Manufacturing
Simon Burns Excerpts(13 years ago)
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Guy Opperman
I thank colleagues who have contributed to the debate, in which there has been a cross-party optimism about the fundamentals of manufacturing. It is a noble profession and a wonderful sector to work in. There is optimism for the future of manufacturing, and that is what this debate is about, rather than the past.
There has been an understanding of the past difficulties from which successive Governments and businesses down the years have suffered and of the present problems of globalisation, the Chinese influence, energy prices and the extent to which the state is struggling with the debt and difficulties faced by each country in the eurozone, particularly this one. There has been recognition that we must subsidise and support individual businesses and manufacturing organisations, whether with a form of capital allowances, R and D, tax credits or the like.
Although there is a tradition for men to be involved in manufacturing, I was particularly heartened to hear my hon. Friend the Member for Erewash (Jessica Lee) contribute so robustly to the debate. As a female Member of Parliament, she spoke very eloquently of the role of women entrepreneurs. I strongly support the view that this is a profession not only for men but for women. I apologise to all women for saying, when I described the need for a Minister for manufacturing, that we needed a go-to guy; of course, it could just as well be a go-to woman.
Guy Opperman
Or gal, as my right hon. Friend on the Front Bench so eloquently puts it. The learned Minister has intervened on many previous occasions, and we have another bon mot at last.
I listened to the 19 speakers who contributed to the debate. We finished, last but by no means least, in Watford, having journeyed north to Morecambe and the bay, taken in Bradford East and Hove, and travelled back up to Yorkshire and Calder Valley and then on to Carlisle and Hartlepool. At this stage, the Minister appeared. I must apologise to him, because I think I said that he was from Bognor. Of course, I have nothing against Bognor—everyone loves Bognor—but he is the representative of Havant, as we all know, except the hon. Member for Hexham. We then journeyed to Erewash, Derby North, Pendle, Blaenau Gwent, Warwick, West Bromwich West, Burnley, Wolverhampton South East, Weaver Vale, and then to Huddersfield and up to the finest constituency of them all—which is, of course, Hexham.
The future of manufacturing is worth our taking up the debating time of the Backbench Business Committee. The three co-sponsors of the debate—my hon. Friends the Members for Warwick and Leamington (Chris White) and for Burnley (Gordon Birtwistle) and the hon. Member for Huddersfield (Mr Sheerman)—have done so much to try to put manufacturing back in the frame in the House of Commons, and that is the right thing to do. It is noticeable that we are already receiving press coverage on the need for a Minister for manufacturing.
There seems to be widespread agreement that the banking system needs reform and improvement so that these businesses, which we all so cherish and want to receive support, receive that support, whether it is from a local bank or an industry bank such as that championed so well by the Germans with the KfW model. Such possibilities give businesses an endless ability to thrive in future. We all agree that that is the model for the way ahead. I look forward to the forthcoming meeting with the Financial Services Authority to discuss the local bank project. The Government should clearly be picking winners; manufacturing is a winner, and it has a very good future.
Question put and agreed to
Resolved,
That this House has considered the matter of the future of manufacturing.
Local Pharmacies
Simon Burns Excerpts(13 years ago)
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The Minister of State, Department of Health (Mr Simon Burns)
May I begin by congratulating the hon. Member for Ogmore (Huw Irranca-Davies) on securing this debate? I know that he has been assiduous in highlighting this important issue in his constituency and beyond, and anyone who doubts that need only have listened to his speech—or read it in Hansard tomorrow—to know about his commitment to, knowledge of and passion for this issue of genuine concern in many areas. It is also a pleasure to see my hon. Friend the Member for Stourbridge (Margot James) in her place, as I know that she has a long-standing interest in the subject, having secured a debate on the pharmaceutical situation earlier in this Session.
I assure all hon. Members that I am sadly all too aware of the difficulties that pharmacists and members of the public have had in obtaining some prescription medicines. It was particularly moving when the hon. Gentleman spoke of the experience of someone he knows who regrettably had trouble getting hold of one of her medicines, Femara, which is used to treat breast cancer. We freely discuss policy at meetings and in the Chamber, but those discussions suddenly seem very distant when we are confronted with the reality of what it means to be unable to access a drug. I am aware that some pharmacists have had difficulties getting Femara, but those difficulties have recently been greatly reduced following the expiry of the patent earlier this year. The generic version of Femara is now widely available under the name letrozole. I know that it is of little consolation to the hon. Gentleman’s friend, but what it does mean is that other people will not have to go through the same heartache as that lady.
I am also aware of how frustrating it is when such problems occur with other drugs—not simply cancer drugs—because for people who need them at the time, they are equally important. The coalition Government have already taken action and we will take further action if necessary.
Supplying medicines to patients requires a complex, international infrastructure. There are around 16,000 licensed medicines covering tablets, capsules and injections, and different dosages, and nearly 900 million NHS prescription items are dispensed every single year. As hon. Members will appreciate, it is a vast undertaking. Given that complexity and scale, there are difficulties from time to time, and not only the UK is affected: recently the US has had problems of its own. There are many different reasons why patients might have problems getting hold of their medicines, and they range from difficulties in obtaining raw materials to manufacturing problems and the overseas sale of medicines intended for this country. I would like to speak about all of these.
Supply issues can arise as a result of parallel trade, as the hon. Gentleman mentioned. That is when medicines are bought at low prices in one European country and then resold at higher prices in another. When the euro got stronger relative to the pound, exporting UK medicines to other European countries become more profitable. At the moment, parallel trade exports are therefore reducing the supply of medicine available to UK patients. I stress that this parallel exporting is legal and can be carried out by anyone who holds the necessary licences under the medicines legislation. Indeed, in the past, UK patients have benefited from medicines being imported to this country by the same process.
I cannot stress firmly enough that there are existing legal duties on manufacturers and distributors, within the limits of their responsibilities, to maintain a suitable supply of medicines to pharmacies so that the needs of patients are met, but regrettably a minority of operators in the supply chain are thought to be putting profit before patients. I know that this is not condoned by the majority of those in the supply chain. Indeed, manufacturers and pharmacies have to fill the gap that these practices create.
Manufacturers have introduced quotas to try to target supply but this reduces pharmacies’ flexibility to meet unexpected patient need. Pharmacies use contingency arrangements to get medicines directly from the manufacturer rather than from their usual wholesaler. We have recognised this in NHS funding for community pharmacies but it still annoys the majority that are putting patients first. I understand that that is frustrating for many parts of the supply chain and can lead to delays in some patients getting their medicines. However, the Department of Health, the Medicines and Healthcare products Regulatory Agency and the supply chain stakeholders—manufacturers, wholesalers and pharmacies —are working together to reduce the impact on patients.
In order to address the issues with supply, the previous Government set up a ministerial summit in March 2010. A wide range of organisations and individuals participated, including those representing pharmacists, wholesalers and doctors. The summit agreed a package of tough actions to be taken forward in collaboration with the industry and other partners. This Government have taken forward many of the actions proposed by the previous Government. We continue to work with all parts of the supply chain to make sure it functions as well as possible through collaboration and collective agreement rather than by increasing the regulatory burden.
Actions taken forward following the summit include: publishing updated guidance on the legal and ethical obligations placed on manufacturers, wholesalers, registered pharmacies and others involved in the supply and trading of medicines in December 2010; publishing best practice guidance agreed by stakeholders of the supply chain clearly stating that under normal circumstances pharmacies should receive requested medicines within 24 hours—if all members of the supply chain followed this, patients might get medicines more quickly—and developing and maintaining a list of products in short supply published on the Pharmaceutical Services Negotiating Committee’s website so that no one trading in these products can say that they are not aware of supply difficulties.
On top of that, MHRA site inspections and follow-up inspections have been conducted and progress has been made, including through written undertakings to comply with the agency’s recommendations. To date, no breaches of the regulation have been established.
Huw Irranca-Davies
This is not a new phenomenon. As the Minister said, the previous Government recognised it, set up the taskforce and introduced proposals on which this Government are acting. The difficulty is that the system is not working properly, despite the best will in the world. I understand the one-in, one-out rule and the necessity to avoid an undue regulatory burden, but a light-touch approach would be welcomed by most of the industry. A manufacturer told me the other day that he was producing 140% of the needs of the UK but there was still a shortage of the drug that he was supplying. Surely a patient service obligation would fit the bill by ensuring that certain things have to happen. It has been done in most other European countries.
Mr Burns
I am grateful to the hon. Gentleman, and I will come to that point a little later in my remarks.
As I was saying, exporting medicines is only one source of supply difficulties. Problems such as obtaining raw materials or problems with manufacturing processes can also cause supply problems. The increasing concentration of pharmaceutical manufacturing has made the situation worse. A medicine may be made only in one or two sites globally, which means that there is not much flexibility if problems are experienced at a particular factory or manufacturing site. Production schedules have to be planned months in advance and if one company has a shortfall, suppliers of alternatives may be unable to make up the shortfall at short notice.
The current trend in the supply chain of pharmaceuticals over the past few years is to move towards a “just in time” set-up, which results in lower stocks of medicines throughout all parts of the supply chain. This trend has resulted in significant savings, but requires more active and reactive stock management. Again, the Government work closely with pharmaceutical companies, wholesalers, pharmacists and the NHS and have well-established procedures to manage these risks.
The Department of Health published joint best practice guidelines with the Association of the British Pharmaceutical Industry and the British Generic Manufacturers Association in January 2007. The guidance gives companies advice on what to do in the event of a shortage and recommends early communication with the Department about possible shortages that might affect patient care. This allows us to work together to explore whether any action can be taken to reduce the impact on patients.
The Department has also created a small buffer stock of some medicines to help manage shortages during pandemics and other emergencies. We are also taking action through the European Commission’s falsified medicines directive to strengthen the supply chain against the risk of counterfeit medicines. This aims to improve the reliability of the medicines supply chain and to respond to the increasing threat of falsified medicines entering it.
As a direct result of the arrangements I have described, combined with the diligence and professionalism of most of the supply chain, patients overwhelmingly have access to the right medicines in a timely and efficient manner. We are continuing to monitor the situation very closely. Of course, we are not prepared to be complacent. That is why we are working so closely and collaboratively with the supply chain, monitoring and intervening as appropriate.
The hon. Gentleman’s intervention was about the public service obligation. I am aware that some—like him, and quite honourably—would prefer to see a public service obligation placed on the medicines supply chain to maintain supplies of medicines. As I have said, it is already the case that manufacturers and distributors must ensure continuous supplies of medicines to meet patients’ needs. Failure to do so could put them at risk of regulatory action or criminal prosecution.
Some other EU member states have a very precise definition of how soon medicines should be received, but we are cautious about going down that road. It would vastly increase regulation on the industry and drive up costs across the board. This is why, as I have said, we have chosen to go down the route of best practice guidance instead. Best practice arrangements exist; they have been agreed with all parts of the supply chain and they have been very successful in minimising the impact of shortages. It is a much more flexible approach than statutory regulation.
In conclusion, I am grateful to the hon. Gentleman for raising this issue—one that will be relevant to all Members across all party divides, as well as to every single community and individual person. It is an issue of true universal interest and concern. I assure the hon. Gentleman that the coalition Government are absolutely committed to patients getting their medicines as quickly as possible. We are also certain that in the supply of medicines, everyone in the supply chain has their part to play, including manufacturers, wholesalers, pharmacists, prescribers and patients. The Government will continue to work closely with all those involved in the supply chain, making sure patients receive their medicines in a timely manner and without any unnecessary complications. This is not an issue that will be discussed just once and then forgotten. We are determined to keep a watchful eye on the situation to see if there are ways to improve it and minimise disruptions or problems for patients, ensuring that they get the best service, to which they are entitled.
Question put and agreed to.
NHS Operating Framework for 2012-13
Simon Burns Excerpts(13 years ago)
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The Minister of State, Department of Health (Mr Simon Burns)
Sir David Nicholson, the NHS chief executive, is publishing “The Operating Framework for the NHS in England 2012-13” today, which sets out the priorities for next year.
The NHS operating framework is an annual publication that outlines the business and planning arrangements for the NHS. It describes the national priorities, system levers and enablers needed for NHS organisations to maintain and improve the quality of services provided, while delivering transformational change and maintaining financial stability.
There are four key themes in the document for this year:
the NHS has put quality of care for older people at the head of its priority list for 2012-13. They will get better care and be treated with more dignity. And the friends and relatives who care for them at home will get more support;
the need to maintain the NHS’s continued strong performance on finance and service quality, including ensuring that the NHS constitution right to treatment within 18 weeks is met;
the need to create the foundations for sustainable delivery against the quality, innovation, prevention and productivity (QIPP) challenge; and
the need to complete the transition to the new delivery system set out in “Equity and Excellence: Liberating the NHS”.
The NHS operating framework sets out the practical steps that need to be taken to carry the NHS through a strong and stable transition over the next year, maintaining high quality standards and financial grip, as we move towards the new modernised system envisaged in “Equity and excellence: Liberating the NHS” (Cm 7881).
A copy of “The Operating Framework for the NHS in England 2012-13” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Oral Answers to Questions
Simon Burns Excerpts(13 years ago)
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Graeme Morrice (Livingston) (Lab)
1. What recent assessment he has made of front-line staffing levels in the NHS.
The Minister of State, Department of Health (Mr Simon Burns)
We fully recognise how important front-line staff are to the provision of high-quality care. Local organisations are best placed to plan the work force who are required to deliver safe and high-quality services to patients.
Graeme Morrice
The Prime Minister promised to cut the deficit and not the national health service. Can the Minister tell us what has changed?
Mr Burns
Nothing has changed. As the hon. Gentleman will know, the NHS budget is a protected budget, and during the lifetime of the present Parliament it will receive real-terms increases. What the hon. Gentleman may not know is that the number of full-time equivalent clinical staff working in the NHS today is higher than it was in May 2010 and September 2009.
Mr James Gray (North Wiltshire) (Con)
Over the weekend, the Minister will have seen a number of reports in the press that tens of thousands of NHS jobs were to go. Is he aware of any evidence that that is the case, or is it pure trade union scaremongering?
Mr Jamie Reed (Copeland) (Lab)
The reality is, of course, that the report from the Royal College of Nursing revealed that thousands of front-line nursing posts are being cut, and that last night a leaked report on commissioning revealed further bad news for front-line staff: that the Government plan to privatise large swathes of the NHS, making GPs “bit-part players”. Does it remain Government policy to promote, in the words of the report,
“a strong and vibrant market”
in the NHS, and, in the words of the Prime Minister, to
“drive the NHS to be a fantastic business”?
Mr Burns
The report that was published at the weekend is deeply flawed. It is outrageous for an organisation to seek to scare people for the sake of cheap publicity. That report is as flawed as the report that was published a year ago. Far from there being the 50,000 cuts to which it referred, since May 2010 the number of doctors has risen by 3,500, the number of consultants by 1,600, the number of registrars by 2,100 and the number of qualified radiography staff by 549. Moreover, the number of managers and administration officers has fallen by 14,000 to release money for improved health care.
Mr Philip Hollobone (Kettering) (Con)
Front-line staffing levels come under particular pressure in the winter months because of the incidence of winter flu. Does my right hon. Friend welcome the news that at Kettering general hospital, almost 60% of front-line staff have now been inoculated against flu? That compares very well with last year’s national average of 35%.
Mr Burns
I join my hon. Friend in congratulating staff at Kettering general hospital on their responsible attitude, and urge other NHS staff throughout the country to follow their example. I am heartened to note that, as a result of the planning and activity that has taken place in the NHS, more staff are having flu jabs than did so last year.
Nick Smith (Blaenau Gwent) (Lab)
2. What plans he has to implement the recommendations of the strategic review of health inequalities by Professor Marmot.
Nic Dakin (Scunthorpe) (Lab)
3. What plans he has for the future of children's cardiac services in England; and if he will make a statement.
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. The Joint Committee of Primary Care Trusts—JCPCT—on behalf of local NHS commissioners, will decide the future pattern of children’s heart surgery services in England. It is expected to make that decision next year.
Nic Dakin
I thank the Minister for his reply. In view of the Royal Brompton’s judicial review verdict, does he agree that it is imperative that the breakdown of the assessments of all centres and all areas is fully disclosed, so that confidence in the Safe and Sustainable review can be restored?
Mr Burns
As the hon. Gentleman will appreciate, it is imperative that Ministers continue to remain totally independent of this review, so that we cannot be accused of interfering. As he knows, the JCPCT has said that it plans to appeal against the decision, and we will have to await the outcome of that.
Dr Julian Lewis (New Forest East) (Con)
I fully appreciate the degree of independence that Ministers must preserve, but is there anything that this Minister can say on the methodology of the review to reassure the children’s heart unit at Southampton general hospital, which is rated the best in the country outside London, given that the review was, at one stage, excluding the entire population of the Isle of Wight in its calculations as to whether or not the unit should be in more than one of the four options being put forward?
Mr Burns
I am grateful to my hon. Friend for his question, although I will disappoint him by saying that I will not be led from my chosen path and start to voice an opinion. I will say, as I did say during the earlier debate that he attended, that of course it is not set in stone that there will be only four options chosen, as and when—the number could be more. That is dependent on the consultations and the decision of the JCPCT, but he will appreciate that I cannot seek to influence those decisions.
Sarah Newton (Truro and Falmouth) (Con)
4. What steps he is taking to reduce the burden of debt for NHS hospitals.
John Mann (Bassetlaw) (Lab)
16. How many accident and emergency departments have reduced their on-site service provision in the last 12 months.
The Minister of State, Department of Health (Mr Simon Burns)
This information is not collected centrally. It is for NHS commissioners to secure high-quality services for their communities. Where a substantial service change is proposed, decisions should be made against the Secretary of State’s four tests, including support from GP commissioners and clear evidence of patient and public engagement.
John Mann
Broadening the definition of major trauma would have disastrous consequences for many A and E departments, not least those in Bassetlaw and the surrounding towns in south Yorkshire and the north midlands. Can the Minister give an absolute guarantee that the definition of major trauma is not being broadened, so that those hospitals and their A and E departments are not put in jeopardy?
Mr Burns
The assurance I can give the hon. Gentleman is that the siting of A and E departments will be a matter of clinical judgment. I can also assure him that £900,000 will be invested in the A and E department at Bassetlaw hospital for improvements, including the creation of a three-bay resuscitation room, a larger waiting area for patients and other improvements to enhance the quality of care for his constituents.
Amber Rudd (Hastings and Rye) (Con)
At a recent surprise visit to my local A and E department, at the Conquest hospital, I was delighted to find a very high quality of care. Will the Minister reassure me that any local reconfiguration puts high-quality patient care at the centre of delivery?
Mr Burns
I am grateful to my hon. Friend, and I am glad that she had such a positive experience visiting her local A and E. I can categorically tell her that reconfigurations must be carried out in accordance with the Secretary of State’s four tests and that clinical safety and quality of care are paramount.
Julie Hilling (Bolton West) (Lab)
17. What discussions he has had with the Chancellor of the Exchequer on the future costs of long-term social care.
Kerry McCarthy (Bristol East) (Lab)
19. What assessment he has made of the effects of publishing his Department’s strategic risk register on his restructuring of the NHS.
The Minister of State, Department of Health (Mr Simon Burns)
Publishing the Department’s risk register would have implications beyond the Department of Health, and we are taking the time granted to us by the Information Commissioner before deciding whether to appeal against his decision requiring its release.
Kerry McCarthy
I think I thank the Minister for that response, which at least gives some indication of where the Government are coming from. But, given the widespread concern among the public about the risks posed by the Health and Social Care Bill, and given that the Information Commission has ruled that the register should be published, does the Minister not think that it should be published before Report stage in the House of Lords, so that at the very least the findings can be used to inform the amendments being tabled to rescue the Bill even at this late stage?
Mr Burns
No, I do not think that the register should be published before then, in so far as we are still considering whether or how to move forward within the time scale that the Information Commissioner has given us—[Interruption.] Before the hon. Lady gets too pious, I must tell her—I do not say “remind her”, because in the previous Government she will have been too busy tweeting, as the tweeting tsar, to know what the Department of Health was doing—that in September 2009 the right hon. Member for Leigh (Andy Burnham) similarly blocked release of the Department of Health’s strategic risk register, using the non-disclosure provisions under section 36 of the Freedom of Information Act 2000, and that his predecessor, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), did the same on two occasions in 2008.
Mr Speaker
Order. It seems that the subject matter for an Adjournment debate is being provided.
Duncan Hames (Chippenham) (LD)
Two, or even three, wrongs do not make a right. Regarding an exemplary risk register, does the Minister consider that the mitigation plans for any risks identified there may serve to reassure Members of the other House, if it were to be published in advance of the conclusion of the Committee stage there?
Mr Burns
If the hon. Gentleman had read it, he would know that the important aspect—[Interruption.] He says that he cannot read it, but if he listens for a minute, he will hear that the important parts that are relevant to the Health and Social Care Bill were published in January and September this year in the impact assessment for the Bill.
Andy Burnham (Leigh) (Lab)
May I first commend the Health Secretary on his ingenious new approach to cutting delayed discharges? If his appearance on continuous loop on hospital TV does not cut length of stay, I do not know what will. One area where he has been noticeably less forthcoming is on the recent ruling by the Information Commissioner, which could not be clearer: Parliament and the public have the right to know what extra risks and threats his Department expects the NHS to face as a result of this top-down reorganisation. Let us give him one more chance to give us a clear commitment: will he live up to the Prime Minister’s words on transparency and openness and publish the report in full without delay?
Mr Burns
The right hon. Gentleman may not have been listening to the response I gave to his hon. Friend, which was that the relevant aspects of the risk assessment have been incorporated into the impact assessments published in January and September. [Interruption.] Before he, too, gets too pious, may I remind him that it was he himself who, in September 2009, blocked the publication of his Department’s risk assessment?
Andy Burnham
I would happily have paid £5 to opt out of that particular pre-scripted loop message. Unlike the Minister and his fellow Front Benchers, I was not subject to a ruling from the Information Commissioner. People watching this today will be left wondering what he and the Secretary of State are so desperate to hide. He can hide the report, but he cannot hide the growing warning signs we are seeing in our NHS: waiting lists up, delayed discharges up, and nurses made redundant. The truth is that he has placed the NHS in the danger zone, with a destabilising and demoralising reorganisation when it most needed stability. He says he wants feedback, so why does he not listen to patients and staff, put the NHS first and drop his dangerous Bill?
Mr Burns
It is marvellous how the right hon. Gentleman repeats his soundbite every time he discusses the NHS. I have to tell him that he is wrong. He knows that the NHS has to evolve. He knows that we have to improve and enhance patient care. I think he does himself a disservice by simply joining the ranks of organisations such as 38 Degrees, which is frightening people and getting them, almost zombie-like, to send in e-mails.
Helen Jones (Warrington North) (Lab)
T1. If he will make a statement on his departmental responsibilities.
Stuart Andrew (Pudsey) (Con)
T8. An independent study of the patient assumptions of the Safe and Sustainable review has confirmed what many of us already knew: that, contrary to the review’s claims, most families in Yorkshire and the Humber will travel not to Newcastle but to Leicester or Liverpool. Will my right hon. Friend seek confirmation from the Safe and Sustainable review body that it will revise its options in the light of that new evidence?
The Minister of State, Department of Health (Mr Simon Burns)
I am grateful to my hon. Friend and I have heard the important point that he has made. No doubt the Joint Committee of Primary Care Trusts will also hear the point that he has made to me. I am sure that he understands that it would be totally inappropriate for me to give any view that might compromise the independence of Ministers on this independent review.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
What is the Secretary of State’s estimation of the number of NHS doctors and nurses who, in an astoundingly demoralising way, are having their pay grades downgraded?
Greg Mulholland (Leeds North West) (LD)
The recent judicial review concerning the unit at the Royal Brompton hospital said that the Safe and Sustainable consultation was unlawful and the review should be quashed. Considering the concern about this matter and the flaws in the review, is it not time for the Minister to indicate when the Government might intervene? Otherwise, there could be further threats of judicial review.
Mr Simon Burns
The straightforward answer is no, because the Joint Committee of Primary Care Trusts has said that it intends to appeal. This is an independent review. It would be inappropriate for me or any other Minister to interfere in such a review, because we could be accused of compromising its independence.
Alex Cunningham (Stockton North) (Lab)
The Prime Minister promised a bare-knuckle fight to save A and E and maternity units at King George hospital, Chase Farm hospital and other hospitals that the Secretary of State now plans to close. When will that fight take place, and where can hon. Members purchase tickets for ringside seats?
Mr Burns
I heard what the hon. Gentleman said, and I was disappointed that we did not reach his question on the Order Paper earlier, because he has been extremely concerned about the A and E in his own area in Hartlepool. That decision was taken on safety grounds. Emergency care has been provided at the One Life centre. The decision was taken with the support of the local overview and scrutiny committee, which he will appreciate has democratic accountability. That was the right decision. Where there are clinical reasons for taking such decisions, they should be taken.
David Tredinnick (Bosworth) (Con)
Has my right hon. Friend the Secretary of State or any of his ministerial colleagues been able to visit the People’s Republic of China to consider traditional Chinese medicine?
Hinchingbrooke Hospital
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Liz Kendall (Leicester West) (Lab) (Urgent Question)
To ask the Minister of State to make a statement on the decision to allow Circle to run Hinchingbrooke hospital.
The Minister of State, Department of Health (Mr Simon Burns)
Today, a 10-year contract was signed by Hinchingbrooke Health Care NHS Trust and Circle allowing Circle to take over management of the trust, which has struggled to be financially viable in recent years. Major service problems have persisted and, despite repeated attempts to tackle it, the trust now has the largest legacy debt as a proportion of turnover in the NHS: £39 million, which amounts to almost half the hospital’s £100 million turnover. Moreover, the Care Quality Commission has expressed concern about the fact that its stroke services are failing and its cancer services under-achieving. The local NHS accepted that major changes were needed, and early in 2007, when the previous Government were in power, established the Hinchingbrooke next steps project to identify options for securing the trust's future.
In 2008, East of England strategy health authority chose a franchise model, and in 2009 it launched a competitive procurement process to identify a preferred bidder. That was agreed with the previous Government, and the power to bring in another person or organisation to manage an NHS hospital was introduced under that Government’s National Health Service Acts 2001 and 2006 and the Health and Social Care Act 2001.
At the end of last year, following a rigorous and open competition that included NHS organisations, NHS East of England announced that Circle had the most viable plans to turn the trust around. That decision has been endorsed by the Department of Health and the Treasury following an equally rigorous approval process this year. It should be noted that it was the Labour Government who set up the initial competition, a process from which many NHS organisations dropped out, leaving only private providers in the competitive tendering frame.
Circle is an established provider of services for NHS patients, although it should be emphasised that under this contract NHS services will continue to be provided by NHS staff, from NHS buildings, and that patients will continue to have access to them as they do now. No NHS staff are leaving, and assets will remain in public ownership. Hinchingbrooke hospital will continue to deliver the same NHS services, as long as commissioners continue to purchase them, adhering to the key NHS principle of care being free at the point of use. This is not a privatisation in any shape or form. Circle will help clinicians and health care professionals improve Hinchingbrooke from the bottom up. Its plans include improvement in length of stay, rationalisation of theatre usage and improvement in back offices. Commissioning leaders, hospital consultants and Royal College of Nursing representatives in Huntingdon clearly support Circle commencing the franchise. Tony Durcan, the RCN professional officer for Cambridgeshire said:
“Circle are very impressive…I welcome working with them.”
He went on to say that he believes the decision to work with Circle
“does secure the long-term future of Hinchingbrooke.”
If Circle achieves its forecasts, the whole of the trust’s accumulated deficit will be repaid by the end of the 10-year contract. Circle is paid from the trust’s surpluses, so if there are no surpluses Circle does not receive a fee. Furthermore, if the trust makes a deficit under Circle’s watch, Circle must fund the first £5 million. At deficits above that, the trust can terminate the contract, so Circle really must perform well.
The Government believe this is a good deal for patients and staff at Hinchingbrooke. It is a new management model being tried in the NHS for the first time, but the trust has had huge problems over the past decade, and it now has an opportunity to turn its fortunes round. The local NHS even stated that without this deal Hinchingbrooke hospital’s future would have been in doubt.
The local NHS will maintain close scrutiny of the contract. The Appointments Commission has appointed a chair and two non-executive director-designates to form a new Hinchingbrooke trust board from February 2012 that will appoint a franchise manager. The franchise manager will be responsible for day-to-day monitoring of contract performance. During the initial mobilisation stages, NHS Midlands and East will continue to oversee the franchise agreement.
Patients and the public deserve, and must get, a safe and sustainable NHS based on its core, historical principles. This contract will deliver that.
Liz Kendall
Patients, the public and NHS staff will be concerned about the implications of this unprecedented agreement not only locally in Cambridgeshire, but for the NHS across the country. Let me be clear that Opposition Members accept that there have been problems with this hospital for some time. My right hon. Friend the Member for Leigh (Andy Burnham)—who is currently visiting St James’s university hospital in Leeds—will set out the background to this issue and how it was dealt with by the previous Government in a statement later this morning, but it is the current Government who have made the decision to transfer the management of Hinchingbrooke to the private sector, and it is the current Government who must account for their actions.
First, I want to deal with the practicalities of the agreement. How many bids to take over the running of the hospital did the Government receive, and what criteria were used to judge them? Circle’s chief executive confirmed on the “Today” programme this morning that Circle has no experience of running emergency and maternity services, so why was the company chosen? What confidence can patients and NHS staff have in the chief executive’s claim this morning that Circle will be able to pay off Hinchingbrooke’s £40 million debt simply by cutting waste and bureaucracy when all previous attempts have failed—at the same time as, apparently, providing patients with Michelin-star meals and delivering profits for Circle’s shareholders? Can the Minister assure the House that this agreement will not, in reality, lead to staff jobs being cut and services being closed, and can he give a firm guarantee that all services currently run at Hinchingbrooke, including accident and emergency and maternity, will remain open throughout the entire period of the deal? Will he also set out whether the agreement requires Circle to work with other local NHS services and the council, what profits are permitted under the agreement, and how decisions will be held to account locally under it? Will he also place a copy of the agreement contract in the Library of the House?
The Minister must also today answer serious questions about the implications of this agreement for the wider NHS. He must set out whether the Government envisage any limit to the role of the private sector in the NHS. We know that Department of Health officials have been discussing the takeover of 20 other hospitals by private companies, so will the Minister tell the House how many of these hospitals will be taken over by the private sector? What steps have the Government taken to ensure the financial stability of Circle and its parent company, Circle Holdings? What will be the implications if the company goes bust, as Southern Cross did, for patients and taxpayers?
Finally, important questions need to be answered about why this company has been chosen. Given its close links to the Conservative party, there needs to be full transparency about all meetings—formal and informal—between Department of Health and Treasury Ministers and this company and any of its paid advisers. So will the Minister agree to publish full details of these meetings so that patients and NHS staff can have full confidence that the Government followed proper due process in their decisions?
Patients and the public will be deeply worried that this morning they have seen this Government’s true vision for the future of our NHS with the wholesale transfer of the management of entire hospitals to the private sector. The Health and Social Care Bill currently before Parliament not only allows that to happen but actively encourages it. Patients and NHS staff do not want this and the public have not voted for it. It is time that the Government agreed to drop their reckless NHS Bill.
Mr Burns
I am rarely speechless, but I am left speechless by the sheer effrontery of the hon. Lady. I have to remind hon. Members that this process stems from the previous Labour Government’s legislation in 2001, which was consolidated in 2006. This process started in 2007 at strategic health authority level, when she was a special adviser in the Department of Health. It continued, and the decision to move forward from a Department of Health level was taken in 2009 by the then Secretary of State for Health, who is now the shadow Secretary of State. It is often thought that shadowing a Department that one ran is helpful because one knows where the bodies are buried. The problem for the shadow Secretary of State is that not only does he know where the bodies are buried, but he was the one who buried them in the first place.
The hon. Lady asks how many bidders there were. As she will appreciate, a number of processes have taken place. There were 11 bidders at the start, the vast majority of which were private sector bidders, although there were some NHS ones—this was in 2009, under a Labour Government. The number reduced to six in December 2009, again under a Labour Government. Of those six bids, one was from an NHS body and one was from an NHS body in conjunction with the private sector. In February 2010, when I believe the right hon. Member for Leigh (Andy Burnham) was the Secretary of State, the number reduced again, this time to five. All these bids were from the private sector, except one, which was made in conjunction with an NHS trust. In March 2010, again under a Labour Government, the number reduced to three, with one bid associated with an NHS body, and then it reduced to two, with both bidders in the private sector.
Mr Burns
In July last year, as part of the ongoing process started by the previous Government.
The hon. Lady also asked whether the contract and the business case would be put into the public domain. They will be published in due course although, as she will appreciate, certain commercially sensitive information will be redacted, which is only reasonable. She also asked about staffing and whether there would be redundancies. May I tell her that there will not be redundancies as a result of the operating franchise? Circle has said that it might need to redeploy and retrain some staff within the hospital, but it does not expect job losses. I reassure the hon. Lady—I think she would like this reassurance—that, as I am sure she understands, Hinchingbrooke will remain an NHS hospital, the staff will remain as NHS staff, and the services will continue, as I said in my statement, within the format of all other services provided in every other NHS hospital, which is within the format of reconfigurations, if and when. [Interruption.] The hon. Lady says I cannot guarantee that they will stay over. I can give the greatest and most honest guarantee as of now because nobody—listen carefully so that it is not got wrong—can guarantee what services a hospital will be providing in 10 or 15 years, due to different and changing circumstances.
The hon. Lady also mentioned, as a hare that she wanted to start running to frighten people, the question of the 20 hospitals within the NHS that are having financial and other problems. The fact is that in the past month or so all those hospitals have published their tripartite formal agreements with regard to the foundation trust pipeline, and I can tell her that all those are options by which to move forward, either as stand-alone bodies or possibly mergers and acquisitions with other foundation trusts within the NHS.
Mr Robert Syms (Poole) (Con)
Is not the key point that the deal will lead to better NHS services for people who live in the area of the hospital? The Minister has reassured us today that if it does not, there will be changes.
Mr Burns
I am extremely grateful to my hon. Friend for that measured contribution. The most important thing must be providing world-class, quality care for patients, not only in the Hinchingbrooke area but throughout the NHS across the country. I am confident that this deal does that, working with the NHS within the NHS, but with a management provided by Circle to do just that.
Chris Ruane (Vale of Clwyd) (Lab)
Can the Minister guarantee that the terms and conditions of current and new staff will be guaranteed by the private sector company, and that it will not go for the easy option of cutting terms and conditions?
Mr Burns
With respect, I do not think the hon. Gentleman fully understands what I have said. I said that the status of staff at the hospital will not change in any way. They will continue to be NHS-employed staff working for the NHS as they did yesterday and as they will from the day the project starts working.
Dr Julian Huppert (Cambridge) (LD)
Many of my constituents are affected directly by what happens at Hinchingbrooke hospital, and the service there has been hit hard over many years by some of the disastrous schemes of the previous Government—private finance initiative contracts that took money away, and money abstracted by the previous Government’s private treatment centre, where private providers were paid more than NHS rates. What we now need is improved service and stability of service. Will this now finally be provided?
Mr Burns
I am grateful to the hon. Gentleman. I can say that this is the best chance for the hospital, which has had a very troubled history, as he knows as the constituency Member for Cambridge, because of the financial problems and governance and management problems. I am confident that this is the best way forward to establish this hospital once again on a firm footing to provide the finest health care for his constituents and those of hon. Members in the Huntingdon and Cambridgeshire area.
Julie Hilling (Bolton West) (Lab)
I do not understand how there can be a surplus to be given to the private company. Surely every penny of taxpayers’ money should be spent on the care of patients. Does this mean that Circle will be inclined to reduce care so that it makes profits?
Mr Burns
I am not. I am just being honest. If there is a loss, Circle will pick it up, up to the first £5 million. Hinchingbrooke is a struggling hospital with a deficit of £39 million. That is why we are having to take the actions that the Government that the hon. Gentleman supported instigated more than three years ago. There is a formula that gives an incentive for Circle to deliver, to raise the quality of care, to reduce and, we hope, over the 10-year period to remove the deficit altogether.
Duncan Hames (Chippenham) (LD)
When a hospital’s consultants have a financial interest in its performance, what safeguards will prevent their private interest in increasing the volume of treatments provided putting the hospital’s financial health ahead of that of the local national health service?
John Healey (Wentworth and Dearne) (Lab)
At a time when progressive reform of our NHS requires greater collaboration and integration of services, with more being done for patients beyond the hospital, cannot Ministers see that that will be much harder to achieve when Hinchingbrooke hospital and others have been handed over to a private company with a single commercial interest in maximising profits and getting more patients into the hospital? Cannot they accept that it is a privatisation and that it is wrong in principle and wrong in practice?
Mr Burns
If it is privatisation—I utterly reject the claim that it is—and if it is wrong, it was the right hon. Gentleman’s Government who gave the powers to do this in their legislation and it was his successor as shadow Health Secretary, when Secretary of State, who instigated the proceedings to bring this about. It is a little odd for the right hon. Gentleman for Wentworth and Dearne (John Healey), for narrow, grimy and party political reasons, to try to blame us for something that he and his party instigated.
Jacob Rees-Mogg (North East Somerset) (Con)
I congratulate the Minister on his excellent announcement. The Circle group runs a hospital in Peasedown St John in my constituency. It has a fantastic partnership model that is a good example of how public-private co-operation should exist and provides better services for my constituents than those that were there before, so the announcement is thoroughly to be welcomed.
Mr Burns
I am extremely grateful to my hon. Friend. I have every confidence that what has been decided today is in the best interests of getting Hinchingbrooke hospital back on its feet. I am heartened not only by his support, but by the fact that the vast majority of people living in the Huntingdon and Cambridgeshire area fully support it, as do clinicians and the NHS locally. I was particularly heartened by a rational statement of fact by the RCN’s area organiser for Cambridgeshire—he was on the negotiating board—who said that he was very impressed when dealing with Circle and was looking forward to working for it. The ultimate point is that there was a possibility two or three years ago that if nothing could be done to turn the hospital around it would have been closed, which would not have been in the interests of local people.
Nick Smith (Blaenau Gwent) (Lab)
Will Circle be able to sell off any of the organisation’s assets and separate the ownership and operation of the hospital, as was the case with Southern Cross?
Mr Burns
Under no circumstances will it be able to do that. As I keep saying to the hon. Gentleman and his right hon. and hon. Friends, Hinchingbrooke is and will remain an NHS hospital, but a private company is providing the management. The NHS, through that management, will continue to operate the hospital.
Mr Peter Bone (Wellingborough) (Con)
I congratulate the hon. Member for Leicester West (Liz Kendall) on securing the urgent question and allowing the Government to concede that they have adopted a Labour policy by bringing in private management. Will the Minister look at the possibility of extending what we might call a pilot to Kettering hospital?
Mr Burns
The answer is no. I do not want to disappoint my hon. Friend, but the simple answer is that Hinchingbrooke hospital, as the right hon. Member for Leigh will know, has a historical problem that the NHS tried to solve but failed. Given that the previous Government enacted powers to allow a franchise in exceptional circumstances, it is better to use that model to turn around the hospital rather than let it fail altogether. It is not a principle that we are considering extending across the NHS.
Fabian Hamilton (Leeds North East) (Lab)
The Minister said in reply to an earlier question that there would be no forced redundancies. However, as he explained, Circle will pay off the deficit over a period of time and has an obligation to make profits for its shareholders. Can he explain how it will manage to do that while paying off the deficit?
The Parliamentary Secretary, Office of the Leader of the House of Commons (Mr David Heath)
Did they not understand the policy when they voted for it?
Mr Burns
My hon. Friend makes a valuable point from a sedentary position. The driving force behind the arrangement and the key criterion for Circle is the need to turn the hospital around, with regard to its quality and standard of care and its finances. The challenge for Circle is to eliminate completely the £39 million historical deficit over the 10-year period and put the day-to-day running costs of the hospital on a firm footing. I am confident that, within the framework of the agreement, that offers the best change to turn the hospital around.
Bob Blackman (Harrow East) (Con)
I congratulate my hon. Friend on exploiting the position presented by the Opposition. Given that this is a one-off, as he has said, what is the future for the other 20 hospitals that are in a desperate financial state? Is this a blueprint for the future and can we look forward to other partnership arrangements coming forward?
Mr Burns
I am grateful to my hon. Friend for the opportunity to put on the record the way forward for those 20 hospitals. This is not a blueprint or model to be used by other hospitals. It is on the statute book, as the hon. Member for Leicester West (Liz Kendall) knows. Where there are problems with the 20 hospitals that are seeking foundation trust status, the SHAs, departmental officials and the trusts themselves are looking at them. They have all published TFAs in the past six weeks or so with their intention for the way forward. I think that I am right in saying that for all of them there is a variety of options that range from a stand-alone FT bid to a possible merger or acquisition with another FT or trust. There are no TFAs for a franchise arrangement. As I have said before, this is a first and, as of now, unique model.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
On 31 December 2010 Circle’s debt stood at £82 million. Does the Minister know what its debt is at the moment, and can he guarantee that its priority will be paying off the hospital’s debt rather than its own?
Mr Burns
I can assure the hon. Gentleman, because of the way in which the agreements have been framed, that there is an incentive and a pressure on Circle to seek to deliver on reducing and—we hope—eliminating over the 10 years the £39 million historical deficit. On the question of who has what size of a deficit, I must tell him that my concern is to remove that shackle from the neck of Hinchingbrooke hospital.
Andrew George (St Ives) (LD)
Notwithstanding the inconsistency of the Opposition’s position, will the Minister clarify whether this marks clearly the termination of public NHS trusts as preferred providers of public NHS services?
Mr Dave Watts (St Helens North) (Lab)
The Minister will be aware that in an Adjournment debate some five months ago, we put forward a leaked document that stated that exactly what has happened today would happen. He denied that it was happening, but obviously it has, so will he answer the question that was put to him in that debate? Is it not the case that the only way in which the company can make a profit is by stopping the provision of expensive services, such as maternity and accident and emergency services, and by creaming off other services from neighbouring hospitals?
Mr Burns
With regard to the hon. Gentleman, I have over the past few months been very restrained. In the light of his question, however, I shall now share with the House what was going on.
The hon. Gentleman is referring to the foundation trust status of his local hospital. A leaked document got into the public domain, but it was nothing to do with me or other Department of Health Ministers; it was an early draft of a tripartite formal agreement. What the hon. Gentleman did then—because he is an Opposition MP and he is entitled to do so—was to run a campaign in his area stating that the Tories were going to privatise his local hospital. I assured him from day one that that was utter rubbish, that there was no truth in it and that he should wait until the TFA was finally published. It was published recently, and of course there was no proposal in it to privatise the health service—[Interruption.]
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
The Minister seems to believe that the continued running of the NHS is the responsibility of the previous Government, rather than of his own Department. Does he accept that this deal is his decision and that he has radically extended the role of the private sector in our health service?
Mr Burns
I do not know who has been briefing the hon. Lady, but the lines are wrong, I am afraid. She is right that the final decision was taken by me, in this Administration, but—[Interruption]—if she will just wait a minute, I will tell her that all we were doing was following what the previous Government set in motion. I will tell her something else: if there were a Labour Government in power and not this Conservative Government, the Labour Minister of State would be standing here today and making exactly the same points—
Valerie Vaz (Walsall South) (Lab)
I encourage the Minister to carry on drinking the peppermint tea, because then he will remain calm. Hinchingbrooke hospital does not have an A and E department, so what resources will be available to those NHS hospitals that have to absorb the extra patients?
Mr Burns
The hon. Lady shakes her head, but of course she is a Member for the north-west, whereas I understand from the Under-Secretary of State for Justice, my hon. Friend the Member for Huntingdon (Mr Djanogly), who is the MP for Hinchingbrooke, that it does have an A and E. I will check and write to her immediately, and no doubt if I am right and she is wrong, she will in her charming way correct the record in due course.
Mr Speaker
I am grateful to the Minister and to colleagues, because everybody who wanted to question him had the chance to do so.
Obesity
Simon Burns Excerpts(13 years ago)
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Dr Sarah Wollaston (Totnes) (Con)
I thank the hon. Member for East Londonderry (Mr Campbell) for securing this important debate. I do not want to repeat his message about the economic cost of the problem, but I would say, having been a general practitioner for 18 years, that once someone becomes obese, it is extraordinarily difficult to regain their normal weight in the long term.
I would like the Minister to consider the following points. We need to focus on better identification of those who are most at risk, particularly children, and to target action on those high-risk children. A nudge will just not go far enough, and it is time for more of a bit of a shove. We need particularly to look at the role of liquid calories in obesity among children. I ask the National Institute for Health and Clinical Excellence to update its guidance and review the evidence.
Nearly two thirds of adults are overweight or obese, but they do not start out that way. Around one in five four to five-year-olds are overweight or obese, but by the time they reach 11, that figure will have risen to one in three.
The Minister of State, Department of Health (Mr Simon Burns)
On the point about NICE, may I give my hon. Friend a reassurance that might be helpful at this stage in her contribution? As she may know, NICE has recently consulted on whether now is the right time to review its original guidance. As a result of that consultation, it will be making a decision later this month.
Dr Wollaston
I thank the Minister for that helpful response and look forward to hearing the outcome of that.
Children at primary school and in the early years before they have reached school are among the really high-risk groups. Some 85% of obese children go on to become obese adults, whereas only 12% of normal weight children become obese adults, so it makes sense to focus on that group of children, but that can happen only if we have better early identification. We should introduce annual measurements of weight and height, so that we can see when children are starting to slip towards obesity. We should target our resources much better on that group.
Andrew Bingham
I was going to come on to other activities shortly. I will watch or take part in sport, but who sponsors it does not chime with me much. However, ideally it would be better for an active product to support a sport. Interestingly, leisure centres all have vending machines full of chocolate. I know from experience that when the chocolate bars are replaced with cereal bars and healthy alternatives, the spend drops, because people like chocolate.
I am fortunate to live in the High Peak, which is a fantastic area with a huge amount of outdoor activity to do, including walking and hiking—the woods to play in. I am lucky, but inner cities do not have a huge playground such as the one I and my constituents have to play in. It is vital that people use leisure centres, and that they are encouraged into them. We can talk about what the Government should or should not do to get people to do that. I agree that the nudge theory will work. We have been subconsciously nudged into the present situation, because people have gone to the quick, easy meal and have taken up a more sedentary lifestyle. We have heard about the PlayStation generation, and we all walk around with BlackBerrys. If texting was good exercise and made people fit, the present generation would be the fittest ever. With young people in particular it is text, text, text. However, that is not active.
Mr Simon Burns
I am very interested in what my hon. Friend says and have listened carefully to the interventions. A number of Members have talked about what the Government, the Department of Health, the Department for Education or local government should do, but it strikes me as slightly odd that there has been little recognition of the responsibility of parents.
Andrew Bingham
I think that the Minister has been reading my notes. The point I was coming to was that we have talked a lot about what the Government can or cannot do, but this is one of many issues on which responsibility lies with us and with the parents of young people. My generation’s parents taught us how to poach eggs, for example; it is all about education in the home. I know that I sound like a grumpy old man, talking about how it was in my day, with rose-coloured glasses—[Hon. Members: “No, Never”] I will concede on grumpy; old I will argue with, at the moment. We can discuss different demographics, but if people are brought up on balanced, home-cooked food they will carry that on through their lives. It worries me that the more ready meal-type culture we have, the more it will go on and the bigger the problem will get.
We can expect, or ask, the Government to do this, that and the other, but as with many things, responsibility lies with individuals and with the parents of young children. That is where we need to start, with people being responsible for their own actions.
We have a fantastic opportunity with the 2012 Olympics, when we will see athletes from across the world. I will wager that in a year’s time, when Jessica Ennis wins a gold medal—I hope she does—we will see children out doing long jump and triple jump, using their own resources to copy their sporting heroes. We must capitalise on that. I played football in the winter as a kid because that was what was on TV, I played cricket in the summer and we all played tennis for two weeks when Wimbledon was on. We can use the Olympics. We talk about the legacy Olympics, and I would like the legacy to be the starting point for people getting active again.
Mr Simon Burns
I have been listening carefully to the hon. Lady, who is making some valid points. The danger has to do with not simply the age of computer games but the age of television before that. For some parents—this is a generalisation—the easy option is to let their children spend hours watching television or playing games, because it involves less effort on the parents’ part. One must try to educate people that that is not only an easy option but an unfair one.
Ms Abbott
I am loth to agree with the Minister, but I think that he is right on that point. A particular interest of mine is the education of urban children and the challenges of getting them to achieve their educational potential. As part of working with parents, especially in urban communities, we must teach them that just putting their children in front of a television set is not necessarily the best thing for their health or their education.
I agree entirely with what has been said about exercise and sport, but we also need a particular focus on girls and exercise. Statistics show that girls give up exercise younger; after they leave school, they do not continue to exercise, as boys do. I was interested to hear about, was it ice hockey—
The Minister of State, Department of Health (Mr Simon Burns)
It is a pleasure to serve under your chairmanship, Mrs Riordan, during this extremely interesting and thoughtful debate, to which there have been a number of erudite and imaginative contributions across the range.
I congratulate the hon. Member for East Londonderry (Mr Campbell) on securing the debate and giving us the opportunity to discuss one of the major public health issues of modern times. He has spoken repeatedly on the subject in the House and should be congratulated on doing so. He knows, of course, the scale of the problem. Most adults in England, 61%, are overweight. Sadly, one third of those are clinically obese, giving us one of the highest obesity rates in the world. As for children, almost a quarter of four to five-year-olds are overweight or obese, rising to one third in 10 to 11-year-olds. I am sure that we all agree that those figures are genuinely shocking. The hon. Gentleman will be aware that the scale of the problem in Northern Ireland, to which he alluded during the course of his remarks, is similarly daunting, with 59% of adults and 22% of children overweight or obese.
As recently as the 1980s, obesity rates among adults were a third of what they are now. Although figures for the last few years show that levels of obesity may be stabilising, that is simply not good enough, because excess weight has serious consequences for individuals, the NHS and the wider community. Not only does it cause day-to-day suffering such as back pain, breathing problems and sleep disruption, but it is a major risk factor for diseases that can kill. An obese man is five times more likely to develop type 2 diabetes, three times more likely to develop colon cancer and two and a half times more likely to develop high blood pressure than a man with a healthy weight, and women face equally serious risks. That is not to mention liver disease, heart disease, some cancers and miscarriages, all of which are linked to excess weight.
Although the real and present danger of obesity in terms of immediate health risks is seen largely in adults, obesity also has significant effects on children and young people, as many hon. Members have mentioned. Obese children are likely to suffer stigmatisation, and there are growing reports of obese children developing type 2 diabetes. We also know that if a child is obese in their early teens, there is a high chance that they will become an obese adult, with related problems later in life.
As waistlines expand, so does the amount of money that we spend on the issue. As a number of Members have said, excess weight is a burden of approximately £5 billion each year, and costs billions more through days of work and incapacity. Neither can we ignore the link between obesity and health inequalities. Data from the national child measurement programme show a marked relationship between deprivation and obesity. The Marmot review in 2010 showed the impact that income, ethnicity and social deprivation have on someone’s chances of becoming obese. As things stand, the less well-off a person is, the more likely they are to be carrying excess weight, so we are talking about an issue of social justice, as well as a narrow health issue involving exercise and healthy living.
The hon. Members for East Londonderry and for Hackney North and Stoke Newington (Ms Abbott) both asked, in effect, whether the Department of Health should work with companies that produce and sell products that contribute to the nation’s obesity and alcohol problems. Up to a point, it is the responsibility of the individual how much they consume and what they consume. How do we make sure that people know what they are eating—the calorie, salt and fat content and so on? To my mind, that means clear, easily understandable labelling, and education about what is healthy and what is the best approach.
On the narrow point of the issue mentioned by both hon. Members, improving the health of the public is clearly a priority for the Government, but we need a whole-society approach to tackle the health problems caused by poor diet, alcohol misuse and lack of exercise. To change people’s behaviours, we need to make the healthier choices the easier choices for everyone.
Commercial organisations have an influence on and can reach consumers in certain ways that Governments cannot. They have a key role in creating an environment that supports people to make informed, balanced choices that will enable them to lead healthier lives. Through their position of influence, they can address some of the wider factors that affect people’s health, such as how healthy our food is and how easy it is to access opportunities to be more physically active. Through the work on the public health responsibility deal, despite what the hon. Member for Hackney North and Stoke Newington has said, we are tapping into that unrealised potential to help improve the public’s health.
Mr Burns
I will give way in a moment. It is also important to say that, if we can get an agreement with commercial companies to change the way they behave and some of their practices, it will be far quicker to achieve that and put it in place than to wait for the heavy hand of Government legislation, which can take a minimum of a year and sometimes years. Why wait for the heavy hand of legislation that might take a long time, if we can get a voluntary agreement that will work quicker and more effectively to start dealing with the problem?
Ms Abbott
On changing commercial practices, when will the Government do something about the practice of so many supermarkets whereby they place rows of sweets next to the checkout? If a parent has fought off their children and not bought sweets on their way around the supermarket, the children then have 10 minutes to whine while the parent waits to pay for their shopping.
Mr Burns
I understand the hon. Lady’s point, because the charge has been made on a number of occasions and I have considerable sympathy with it. The supermarket at which I shop each week—I shall not name it, because I do not want to advertise for it—does not do that any more. I think that the hon. Lady will find that, throughout the country, the responsible supermarkets have stopped that practice, for the very reasons that she has mentioned.
Dr Poulter
Does my right hon. Friend agree that we need to be careful about introducing regulation for alcohol and other relevant products? It could be a very crude measure and have unforeseen consequences. For example, on alcohol, we may be concerned about the cheap sale of white cider, but the bigger issue is that introducing legislation may impact on brands that market themselves responsibly to responsible drinkers. We have to be careful about that sort of thing.
Mr Burns
My hon. Friend makes a valid point.
I will address a number of issues that some of my hon. Friends have raised. My hon. Friend the Member for Totnes (Dr Wollaston) talked about the important issue of weighing and measuring children. I hope that she will be reassured by the national child measurement programme. It measures children in reception class—four to five-year-olds—and in year 6. Those measurements and weights are fed back to parents, so that they can not only know the information, but make informed choices about the lifestyles of their children.
My hon. Friend the Member for North Swindon (Justin Tomlinson) made some valid and good points about the planning regime and open spaces that enable parents and children to exercise. His points were well made and sensible. It would be worthwhile for local government, which has responsibility for the issue, to read what he has had to say, particularly, as the hon. Member for Hackney North and Stoke Newington has said, because certain inner-city areas do not have the advantages of some of the more rural and smaller town constituencies, which have far more access to open spaces.
As a Government, our general approach to tackling the problem is based on the latest scientific evidence on the underlying issues and causes of obesity, as well as what has worked best previously. Ultimately, there is a simple equation: people put on weight because they consume more calories than they need.
Mr Burns
No, I will not, because I have only three minutes. People need to be honest with themselves. We need to recognise that we are responsible for controlling our weight. That means eating less, drinking less and exercising more.
We are also calling on the food and drink industry to play a much bigger role in reducing the population’s calorie intake by 5 billion calories a day, to help close the crucial imbalance between energy in and energy out. That will build on commitments that businesses have already made, through the public health responsibility deal, on things such as eliminating trans fats, reducing the amount of salt in food, and proper calorie labelling.
Of course, it is for each of us to make our own decisions about how we live our lives. The best and most sustainable changes come not when people are ordered about, but when they are given the tools to change, given the justification and then take responsibility to do it themselves. That is why we need to work together to make sure that the healthier choices become the easier choices. Everyone has a role to play—the food industry, the drinks industry, the many organisations that encourage physical activity and sport, employers who can support the health of their employees, and the local NHS staff in talking to people more about obesity and its consequences.
Under the new public health system, local leadership will be critical. We want to move away from the days when legislation and demands came down from Whitehall like thunderbolts from Mount Olympus. Local authorities will be supported by a ring-fenced budget and will bring together local partners, including the NHS, to provide the most effective services for their communities. We will support local people and local authorities by making sure that they have access to the best possible data and evidence.
We will not shirk our duty to provide national leadership where it is necessary—by working, for example, with business and non-governmental organisations, and making sure that Government Departments work together in supporting better health. That is already happening. The Department for Transport is providing more than half a billion pounds of funding for local authorities to increase sustainable travel such as walking and cycling. The new teaching schools programme, led by the Department for Education, will explore how schools can support and encourage children’s health and well-being. We will also continue to try to inspire people, young and old, to embrace a healthy, active lifestyle, via, for example, Change4Life. Moreover, the London Olympics, as many of my hon. Friends have mentioned, give us the golden opportunity to perpetuate that legacy after they have finished.
The new national ambitions provide a clear goal that we can all aim for. We should all play our part in raising awareness. Once again, I congratulate the hon. Member for East Londonderry on securing this debate, and I hope that he sees the benefits in our strategy. I hope that he supports it and that he will continue to be an advocate for his constituents on the matter.
Mrs Linda Riordan (in the Chair)
Order. Mr Bryant has withdrawn his debate, so the sitting is suspended until 4.30 pm.
Parliamentary Written Question (Correction)
Simon Burns Excerpts(13 years ago)
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The Minister of State, Department of Health (Mr Simon Burns)
I regret that the written answer given to the right hon. Member for Holborn and St Pancras (Frank Dobson) on 25 October 2011, Official Report, column 192W, contained some incorrect figures in the table.
The information provided in the original answer contained some unvalidated data but it has subsequently been brought to my attention that the Department holds more accurate, cleansed and validated data, which have now been provided where available. I have also taken this opportunity to provide the Connecting for Health figures for 2009-10 and 2010-11 rounded to the nearest £1,000, and figures that were previously not available.
A table showing the corrected figures is given below.
£000s | |||||
|---|---|---|---|---|---|
2010-11 | 2009-10 | 2008-09 | 2007-08 | 2006-07 | |
NHS bodies (excluding foundation trusts)1 | 291,047 | 455,213 | 419,579 | 308,462 | n/a |
Executive non-departmental public bodies, executive agencies and special health authorities 2,3 & 4 | 8,828 | 41,732 | 11,324 | 8,183 | 8,437 |
Connecting for Health | 4,975 | 6,259 | 5,102 | 4,551 | 4,825 |
1 Primary care trusts (PCTs), strategic health authorities (SHAs) and NHS trusts. The Department does not collect data from NHS foundation trusts. Where an NHS trust obtains foundation trust status part way through any year, the data provided are only for the part of the year the organisation operated as an NHS trust. Data for consultancy services expenditure were collected from NHS bodies for the first time in 2007-08. Source: NHS audited summarisation schedules. 2 Figures for 2009-10 and 2010-11 for executive non-departmental public bodies, executive agencies and special health authorities are on a different basis to those for earlier years and are therefore not directly comparable. 3 Figures included for the Human Fertilisation and Embryology Authority (HFEA) are for “Professional and administrative fees”. This category includes litigation and other legal costs as well as expenditure on consultancy services, which cannot be separately identified. 4 Figures included for the Care Quality Commission do not include external legal advice. It is not possible to identify how much of this expenditure falls within the definition of “consultancy services”. |
King George Hospital
Simon Burns Excerpts(13 years ago)
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This information is provided by Parallel Parliament and does not comprise part of the offical record
Mike Gapes
I suspect that that may be the case. A number of others were also on the payroll in one way or another—including many who were the lead GPs in the consortia that endorsed the proposals.
It is important to get the chronology right. Following the decision of the joint primary care trust meeting in December to endorse the proposals, all the councillors from all the parties in the London borough of Redbridge made a unanimous referral to the Secretary of State. The joint overview and scrutiny committee for all the boroughs in outer north-east London also made a referral to the Secretary of State. The Secretary of State then decided—the Minister will recall a previous debate in the main Chamber, in which we had an interesting exchange on the matter—to refer the case to a new independent reconfiguration panel investigation.
The IRP spent a lot of time talking to Members of Parliament and councillors, and it worked hard; I have no criticism of the consultation process. In its analysis, although it tended to group us all into one paragraph called, “Save King George Hospital” campaign, which covers many interviews and consultations, the community’s opposition was reflected. The view was expressed, if tucked away, that the local community was overwhelmingly against the proposals.
The IRP published its report internally, but not publicly, and put it on the desk of the Secretary of State on 22 July, and there it sat. Two or three weeks after that, the CQC decided to carry out a full, no-holds-barred look at Barking, Havering and Redbridge trust. Understandably, I guess, the Secretary of State decided to hold back until he had received the CQC report before he published the IRP report and gave his official response; Members of Parliament expected something like that to happen.
Then, interestingly, everything went quiet. We originally thought that we were going to get an announcement in September, but September came and went. Then we thought that we would get an announcement in early October, but that did not happen. Eventually, three hours after the CQC report was made public, the Secretary of State published his response.
There is a little bit of history here. As a local Member of Parliament—I know that other MPs feel the same—I was not appropriately informed about the matters. BBC London news on television at 6.30 pm on Wednesday evening ran a story saying that the Secretary of State was going to announce at 12 o’clock the following day the closure of A and E and maternity services at King George hospital. I raised a point of order in the Chamber that evening with Madam Deputy Speaker, who had no knowledge of the matter—there was no statement or announcement to come.
The following morning, telephone calls to the private and press offices of the Department of Health ascertained that, yes, the news was true: there was going to be an announcement. To be fair, I was phoned back eventually, at 11.15 am, and told that the announcement would be made at 1 pm, and that I would be told in advance of it. That is true: I received an e-mail at, I think, 12.46 pm. Attached was a letter from the Secretary of State with a link to the IRP report, but the report was not available on that link; the link did not work until 1.10 pm. Other people had a similar problem, by which time the announcement was already up and running. Therefore, we knew what the decision was—to endorse the report—but we did not know the content of the report. That is a matter of concern.
Nevertheless, the essence of the proposal is that Barking, Havering and Redbridge trust will be completely reorganised, because the IRP recommended going ahead with the downgrading of services at King George hospital, despite public opposition and deep concerns.
I have a question. The CQC report was published at 10 o’clock. Is the CQC report consistent with the IRP report and the Secretary of State’s decision? The Secretary of State, having read the CQC report, should have thought hard about whether to endorse the IRP report. The CQC report is absolutely damning about services at Queen’s hospital. It contains some criticisms of King George, principally because that hospital is in the same trust as Queen’s, with the same management, which the report is also strongly critical of. However, of the 73 recommendations in the CQC report, concerning maternity, A and E, children’s services, dealing with complaints from MPs, quality of care, cleanliness and all kinds of other issues, the vast majority relate to the new, five-year-old, private finance initiative-built Queen’s hospital in Romford. The report explicitly says on occasion that the recommendations do not apply to King George and that at King George, there is a different case. We have a series of absolutely damning recommendations relating to the larger hospital in the trust.
I do not wish to go through the report in great detail, as it is a long document. If people are looking for horror reading at Christmas, I recommend taking the report away and reading it. Apart from criticising poor management, it says that some staff, particularly in the maternity services at Queen’s, have very poor attitudes to the patients whom they are treating. It also confirms that attempts to cut the deficit at Barking, Havering and Redbridge trust over the years have led to reductions in the quality of care.
The IRP report also flags up concerns, saying that if the trust drove on with the deficit reduction programme and reduced the number of staff and beds, there could be an issue with quality. Damningly, the report makes it clear that although services at King George were reduced over the years, it has not led to efficiency savings. All it has done is reduce the quality of care in a hospital that serves my constituents and those of a number of other MPs. The cost of doing that has not led to improvements in efficiency; on the contrary, it has contributed to the ongoing deficit problems in the dysfunctional trust.
There we have it. The Secretary of State receives a report from the IRP recommending the endorsement of NHS London’s vision to downgrade services at King George hospital in Ilford. He then receives a report saying that there are two hospitals in the trust, covering 750,000 people in the community in the three boroughs, one of which is doing badly and there are criticisms of the other. He therefore endorses the recommendations to cut the services at the hospital that is doing better, on the aspiration, but with no evidence, that it will lead to a miraculous Stakhanovite improvement in the services at the bigger, supposedly better and more expensive hospital in the long term. You really could not make it up.
The Secretary of State could have delayed his decision on the IRP report. He could have said, “I am concerned about the CQC report and the damning indictment of what is going on at Queen’s hospital. I have waited three months with the report sitting on my desk, and I will wait another year to see whether I am satisfied that the improvements at Queen’s hospital are happening and have happened, that the quality of services provided is sufficient and that there has been an improvement in primary care services, which is also called for in the IRP report.” He could have waited, or he could have said, “I have made an announcement. I am minded to support the recommendations unless there is a significant improvement at Queen’s hospital and other services.”
The Minister of State, Department of Health (Mr Simon Burns)
I am grateful to the hon. Gentleman for giving way, and I hope this reassures him. As he will know from the decision, nothing to do with the IRP proposals will come into effect until the problems highlighted in the CQC report have been remedied, and the time scale for that in many ways fits in with the hon. Gentleman’s point.
Mike Gapes
I am sorry, but that is not good enough. The Minister gives the impression that the Secretary of State has somehow not “fully supported”—to use his own words—the recommendations. The letter that I have from Heather Mullin of the Health for north east London programme states that the Secretary of State fully supports the recommendations of the IRP.
Mr Burns
The hon. Gentleman is making a fallacious point. I have never said that at all. It is quite clear from the letter that my right hon. Friend the Secretary of State sent to him and to other hon. Members that he does. The point that I was making in my intervention is that he said that the IRP proposals should not come into effect until the problems have been sorted out at the two hospitals. I am saying that it has already been accepted that those improvements have to be made prior to the IRP proposals coming into effect, which is what I understood that the hon. Gentleman was saying should happen.
Mike Gapes
I am saying something different; I am saying that the Secretary of State could have delayed his decision or that he could have said that he was minded to—the words that I used—support the proposals, but would not make a final decision until he was satisfied.
I spoke to people within the Health for north east London programme last week. I asked them what the timetable for the implementation of the proposals was, and they could not tell me. I asked them whether babies will be born at King George hospital, Ilford, in five years’ time, and I was told, “Almost certainly not.” I therefore asked whether babies would be born there in two years’ time, and I was told, “They may be. We have not yet worked out the detail of these proposals. There is still a lot of work to do.”
Mr Burns
To respond to the hon. Gentleman and the right hon. Member for Barking (Margaret Hodge), I will repeat what I said before, which is that it is of paramount importance that the recommendations and demands of CQC are met before anything happens with the IRP recommendations, because patient safety is paramount. As far as can be assessed, it will probably be two years to get patient safety to the required levels and to address all the problems highlighted in the CQC report. Whatever the hon. Gentleman or the right hon. Lady may have heard from other people, we estimate that the time scale will probably be about two years, because the CQC’s requirements are paramount.
Mike Gapes
I would like to move on to what the CQC actually said, because it has made several criticisms and expressed deep concern. It will prove difficult for the management of the trust and the present configuration of Queen’s hospital to meet the required improvements within a two-year timetable. My right hon. Friend the Member for Barking and I have visited the hospital, and there are, for example, bottlenecks where people are on trolleys around the corner where they cannot be seen, which is pointed out in the report. There are design faults, and it is a bit like Eros at Piccadilly circus with trolleys suddenly coming from both directions. This newly designed hospital has a level of chaos. Whoever was responsible for signing off the design must have decided that it was an airport rather than a hospital, because the design has big issues—
Mike Gapes
Before the Minister intervenes, I am criticising the previous Government, the private finance initiative and the people in the consultancies and the private sector who run the PFI and make a huge amount of money from it, for designing a hospital that does not work well. The reports state that. They criticise the bad signage, the design and the way that wards are structured. Queen’s hospital has, for example, areas where children cannot be seen and areas where people wait for more than an hour before being attended to by a nurse or doctor. There is a whole litany of things that relate partly to design, partly to management, partly to staff shortages and partly to other issues at the hospital.
I do not believe that Queen’s hospital can be turned around in the suggested time scale, and that raises wider questions. The CQC wrote to me after I asked for an update following the publication of its report, and I received it yesterday. The update confirms the reasons why it had to intervene, which included the poor performance of the trust in the past and the fact that long-term problems prevented offering care that consistently meets CQC’s essential standards. To be fair, the CQC refers to both hospitals. It continues by saying that they have taken action to mitigate the risk of immediate harm in the short term, which includes reducing births at both Queen’s hospital and King George hospital and transferring caesareans out of the area. When they will be transferred back is an interesting question, which we can perhaps come to later. The update also states that the CQC met many staff and patients and that their concerns were made known, but the nub of the issue is that if improvements are not forthcoming, the CQC is prepared to restrict access to or close services that appear to be basically unsustainable. It then states that the CQC is not responsible for service reconfiguration.
The CQC, therefore, is not yet convinced that the 74 improvements that it has requested will be met. The final paragraph in the letter to me states that the CQC has set out 16 key recommendations that must be fulfilled by the trust and that it will monitor their implementation, but it admits that the trust needs help from organisations in the local health economy such as NHS London and commissioners and that the necessary significant changes are likely to challenge both clinical flows and trust finances.
There it is. We have problems with capacity and money, and we have a decision from the IRP and the Secretary of State to downgrade King George hospital, but serious concerns remain about Queen’s hospital. Are we confident that within two years those problems will have been addressed sufficiently well, at a time when there are financial problems; that Queen’s hospital will suddenly have been turned around, so that it is such a fantastic place that my constituents and the constituents of my neighbouring MPs—my right hon. Friend the Member for Barking and my hon. Friend the Member for Dagenham and Rainham—will feel happy to go into it to give birth to their children? I already have constituents expressing concerns because of the media reports and other things that are going on.
The CQC report points out that in the past there were more than 2,000 births a year in the King George hospital; at one time, there were 2,500 births a year. However, those numbers were deliberately run down by the trust to around 1,300 births a year. Then, a few months ago, the trust began to push the numbers up again, because Queen’s hospital could not cope. Within two years of now, the capacity for births at King George hospital—a capacity of around 2,000 births a year—will go. We are told that some of that capacity will go to a midwife-led birthing unit on the Barking hospital site, where there are currently about 10 births a week, or about 500 births a year. I am told that that figure is the maximum for that unit, although I do not know whether that is accurate. There is no proposal to have a similar unit on the King George site. That idea was floated in the consultation, but it was ruled out.
We have had a maternity hospital in Ilford since 1926; children have been born in that hospital since 1926. But from 2013 there will be no children born in that hospital, even though we have a young population. People in Ilford will be forced to go to the Queen’s hospital, where there is capacity for 9,000 or 10,000 births a year. It will be one of the largest maternity units in the country and it has been described as a “baby factory” in one of the documents that I have referred to this morning. Alternatively, they can go to Newham hospital or Whipps Cross hospital. Apparently, the facilities for babies to be born at Newham hospital or Whipps Cross hospital will be increased, although the cost of doing that is undefined. That will happen, while the perfectly good maternity service that exists in Ilford at King George hospital is being run down. My constituents will have to travel to Havering or to Whipps Cross. It is not easy to get to Whipps Cross from Ilford lane; the route is complicated and there are sometimes lots of traffic problems. There will be concerns about that.
Interestingly, Havering has the oldest population of any London borough; that is pointed out in the IRP report. The boroughs with the youngest populations in London are Barking and Dagenham, and Redbridge. So we have this huge increase in young people in north-east London, but their hospital will not be in the communities where they live. I could understand it if we had had a hospital at Queen’s hospital that provided long-term care for people suffering from long-term illnesses, mental health problems and so on, and if we had our maternity hospital in the area where most of the births were taking place. But oh no—the IRP, Health for north east London and the Government do it the other way round. We pointed that out in the consultation and the local MPs and councillors kept making these points, but we have been ignored.
Mr Brady, I am conscious of the time and that other Members wish to speak, so I simply want to get back to the CQC. I have been told that the CQC will review in March 2012 whether or not the Barking, Havering and Redbridge University Hospitals NHS Trust is delivering improvements. The CQC says:
“If we do not see improvements, we are prepared to take further action to restrict and ultimately close services that do not deliver care that meets our essential standards of safety and quality, and that present risks to people using services.”
That review is due to take place in March 2012, which is not very far away. It is not two years away; it is just a few months away.
I hope that the quality of care at Queen’s hospital improves sufficiently; I hope that services at King George hospital are not run down by surreptitious salami-slicing cuts in preparation for the implementation of Health for north east London’s plans, as they have been for several years now; and I hope that quality of patient care and treatment for my constituents is put ahead of the bean-counting desire to reduce the deficit at the Barking, Havering and Redbridge University Hospitals NHS Trust.
However, I am not confident that those things will happen. I am extremely angry at the betrayal of my constituents by the bureaucracy in Health for north east London; by the Minister, who said before the general election last year that there would be no top-down reorganisation; and by others, who said that they would keep district general hospitals open and that those hospitals should not close. The Prime Minister said that in 2007. In 2009, he promised “a bare-knuckle fight”. That was in the context of Chase Farm hospital, but the principles involved are the same. I feel that we have been betrayed and that our services are going to be reduced, and I fear the consequences of that for my constituents.
Mr Scott
I thank the hon. Gentleman for that intervention.
I want to praise the hospital’s new management. Averil Dongworth is doing a good job with her staff. She inherited a difficult situation, with a £117 million deficit and low morale, and she should be praised for doing her utmost to turn things around. The CQC report stated that things had improved over the past months.
The hon. Gentleman said that there are 265,000 people in the London borough of Redbridge alone and, given the amount of new build that has outline or detailed planning permission, the population is going to grow considerably. I understand that the situation is similar in Barking and Dagenham, and it is estimated that the area could grow by about 50,000 people in the next five years or so. When I met with the independent reconfiguration panel and the CQC, I mentioned that issue in relation to my own constituency, and I am sure that colleagues have also done so.
On the ballot of GPs that did not take place, GPs were consulted and the report says that they gave their blessing to what was happening. However, that seems to contradict what I heard from a number of GPs who contacted me in private, as they made it clear that although they did not feel confident enough to make their views public they had grave concerns. I know that that is anecdotal, but I want to put it on the record. It certainly happened with me; I know not whether it happened with other Members, but I would be surprised if it had not.
I think that it is fair to say that the private finance initiative at Queen’s hospital has been a failure. It was badly negotiated—the hon. Gentleman acknowledged that that was done by the previous Government and not the current one—it was a bad deal; it was badly set out and there are grave concerns. I understand that the planning applications for the new units that would need to be built at Queen’s have not even gone in, and are unlikely to do so before the new year. The time scale for the build ties in with the two years the Minister mentioned earlier, so that would obviously be a constraint.
In a letter to the hon. Gentleman, we heard that the CQC would undertake a re-evaluation in March 2012. I urge it to make a full report before any changes are made—in two years’ time or whenever—to say, “Yes, we are satisfied that our 73 points of concern have been rectified.”
Mr Simon Burns
As my hon. Friend will appreciate, the CQC is independent of the Department of Health, because it is a regulatory body that is concerned with standards of quality. Knowing how it works, however, I have no doubt that on an ongoing basis it will look closely at ensuring that its recommendations are implemented and the required standards for people in that community are reached.
Mr Scott
I thank the Minister. I am sure that the CQC will take note of what the Minister, other colleagues and I say in this debate. I have presented petitions signed by a total of 39,000 people, and other Members have presented petitions directly to Downing street; via our local Ilford Recorder, to which I pay tribute for its continued campaign; and in other ways. I am sure that it is an underestimate to say that there must have been a total of 50,000-plus signatures.
Margaret Hodge (Barking) (Lab)
I congratulate my hon. Friend the Member for Ilford South (Mike Gapes) on securing this debate and on giving us the opportunity to comment on something that impacts on all constituents of all hon. Members participating today.
I am really disappointed, because I feel that the Minister and his Secretary of State have reneged on promises that he gave to my constituents before the election. First, he said that he would never close the A and E, and we all know that the closure of such a department means the closure of a hospital over time, because most patients who go through a hospital come in that way. Secondly, he said that there would be more money in real terms for the NHS. Sadly, that is not true either, and it is impacting dreadfully—[Interruption.] The Minister can reply if he wishes. A 0.1% increase in cash terms is not real-terms growth, especially when inflation is running at about 5%. Thirdly, he promised no more top-down reorganisation. In north-east London, we are suffering from his reneging on those three promises. He must listen to that, because it has a terrible impact on the quality of the health service offered to my constituents. I have said to him privately, and will say to him publicly, that that will grow health inequalities in London.
I do not want to repeat what others have said about the Care Quality Commission. What I will say is that a lot of emphasis has been placed on confidence in the new management at Queen’s. I am on my fifth chief executive there, and every time a new one arrives, I think, “Perhaps this one will be a little better.” The new chief executive has been in place for six months, and so far I am not sure about that confidence. If one looks at the maternity services, why in September did we suddenly see elective caesareans being transferred from Queen’s to the London hospital? None of us knew why; none of us could understand it; none of us was told the reason, but it was because the CQC went back into the maternity unit because it was so bad and threatened to close the entire unit. The only way for the hospital to maintain the unit was for it to accept that caesareans should be transferred. The teams were not talking to each other; people were not taking responsibility, and no one was putting the patient at the heart of care, but the required cultural change has not occurred. Yes, new midwives are being recruited, but not at the right grade and not to manage the unit. The Minister is putting too much on Averil Dongworth, because she will not be able to turn around those cultural issues. The record so far shows that she does not share information freely, particularly with Members of Parliament, and that she has not done much.
The most recent case that I have had at the unit is an anonymous one—the woman does not want to reveal her name, although the case will be investigated. This mother was left for hours without being checked on, and it was her mother—the grandmother—who had to look after her. She was almost lifeless and delirious, and she was discharged without anyone checking her scar from the cuts she was given or changing her dressing. She was asked to give water samples, but they were left in the bathroom and were still there when she left, which is just not on. Queen’s provides facilities for 7,000 births, and if the proposals go ahead that will increase to 9,000, making it the biggest single maternity unit in the country. Given the quality of care, the problems faced and the population growth, it is sheer madness to go ahead with a proposition that closes a hospital in this area of London.
Perhaps the Minister will give us some words of comfort about the finances. The trust’s finances have been in a mess for ever, since well before the Labour Government came into office. I assure the Minister that when I became a Member of Parliament in 1994 there was already a deficit in the trust. David Varney, a well-respected and talented man with a lot of experience, was chairman of the trust although for a very short time, and I breathed an enormous sigh of relief that at last we had someone there who could sort the trust out. He went to NHS London and said, “Write off the debt, give me a blank sheet of paper and I’ll provide you with a decent health service within budget.” NHS London refused, so David Varney walked away. That was a tragedy for the people of that part of London, and such tragedies will continue to be repeated. The problems will not be sorted out until somebody grasps them properly and says, “Right, we will do something about the finances,” enabling the trust to run a decent service within budget rather than always chasing a deficit.
One thing about the CQC report that has not been raised is that it is about not only maternity but accident and emergency. One of the most shocking things, for me, involves radiology. The results of scans are just sitting around. Some scans show a possibility of cancer, but individuals are seen so late that the cancer has grown. People’s lives are being threatened and death warrants are being written simply because the hospital has no systems to transfer knowledge from a scan to a consultant who can quickly pick up on the symptoms and deal with the patient.
That is awful, as is the fact that people sit in theatre all the time. The fact that A and E is bound to be bad again this winter is awful. The fact that proper records are not kept of who has had cannulas inserted for treatment is awful. The culture throughout the hospital is awful, and it seems to me that it will take a heck of a lot more than Averil Dongworth, whose only record is the closure of Chase Farm hospital, to turn that around.
I am conscious of time. I campaigned for years to reopen a birthing unit at Barking hospital, for all sorts of reasons, including pressure on Queen’s, population growth and the fact that I wanted babies to be born in Barking again. I was grateful when it was finally built. Those hospital beds have been ready for occupation since March this year, but they are still not occupied. When I last asked NHS London what was happening, I was told that the unit would be open by March next year. That is a 12-month wait. If the hospital is kept empty, £1 million in costs for security, electricity, heating and so on will go down the drain each year. Now the deadline has changed from next March to next spring.
That is absolute madness. There is pressure on Queen’s. Queen’s is failing to deliver, so people are being sent to London, while a brand-new facility that could provide for many more births than my hon. Friend the Member for Ilford South has suggested stands empty. Will the Minister give us an assurance that the unit will be open not next spring but by Christmas, so that people in my constituency can have hope?
The decision whether to close the A and E at King George hospital was predicated on the idea that fewer people should go to A and E; I agree. If and when the Minister can demonstrate to me and other Members of Parliament that fewer people are actually going to A and E, maybe we can have a serious conversation about whether that part of north-east London has too many hospital places. The reality is that we have a mobile and transient population, many of whom have not registered with a GP and who, if they want to access health care, go first to A and E.
Another reality is that GP and community services also have issues. Before taking a decision, is the Minister willing to do a comprehensive inspection of GP services in my area to ensure that they can fulfil the demands on them, as the decision to close assumes they can? If GP services prove to be up to scratch, again, I am willing to enter into conversation with him about whether there are too many hospital places. However, at present, he is letting down the people in my borough.
Time and again people say to me, “I rang the GP at 6.30 in the evening. He said to ring back the following morning. I rang at 8 o’clock in the morning, and I couldn’t get through. By that time, I felt that the only way to be seen was to go to A and E.” [Interruption.] The Minister looks at me in amazement. That is the reality on the ground.
Mr Simon Burns
I am fascinated to hear the right hon. Lady say that. Does she know who the authors were of the GP contract that ended evening and weekend work for GPs? It certainly was not my Government.
Margaret Hodge
Making a political point does not get at what is happening in practice. It is not about the contract; it is about the practice, attitude and culture in the whole NHS economy in our part of north-east London. That is the problem that the Minister must tackle. Making a cheap political point does not help make any advances in the quality of health care in my quarter of London, for which he is responsible.
Finally—I have said this to the Minister privately, and I will say it publicly—there is inequality in health care across London. The teaching hospitals in the heart of London take away necessary resources from outer London, whether north-east or south-east. If Queen’s becomes the only hospital in our part of London, it will have to meet the health needs of 500,000 people, according to the CQC. The catchment area in inner London has a population of about 200,000. It is completely different.
I have spent my whole adult life bringing up my children in north London. The catchment area where I live has four hospitals that I can reach within 10 minutes and that provide excellent health care for me and my family. In north-east London, where I work, if King George hospital closes, it will take those who live on the Thames View estate an hour and a half on three buses to get to Queen’s hospital. People with weekly hospital appointments will not go. With the greatest respect to the Minister, that means that they will die earlier. His Government have said that they want to tackle health inequalities. Our Government tried to tackle them, but did not make much progress. Those health inequalities will grow.
Why does the Minister not take a bold move and consider the configuration of teaching hospitals in inner London? For example, the Royal Free hospital is not a good hospital. The physical building is terrible, and it sits on an extremely valuable site that would do a lot to sort out the financial situation faced by the NHS, but some talented and good people with the right culture and attitude work there. Those people ought to be working in areas of health need, such as our bit of north-east London. They should be operating out of the brand-new Queen’s hospital on the Romford site. If he did something radical and sensible like that, it would improve health outcomes for people in my constituency. It would also help him tackle some of the financial problems that he faces, and it would make sense in terms of tackling health inequalities across the capital.
Andrew Gwynne (Denton and Reddish) (Lab)
I welcome you to the Chair, Mr Brady, and congratulate my hon. Friend the Member for Ilford South (Mike Gapes) on securing this important debate on the issues facing his local hospitals. I know that he, my right hon. and hon. Friends, and other Members across the party divide have campaigned extensively for their local health services, and I commend them for it.
The Government are implementing a number of much wider changes in the health service—I will touch on those later—but my hon. Friend must be disappointed with the recent decisions made about the hospitals in his area and the health services used by his constituents. He and others have mentioned the recent Care Quality Commission report on the standard of care received by people under Barking, Havering and Redbridge University Hospitals NHS Trust. The report had immediate concerns in relation to maternity services, identified failings in emergency care and radiology, and demanded widespread improvement.
As Members have mentioned, Queen’s hospital had the most serious concerns, including poor clinical care, verbally abusive and unprofessional behaviour by staff towards patients and colleagues, and a lack of learning from maternal deaths and incidents. The report states:
“Despite some signs of improvement in recent months, patients remain at risk of poor care in this trust”.
It also notes that the trust addresses issues on a short-term basis, under instruction, rather than proactively looking for longer term solutions. The report also states:
“There is past and current evidence of poor leadership from some managers and a culture among some staff of poor attitude and a lack of care for patients, especially in maternity.”
That is of extreme concern, and those views have been reinforced in this debate. The report also confirmed that attempts to cut the financial deficit at Barking, Havering and Redbridge trust led to reductions in the quality of care.
About three hours after the CQC report was published, the Health Secretary made an announcement about King George hospital, which now looks set to lose its A and E and maternity units. We know that the Health Secretary backed the IRP’s proposal for services to be expanded at nearby Queen’s hospital in Romford. That raises the question why, when the report on King George hospital was presented to the Secretary of State on 22 July, it then sat on his desk for more than three months and he chose to release its conclusions and recommendations on the same day, three hours after the CQC report.
From articles in the Ilford Recorder, in the constituency of my hon. Friend the Member for Ilford South, I see that there is a great deal of concern and consternation about that decision. Indeed, my right hon. Friend the Member for Barking (Margaret Hodge) described the decision in the press as “sheer madness”, outlining how Queen’s hospital is already having difficulty dealing with existing pressures—an issue which she raised today. My hon. Friend the Member for Ilford South previously described the decision as a disaster and is quoted in the Ilford Recorder as saying that the decision on King George hospital showed an
“absolutely contemptuous attitude to local people’s wishes and concerns”.
The proposed changes will not take place until the Barking, Havering and Redbridge University Hospitals NHS Trust, which runs both sites, tackles the issues raised by the CQC. The Minister went into a little more detail about that in the debate. However, it is not just the disruption, but the uncertainty of local people, who will no longer have access to A and E and maternity services on their doorstep, that should be of concern to all hon. Members.
Yes, we need to acknowledge that reconfigurations are unpopular. We went through that a few years ago in Greater Manchester. Nevertheless, given public opposition and the views of the overview and scrutiny panel, local MPs and members of the local authorities across party, will the Minister say what account has been taken of the level of local opinion on the local health services by the IRP? My hon. Friend says that it was in its report, but what weight did the IRP and the Secretary of State give to that level of opinion?
Mr Simon Burns
May I help the shadow Minister? The consultations—not on the IRP level when it was doing its work, but on the proposals themselves—have, since 20 March 2010, had to fulfil the four conditions for reconfigurations set out by my right hon. Friend the Secretary of State, which include consulting local people within the health economy and local opinion.
Andrew Gwynne
I appreciate that, but we heard today that there is a great deal of concern across local authorities and the communities, and I would like to know what weight was given to their views.
Andrew Gwynne
Absolutely. We recognise that reconfiguration is sometimes necessary in parts of the country for reasons of financial efficiency, safety and better health outcomes. However, people are rightly disappointed by the way in which the nature of the debate changed in the run-up to the general election. As hon. Members rightly said, the general election was fought with a pledge about hospital closures and reconfigurations that is not being met. Back in 2010, the now Prime Minister clearly promised a moratorium to stop closures. Indeed, in opposition both he and the Secretary of State toured the country making promises to overturn some very difficult reconfiguration decisions taken by the previous Labour Government. Yet, as we have seen, the moratorium has not materialised, and there is now evidence of major changes to hospital services across the country.
I do not want to stray too far from the subject, but it is worth remembering that the Prime Minister gave a firm pledge not to close services at Chase Farm hospital, but in September 2011 the Secretary of State accepted the recommendations of the IRP and approved the downgrading and closure of services at Chase Farm. Similarly, at the Fairfield maternity department near Bury, we were told on a visit by the now Secretary of State that the service would be kept open. We now know that the maternity department at Fairfield general hospital is scheduled to close in March 2012.
My hon. Friend the Member for Ilford South raised concerns about the ability of Queen’s hospital to improve when the NHS faces tough financial challenges in the years ahead. That is fair comment. At the general election, Labour promised to guarantee to maintain NHS front-line funding in real terms. In contrast, the Prime Minister offered real-terms increases. We can debate that another time, but I would suggest that that was just an electoral gimmick. The Treasury figures show that in 2009-10 health spending was £102,751 million in the last year of the Labour Government. In 2010-11, actual health spending was £101,985 million.
Mr Simon Burns
Will the hon. Gentleman be kind enough to tell hon. Members that the health spending figures for the financial year 2010-11 were set by his own Government, and that, for the lifetime of this Parliament and thereafter, we are increasing health spending in real terms, albeit a modest increase because of the financial mess we inherited, which needs to be sorted out?
Andrew Gwynne
I said that that was the actual health spend for the first year of this Government, which represents a real-terms cut of £766 million, according to Treasury figures. That includes the GDP deflator, which so excited the Minister during the Opposition day debate when my hon. Friend the Member for Leicester West (Liz Kendall) tried to raise this issue. That is the first cut in health spending for 14 years. Indeed, that is the first real-terms cut since the last year of the previous Conservative Government in 1996-97. The Government promised a real-terms increase in health spending; they have delivered a real-terms cut.
There are wider concerns about how the Health and Social Care Bill will impact on local health services. The extensive reorganisation of the NHS was not put forward by either party in government in their manifestos, or in the coalition agreement. Clearly, such a massive reorganisation will make it harder for the NHS to tackle the sorts of problems identified at Barking, Havering and Redbridge University Hospitals NHS Trust, and the wider issue of social care for older people by the CQC. The Prime Minister has clearly gone back on his promise on NHS reorganisation. The coalition agreement could not have been any clearer:
“We will stop the top-down reorganisations of the NHS”.
It is difficult to see how the coalition Government could have said that, when only weeks later they published a White Paper outlining the biggest reorganisation of the NHS since 1948. It is clear that such a change on this scale is the last thing that the NHS needs right now.
Returning to the more specific question about Barking, Havering and Redbridge trust and the future of King George hospital, given the CQC report and what hon. Members have said today, what consideration has the Minister given to the ability of Queen’s hospital to deal with the added pressures on its services when King George hospital closes its A and E and maternity services? On the face of it, no consideration has been given to the local support for keeping A and E and maternity services at King George hospital. If services are to be transferred—the Minister says within two years—does he recognise that people need certainty and that NHS staff need proper expectations to plan and manage those changes? If those time scales are not met, what plans are in place for NHS services in that part of London?
The concerns expressed by Members today are right and need to be addressed by the Minister. Also, the wider changes to the NHS will make it much harder to identify such failures in care in future and to deal with them effectively. That is why we are so against what the Government are doing to our national health service.
The Minister of State, Department of Health (Mr Simon Burns)
It is a pleasure to serve under your chairmanship today, Mr Brady.
I congratulate the hon. Member for Ilford South (Mike Gapes) on securing the debate because, from personal experience in a previous debate and from meetings, I know that he and other right hon. and hon. Members have a tremendous interest in, and concern about, securing the highest-quality health care for their constituents. I share their desire for excellent health services in hospitals and in the community, whether in Barking, Dagenham, Ilford or elsewhere in London and the country. That is why it is so important that the issues raised by the Care Quality Commission’s investigation into Barking, Havering and Redbridge University Hospitals NHS Trust are acted on immediately and that safe services are realised and sustained.
Before I go on, I extend my sympathies to anyone who has experienced poor care at the trust. We can all be united in our concern and, in certain cases, even horror at what the CQC report showed. It is unacceptable in this day and age for services to deteriorate to that level, with such low-quality patient care. The improvement of the quality of care in that area and throughout the NHS is crucial—it is imperative and a priority. I can assure right hon. and hon. Members that the Secretary of State, my ministerial colleagues and I take such issues every bit as seriously as they do.
Although the CQC report identified some risk of poor care throughout the trust, it is the maternity service that requires immediate action and where the biggest risk of poor care was identified. The local NHS has taken immediate action at the trust to ensure that services are safe. NHS London and the Outer North East London PCT cluster have been working in collaboration with the trust to manage capacity and demand, to support its clinical leadership and to address the gaps in capability.
Margaret Hodge
Will the Minister therefore ensure that the unit at Barking hospital is open before Christmas?
Mr Burns
Since the right hon. Lady has specifically mentioned it, I will discuss that now, instead of later as I had intended. There is a plan to move the midwifery-led unit services into Barking hospital; that is a continuing, high priority for the hospital, and currently I believe that capacity is about 50%. [Interruption] She ought to have waited until she had heard the end of my answer. If she wants to intervene again, I point out that I have only been left seven minutes and there is a lot to deal with. However, it is not for me in Whitehall to micro-manage decisions; services and the speed at which services are provided must be a local decision by the local health economy. The only assurance that I can give—it is an assurance—is that the MLU is a priority for the hospital. I am advised that the whole service is expected to be provided at Barking hospital by April 2012, which I think is the date given to the right hon. Lady.
NHS London continues to monitor closely the actions taken in the local NHS, including twice-weekly discussions with all key stakeholders, as well as regular meetings with the PCT cluster, the trust and NHS London’s performance and chief nurse’s teams. Some concrete actions, which I hope reassure right hon. and hon. Members, have already been taken. To ensure safety, NHS London, PCTs and the trust decided to cap the number of deliveries to 20 a day at Queen’s and seven a day at King George from the beginning of October. In collaboration with the South West Essex commissioning cluster, a number of women with Essex postcodes due to give birth at Queen’s or King George will give, and have given, birth in hospitals in Essex instead. Additional, part-time professionals are being brought in—including the well-respected head of midwifery from the Royal Free hospital—to support the maternity unit until substantive leadership can be appointed.
Five supervisors of midwives from surrounding trusts have agreed to support the team at Queen’s. A senior obstetrician has been recruited and will begin working with the trust shortly. Given CQC concerns about the number of vacancies and the skill mix in the maternity work force, NHS London’s chief nurse has set up a midwifery leadership scheme to attract 12 experienced midwives to the trust. For an initial period of eight weeks, Caesarean sections have been transferred from the trust to Homerton university hospital in Hackney. All such actions are having an immediate impact on the ground and protect patients.
In February of this year, the trust gained a new chief executive, Ms Dongworth. The CQC and NHS London have confidence in her and have given her their full support. The CQC reported:
“Almost without exception, staff were positive about the impact the new Chief Executive is having at the Trust. They have embraced the Chief Executive’s inclusive style and believe, for the first time in many years, that there is a real opportunity for positive change.”
It is my belief that such positive leadership can help the trust to move forward from the report and to continue to make the improvements that are so badly needed. A recruitment drive has already brought in an additional 72 midwives, enabling the trust to have one of the best midwife-to-birth ratios anywhere in London, and one of the highest levels of senior doctor cover. There is now regular, independent monitoring of performance every week. The trust has made it absolutely clear that continuing to improve is its top priority. All local NHS partners are committed to making that happen. The Secretary of State will also actively monitor developments.
I now pick up on a point made by my hon. Friend the Member for Ilford North (Mr Scott) which, to be fair, I think was a special plea about his urgent care centre. The urgent care centre at King George’s will see the majority of patients who already attend. I must advise my hon. Friend that few blue-light cases are actually taken to that unit. He might have been hoping that I would do something to upgrade the centre to an accident and emergency unit, but I am afraid that that is not within my remit. However, under the modernisation of the NHS, nothing prevents the clinical commissioning group, when commissioning care for its patients, from looking at the situation if it is so minded. If it wants to commission enhanced care in an urgent care or A and E centre, it has the powers to do so if it wishes. I cannot prejudge what a local CCG might or might not want to commission in the future, but the opportunity is available.
Owing to the shortage of time in the debate, I have not been able to answer all the points made by the hon. Member for Ilford South, or by the right hon. Member for Barking (Margaret Hodge) and the hon. Member for Dagenham and Rainham (Jon Cruddas). I commit to writing to them with the answers to their specific points, made during this interesting and in many ways traumatic debate. I appreciate, as they do as constituency MPs, that it is totally unacceptable to have poor-quality health care for our constituents and for patients within the NHS.
National Health Service
Simon Burns Excerpts(13 years ago)
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Mr Lansley
In a moment.
We know what that meant, because when we opened the books on arriving in the Department we saw that Labour was planning to slash by more than half the capital budget of the NHS. Every Member of Parliament who has a major hospital building programme in their constituency would have been affected by that. That might include my hon. Friend the Member for Harrow East (Bob Blackman), who has the Royal National Orthopaedic hospital in his constituency, or Members from Liverpool, who have the rebuild of the Royal Liverpool and Broadgreen hospitals and, all being well, the rebuilding of Alder Hey. That might also include the hon. Member for Copeland (Mr Reed). The last Labour Government, before the election, cut the capital budget, and his project—the West Cumberland hospital at Whitehaven—could have been at risk as a consequence of that. [Interruption.]
Mr Lansley
I went with my colleagues; in fact, the Chief Secretary to the Treasury stood here at the Dispatch Box and reconfirmed support for that project, so I will not have any nonsense from the hon. Member for Copeland. [Interruption.] Withdraw that. I have not misled the House. The Chief Secretary to the Treasury came here and reconfirmed support for that project. I will not put up with being told from a sedentary position that I am misleading the House. I ask the hon. Gentleman to withdraw that accusation.
Rosie Cooper
Forgive me; I need to get to the end of my speech.
My right hon. Friend the Member for Leigh dealt with the finances and the myth of real-terms growth in the NHS budget. My local trust is being asked to go beyond the 4% savings compounded over the next four years and will be expected to achieve 6% or £8.5 million in this financial year. On top of that, Monitor expects trusts to make a 1% profit. People who have given evidence to the Select Committee have said it is clear that there will need to be hospital closures in order to release money back into the wider health service. We are told that this is all part of managing demand and redesigning pathways—two horrible phrases that appear to be back in vogue.
I want to deal quickly with the re-banding of nurses to reduce budgets, which the Health Secretary appears to have little understanding of. I am sorry he is no longer in his place. He clearly told the Health Committee that he was unaware that re-banding was taking place. His problem is that Janet Davies from the Royal College of Nursing told the Committee that, although the RCN does not release conversations, that issue was clearly discussed. I really worry about that. Does he have a twin he is sending into meetings on his behalf? Does he simply not listen? It would not be the first time. Or is the truth even worse, and should he be described in terms that Mr Speaker would call unparliamentary? The Secretary of State said earlier that he stood by his answers to the Committee. He has also claimed that he did not receive a letter from me, but I can confirm that he received it at 11.57 on 13 October, and I have confirmation from his office.
Rosie Cooper
I will not.
The point is that even if the Secretary of State was not aware of the re-banding, as he claims, that speaks volumes about how out of touch he is with the hard-working staff he is supposed to represent. Perhaps he would like to remove himself from his parallel universe—
Dr Poulter
The hon. Lady did not make her point very well, and she did not allow me to intervene on her. I am sure that the Minister will address the points that she made about the letter.
Mr Simon Burns
It might be useful at this stage to clear up the point about the letter. The hon. Member for West Lancashire (Rosie Cooper) said that my right hon. Friend the Secretary of State had not replied to her letter, as though it had been sent months ago. It was dated 12 October, so I presume that it arrived in the Department of Health on 13 or 14 October, about 12 or 13 days ago. Hon. Members know that the guidelines, which the Department rigorously keeps to, state that it may take up to 20 days to receive a response. My right hon. Friend has not been discourteous, and the hon. Lady will receive a reply within the time scale.
Dr Poulter
I thank my hon. Friend for clarifying an earlier point.
I will not engage in mud-slinging, but will talk about what hon. Members on both sides of the House want to emerge from the NHS. The right hon. Member for Leigh (Andy Burnham) was absolutely right that some service reconfiguration is necessary to deliver services in communities, improve community care and build an integrated health service with integrated health care. The right hon. Gentleman spoke specifically about an integrated system and better integrating adult social care, especially for the elderly, with current NHS providers, breaking down some of the silos between primary care, the hospital sector, and adult social services.
The Minister of State, Department of Health (Mr Simon Burns)
It has been an interesting experience listening to the range of contributions that have been made over the past few hours. Having studied the shadow Secretary of State’s tweets yesterday afternoon heralding today’s debate, one would have expected this to be an action-packed afternoon. One remembers the grand old Duke of York marching his troops up to the top of the hill and then down to the bottom, but the grand old Duke of York had 10,000 men. For most of this debate, apart from the wind-ups, the shadow Secretary of State has barely managed to get more than six Opposition Back Benchers here, which is fewer than the Government have had, so on that point I fear that he has failed.
Let me turn to some of the speeches that I had to listen to. It was a delight to hear the hon. Member for Easington (Grahame M. Morris) again, after a break from the Committee stage of the Health and Social Care Bill. Broken record his speech may have been—it was the same story—but it was worth listening to, even though the accuracy gained nothing in the telling.
My hon. Friend the Member for Kingswood (Chris Skidmore) made an excellent speech, as did my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who spoke fluently and knowledgably, on the basis of his intense and intimate experience of working in the NHS and his insights into the challenges we face in social care and improving the integration of care.
The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) made an interesting contribution, although at times I began to think that she might be the only person who believed what she was saying. None the less, it was interesting.
The hon. Member for Ealing North (Stephen Pound)—as always, a jokester in our midst—put forward a serious message in a jocular way. From my experience of the NHS, both personal and professional, however, I felt that a lot of what he said bore little relation to reality. I can assure him that Government Members share the core principles of the NHS. I was also interested to hear the comments of my hon. Friend the Member for Stafford (Jeremy Lefroy). Anyone who represents that part of the country will have a deep understanding of the problems, as well as the successes, of the local health service. He was right in what he said about the future of accident and emergency services and about the critical issue of training.
I am saddened by the fact that the Opposition have once again shown themselves to be more interested in trying to revive their own political fortunes than in improving the outcomes of patients. Once again, they prefer to scaremonger and blindly attack, rather than put forward any policies of their own. They have been a policy-free zone in this debate. Once again, they reveal themselves to be on the back foot when it comes to securing the future of the NHS, as well as wrong-headed.
The Opposition claim that the Government are cutting NHS spending, which is not only nonsense but outrageous. Surprisingly, only last summer, the right hon. Member for Leigh said—this has been quoted before, but I will repeat it—that it would be
“irresponsible to increase NHS spending in real terms”.
Ironically, that is not a view that I share. I fundamental disagree with it, because I believe that we should increase the funding of the NHS in real terms. [Interruption.] I do not care how much the right hon. Gentleman says it; if he looks at the—
Mr Burns
I will in one minute, just to disprove what the hon. Member for Leicester West (Liz Kendall) says.
If the right hon. Gentleman does not want to believe what I say, he can look at the chart produced by the Wales Audit Office, an independent body, which shows, if one cares to read it, real-terms spending increases in each year in the English NHS. Ironically, it also shows such increases in Northern Ireland and Scotland, but if we look at the red parts of the chart, we can see that there are certainly no increases in Labour-controlled Wales.
Andy Burnham
The Minister says that the Government are providing real-terms increases, but he does not take into account inflation or the £1 billion transfer to social care. Will he accept the figures that I have here? They are the total departmental expenditure limits published by the Treasury in July 2011. They show that, in 2009-10, £102 billion was spent on the NHS. The figure for 2010-11 was £101 billion. I invite him to tell me that those figures are not correct.
Mr Burns
One minute. The right hon. Gentleman wants a reply, so he must hold his horses.
It is the gross domestic product deflator that determines how one increases in real terms the funding of the NHS. The right hon. Gentleman has once again scored an own goal in reading out those figures, because they are based on the Labour Government’s spending for the year in which they were leaving power.
Mr Burns
No, I said that I would give way once. I must now make progress.
We are increasing funding for the NHS in real terms over this Parliament, and stripping out unnecessary bureaucracy to focus precious resources on the front line and not the back office. So in place of management-led primary care trusts and strategic health authorities, we are introducing clinically led clinical commissioning groups, to put money and power in the hands of front-line doctors and nurses. That is why we are driving through the plans to make the NHS more efficient by focusing on prevention, on innovation, on productivity and on driving up the quality of care. A fact that Labour Members appear rapidly to have forgotten is that better care is very often less expensive care, and less expensive care means there is more money to spend on the health service.
Mr Burns
In Yorkshire and the Humber, the ambulance service gives PCTs a monthly list of their top 10 most frequent callers. These people are then given intensive personalised help, including the use of modern telemedicine to monitor their vital signs. The result is better care for patients as well as—
Mr Barron
On a point of order, Mr Deputy Speaker. As you know, I took part in this debate and I asked the Minister a question and requested him to answer it in his winding-up speech. Yet he will not even acknowledge that I spoke in the debate. Is there anything you can do, Mr Deputy Speaker, to help Back Benchers keep the Executive in check?
Mr Deputy Speaker (Mr Nigel Evans)
Absolutely nothing. I am sure, however, that the Minister will have heard the point.
Mr Burns
Did I hear the right hon. Gentleman’s point, Mr Deputy Speaker? I heard it about three times in Committee and I heard it on Report; I replied each time, as well as writing to the right hon. Gentleman. He does not like the answer, so there is no point in taking the intervention again.
As I was saying, in Yorkshire and the Humber the ambulance service gives PCTs—[Interruption.] I know I have already said it, but there was so much disruption and noise that Labour Members did not hear it. In Yorkshire and the Humber, the ambulance service gives PCTs a monthly list of their top 10 most frequent callers so that they can talk to them and help them in future, saving money and staff time that can be concentrated elsewhere.
Mr Burns
Just as Labour Members are wrong about NHS funding, they are also wrong about the Bill. [Interruption.] The Bill focuses on the most important thing for patients—the outcome of the treatment they need either to cure them or to stabilise their long-term conditions. Doctors, nurses and other health care professionals—[Interruption.]
Mr Deputy Speaker (Mr Nigel Evans)
Order. I am finding it difficult to hear the Minister. [Interruption.] Order. He has made it quite clear that he is not giving way.
Mr Burns
Doctors, nurses and other health care professionals are being empowered to take decisions and to design the innovative, integrated services that will best serve the interests of their patients, with a resolute focus on outcomes. The NHS outcomes framework, and the growing number of National Institute for Health and Clinical Excellence quality standards will mean that patients and clinicians will be able to see clearly just how good individual providers—even individual consultant teams—are performing and then demand the treatment that they deserve.
In the short time since this Government have been elected, care for patients has improved significantly in many areas. For example, MRSA down; C. difficile, down; mixed-sex accommodation, massively down; more doctors, fewer managers; more patients with an NHS dentist; more cancer screening; the cancer drugs fund; the new 111 urgent care service; more money; less bureaucracy; and a far brighter future for the national health service. The motion before us is devoid of reality and it was backed up by a number of speeches that were divorced from the real world. Its claims are false, its premises unsound. For those reasons, I urge the House to reject it.
Question put.
Ritalin
Simon Burns Excerpts(13 years, 1 month ago)
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The Minister of State, Department of Health (Mr Simon Burns)
I congratulate the right hon. Member for Wolverhampton South East (Mr McFadden) on introducing a particularly interesting and sensitive subject. He made his points very fairly and very well. In passing, I should, I suppose, declare an interest because a member of my family has for a number of years been on Ritalin and, contrary to the observations of the hon. Member for Newport West (Paul Flynn), the benefits to that person’s education have been immense—the decision was taken on clinical advice, not on the advice of parents.
I am pleased that the right hon. Gentleman has welcomed the announcement by the Minister with responsibility for social care, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), of £32 million to help with children’s mental health. The right hon. Gentleman asked whether that was new money. It comes from within the £400 million that was identified by the Treasury in the spending review last year.
The right hon. Member for Birkenhead (Mr Field) asked about the link between disability allowance, and other entitlements, and children on Ritalin. The entitlement is based not on having a specific health condition diagnosis or treatment, but on what help is needed with personal care as a result of the disability. Nevertheless, I will certainly draw his comments to the attention of my right hon. Friend the Secretary of State for Work and Pensions, whose Department will hopefully get back to him.
Let me set out some of the background to this issue. According to NICE, between 3% and 9% of school-aged children and young people in the UK meet the broad criteria for mild to moderate attention deficit and hyperactivity disorder, and between 1% and 2% suffer from severe ADHD. Methylphenidate, commonly known as Ritalin, and similar drugs are used to treat a range of mental health conditions, including ADHD. The NICE guidelines, published in 2008, recommend that medication should always form part of a holistic package of care, which might include talking therapies. I fully appreciate the concerns raised by the right hon. Member for Wolverhampton South East about the increase in the number of prescriptions for Ritalin and similar drugs. We need better to understand the reason for that. It is always wrong for doctors to prescribe medication inappropriately, and medication should not be the sole response to an individual’s condition.
I fully appreciate the concerns of those worried about the growth in prescriptions for Ritalin. We do, however, need to acknowledge the fact that too many young people and their families are not getting the support they need. The NICE clinical guidelines on ADHD said, at the time of their publication in 2008, that a minority—fewer than 50%—of all individuals who should be receiving medication and/or specialist care were in receipt of such care. If left untreated, mental health problems can lead to low attainment in school, antisocial behaviour, drink and drug misuse, worklessness and even criminality in adult life. Getting things right for children and their families—through a broad range of support to promote good mental health from the start of life, through the school years and into adulthood—can make a real difference to young lives.
The costs of doing nothing are simply too great. Across hospital and primary care, the prescribing of drugs for ADHD increased by around 12.5% between 2007 and 2010, the latest four years for which data are available, and by around 6% in 2010 alone. Prescribing in primary care alone increased by 22% in that four-year period, reflecting a significant shift in prescribing activity from a hospital setting and into primary care. Looking back further, one sees that prescribing in primary care has tripled in the past 10 years. Some variation in the prescribing of ADHD drugs around the country must be expected in the light of the distribution of specialist services, which might be more likely both to diagnose children with ADHD and to support GPs in taking responsibility from hospital teams for repeat prescriptions; the different local patterns of prescribing across primary care and specialist settings; and demographic factors, such as deprivation, which might be correlated with ADHD.
We do not, however, have good-quality data on the number of children and young people assessed with ADHD, against which prescribing patterns could be compared. If we had, it would be possible to gain a true measure of variations in clinical practice. Prescribing data are not routinely collected by age, but we do need better to understand the position. In the shorter term, we are investigating whether further helpful information can be derived from prescribing research databases. As a result, the data we do have must be interpreted with care and in the context of all the evidence that suggests under-diagnosis and under-treatment of this distressing behavioural disorder.
Mr McFadden
The point about age is important. The NICE guidelines on children under six could not be clearer. The Minister acknowledges that the Government do not know—I will leave aside whether that is a good state of affairs—how many children are prescribed these drugs. His Department has a research budget, so, rather than trawling other research projects, why can it not commit to research to find out from professionals how many children under six have been prescribed such drugs?
Mr Burns
The right hon. Gentleman anticipates my remarks on the NICE guidelines, and I hope that once he has heard them the situation will be clearer.
The 2008 NICE clinical guidelines on the treatment of ADHD are clear that medication is an appropriate treatment for severe ADHD, but that it should be initiated only by a specialist and should form part of a holistic care package that may include talking therapies. The guidelines do not recommend drug treatment for pre-school children, and health care professionals are expected to take the guidelines fully into account when exercising their clinical judgment. They do, however, have the right to prescribe the drugs if they feel it is clinically justified and in keeping with specialist consensus, given the individual circumstances of the child and in consultation with the parent or guardian. Such prescribing can include so-called off licence prescriptions, which means a prescription of medication outside its licensed age indications.
The right hon. Gentleman has asked the Department of Health to conduct a review of the prescription of drugs for the treatment of ADHD, working with families, teachers, medical and mental health professionals. It is, however, for NICE, as an independent organisation, and not for the Department of Health, to review the evidence and to provide national clinical guidance. Between 30 August and 12 September, NICE consulted stakeholders on whether to update its 2008 clinical guidelines. The review is a thorough assessment of the ways in which evidence on ADHD, including pharmacological treatments, has since developed. It will announce a final decision on its review shortly.
In June 2007, the UK led a European review of the risks and benefits of Ritalin and sought advice from independent scientific advisory groups on the available evidence. As a result of that review, the prescribing guidance for patients has been updated to ensure that it contains clear, comprehensive information about the effects of Ritalin and the importance of monitoring children and adolescents throughout their treatment. The safety of Ritalin remains under close review. In addition, the findings of research continue to inform the field and a number of bodies may commission such research, including the National Institute for Health Research. The Government are committed to improving mental health outcomes and have laid down important principles for the future in the strategy, “No health without mental health”, published earlier this year.
The emotional well-being and mental health of children and young people are vital to them as individuals, to their families and to wider society. A principle of the Government's mental health outcomes strategy is the importance of prevention and early evidence-based intervention. Half of those with lifelong mental health problems first experience symptoms before the age of 14, and three quarters of them before their mid-20s. Indeed, today, the Minister with responsibility for social care, my hon. Friend the Member for Sutton and Cheam, has announced £32 million of funding to improve access to psychological therapies for children and young people over the next four years.
Psychological therapies can in some cases form part of the holistic package of care that NICE recommended for children and young people with ADHD. It is important that a range of clinicians—paediatricians and GPs as well as child and adolescent mental health service professionals—are well informed on the diagnosis and treatment of mental health problems in children and young people. I am pleased to tell the right hon. Gentleman that the chief medical officer and the NHS medical director plan to write to clinicians to remind them of the full range of NICE guidelines on conditions—including ADHD—that affect children's mental health. They will highlight the opportunities to support rigorous use of evidence-based treatment through the improving access to psychological therapies programme. High-quality, evidence-based treatment is central to our programme to transform mental health services for children.
The right hon. Gentleman referred to DSM-V. This point goes much wider than ADHD alone and touches on the appropriateness of diagnostic categories that are the subject of international professional consensus through the American Psychiatric Association and through the World Health Organisation. The Association of Educational Psychologists and other concerned professional organisations might wish to make their representations on this issue through the American Psychiatric Association and the World Health Organisation.
The right hon. Gentleman asked what the Government’s response would be, but it is not the responsibility of the Department of Health to respond. The professional bodies respond and reach a broad, scientific consensus on the way forward.
I fully appreciate the concerns of those worried by the increasing number of prescriptions for Ritalin and similar drugs. We are investigating whether further helpful information can be derived from prescribing research databases. It is of course for NICE, not the Department, to review the broader evidence and to consider the case for updating the existing clinical guidelines. That is what it has been doing and we await its conclusion. Furthermore, the NICE clinical guidelines on ADHD state that drug treatment for children and young people with ADHD
“should always form part of a comprehensive treatment plan that includes psychological, behavioural and educational advice and interventions.”
The NICE guidelines do not replace the clinical judgment needed to treat individual cases, but health care professionals are expected to consider fully the guidelines alongside professional consensus when exercising their clinical judgment.