surgery, they will be transferred to the arterial centre. I have been informed that vascular surgeons will be based at local hospitals as well as arterial centres, which will ensure that patients can have access to their expertise.

[Helen Jones]

How many vascular surgeons will be based at Warrington, and what kind of rota will there be? The Minister knows as well as I do that problems occur with rotas when those surgeons are not available.

[Mr Burns]

Given that I want to deal with some of the other points raised by the hon. Lady, may I write to her about that? Given the shortage of time, I suspect that I shall also have to write to her about a number of other issues.

The Cheshire and Merseyside vascular review project board led the review, and was advised by a clinical advisory group consisting of local clinicians, including some from Warrington. The group developed a set of standards that each vascular network would need to meet, along with locally agreed minimum activity thresholds. They were considered in the light of the size of the population served by Cheshire and Merseyside. On the basis of advice from the clinicians, the project board concluded that, given the clinical activity and population size, it would be best for two vascular networks to serve populations in north and south Mersey, and that each network should have its own arterial centre.

In January 2011, the project board undertook a pre-consultation of local people, which included public and NHS staff meetings. They presented the pre-consultation to the local overview and scrutiny committees in every local authority across Cheshire and Merseyside, and wrote to local MPs, including the hon. Lady and, I assume, the hon. Member for Halton (Derek Twigg) and my hon. Friend the Member for Warrington South (David Mowat). In October 2011, the board provided the commissioners in Cheshire and Merseyside with a report setting out its findings and recommendations. The report proposed that the arterial centre in the north Mersey network should be based at Royal Liverpool university hospital, while the arterial centre in the south Mersey network should be based at either Warrington hospital or Countess of Chester hospital. However, the final decision was left to commissioners.

The two joint bids for the south Mersey network from the Warrington and Chester trusts were presented to the clinical commissioning group chairs in Runcorn, Widnes, Warrington, Wirral and Western Cheshire. The commissioning groups, including Warrington, unanimously decided to recommend to the PCT cluster board that the arterial centre for the south Mersey network should be based at Countess of Chester hospital. I understand that they felt that the joint bid from Chester and Wirral contained the most credible plan for developing a networked vascular service for the populations of Warrington, Halton, Western Cheshire and Wirral, while facilitating a full range of local hospital services. I appreciate the hon. Lady’s concerns about the impact on Warrington hospital of the arterial centre being located at Chester. I understand the project board commissioned an impact assessment of the changes on Warrington, which highlighted a number of issues, but it concluded that these could be mitigated. The proposals have been considered by the Cheshire, Warrington and Wirral and Merseyside primary care trust cluster boards, which have supported the project board’s recommendations, subject to formal public consultation.

The proposals will also be subject to gateway review and national clinical advisory team assessment, as well as assurance from NHS North West that they meet my right hon. Friend the Secretary of State for Health’s four tests for service change: the proposals must demonstrate strengthened public and patient engagement; be based on sound clinical evidence; there must be support from GP commissioners; and there must be consideration of patient choice.

[David Mowat (Warrington South) (Con)]

The Minister is describing in some detail the process by which the nine centres that previously existed are to be reduced to two, and we can, perhaps, accept the logic of that. This is a piecemeal decision for one type of service, however. If every centralisation decision is taken in a piecemeal way, Warrington and Halton might well lose every single time. When decisions on centralisation are made, should there not be some kind of strategy for deciding what will end up where, so that every decision is not made on a piecemeal basis?

[Mr Burns]

If my hon. Friend means by “piecemeal” that the decision is dealing only with a certain part of the country, then that is indeed the case. However, the review was carried out in the context of a wider geographical area in and around Merseyside, and in that respect it is achieving its aim of finding the most relevant service for the local communities. That is why the recommendation was to have two arterial centres located there.

The hon. Member for Warrington North raised the issue of population, as she believes, I think, that there should be a third centre. The following point is based on advice from both the Vascular Society of Great Britain and Ireland and the local clinical advisory group. The population in the area under discussion in respect of this decision on services is 1.2 million, whereas the figures that would be required to have a third centre are 1.4 million for the vascular networks and 1.6 million for abdominal aortic aneurysm screening programmes. Therefore, the population currently under discussion is too small to warrant an extra centre. I hope she will accept that.

[Derek Twigg]

Will the Minister give way?

[Mr Burns]

No, as there is not sufficient time.

On the proposals for consultation, I have been assured by NHS North West and the PCT cluster boards that an implementation steering group will ensure that the recommendations made in the impact assessment are taken forward. The final proposals will be subject to formal public consultation in 2012.

I appreciate that the hon. Lady and her constituents have concerns about the proposals for vascular services. However, I should stress that these proposals have been developed by the NHS in Cheshire and Merseyside based on advice by clinicians made in the light of best practice recommendations by the Vascular Society of Great Britain and Ireland. I therefore encourage her to take the opportunity to discuss the proposals with the Cheshire and Warrington and Wirral PCT cluster boards while they are being prepared for formal consultation, which will take place next year, as I mentioned earlier.

Question put and agreed to.