Oral Answers to Questions
Debate between Simon Burns and Julian Smith(12 years, 5 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Julian Smith (Skipton and Ripon) (Con)
T6. What progress has been made in discussions with primary care trusts on the transfer of assets to NHS Property Services Ltd?
The Minister of State, Department of Health (Mr Simon Burns)
The Department is currently reviewing updated lists of properties for proposed transfer. Thereafter, the boards of the sending and receiving organisations will endorse the transfers and give their final approval in the next few weeks to allow the legal transfer process and human resources consultations to commence. The legal transfer of assets to either NHS providers or NHS Property Services Ltd will take place on 31 March 2013.
Congenital Cardiac Services for Children
Debate between Simon Burns and Julian Smith(13 years, 5 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Burns
I fully appreciate the hon. Gentleman’s point, but I hope that he will appreciate that he is now trying to draw me into a discussion on the merits of Leeds as against Newcastle. As I said earlier, it is inappropriate for me as a Minister to do that. However, it is a point that the hon. Gentleman, my hon. Friend the Member for Pudsey and others can make more than adequately to the joint committee, which will be able to determine the merits of the argument prior to reaching a decision. I urge the hon. Gentleman to understand how inappropriate it would be for me to go down the route of arguing the merits or demerits of one area or another.
Smaller centres struggle to train and mentor junior surgeons, making these units less attractive to the senior surgeons of tomorrow and making it difficult to provide a safe 24-hour service. We must ensure that our surgeons and their teams are well supported. They need opportunities to develop their experience as they become increasingly expert in these intricate and complex procedures. We must ensure that all the hospitals that provide heart surgery for children can also provide care within safe medical rotas.
No parent would wish the care of their child to be entrusted to a surgeon who, though an excellent doctor, is overly tired because they have had to work around the clock without any peer support. This means that to reduce the risk of surgery in sick children and to improve their long-term outcomes, we must focus our surgical expertise in larger centres. The need has become ever more pressing with the increasing complexity of treatment.
As hon. Members will know, the national review is known as the Safe and Sustainable review. Its aim is to ensure that children’s heart services deliver the very highest standard of care. The NHS must use its skills and resources collectively to gain the best outcomes for patients. As I stated at the beginning of my speech, in line with the Government’s entire approach to the NHS, this review is both independent and clinically led. May I reassure hon. Members that the objective of the review is not to close children’s heart centres? Far from it. While surgery may cease in some centres, they will continue to provide specialist, non-interventional services for their local population.
Indeed, the review proposes to extend local care further, supported by the professional associations that support the increased clinical expertise across England. This wider support is crucial. Surgery is usually a single, short episode in what is often a lifelong relationship with specialist congenital heart services. The aim is to improve those services as a whole and to ensure that as much non-surgical care as possible is delivered as close to the child’s home as possible through the development of local congenital heart networks. These will enable children to be safely and expertly cared for nearer to home in the longer term.
Given the complexity of the issues for consideration, the NHS has held a four-month, rather than the usual three-month, consultation. Hon. Members should be reassured that the consultation process has been impressive in its scope, inclusiveness and transparency.
Julian Smith
I thank the Minister. Will he comment on the lack of translation of certain consultation documents, which has affected many communities, particularly in and around the Leeds area?
Mr Burns
I am grateful to my hon. Friend for raising that issue, and I will address it later in my speech.
No decision has yet been made about which centres should continue to undertake surgery. That decision will be made only after the responses to the consultation have been properly and fully considered. The chair of the joint committee of primary care trusts, Sir Neil McKay, has made it clear that it is a genuine consultation and that all viable proposals will be considered, and I agree with that. There has been no pre-determination of the number of centres that will be selected. Rather, the review remains flexible and open-minded as to the final number and is happy to listen to all options that would produce the excellent clinical outcomes for our children that we desire.
As I have said however, this review is being driven by a powerful clinical imperative. The trend in children’s heart care is towards increasingly complex surgery on ever-smaller babies. That requires surgical teams that are large enough to provide sufficient exposure to complex cases, so that surgeons and their teams can maintain and develop their specialist skills. Larger teams also provide the capacity to train and mentor the next generation of surgeons. In recent years, other countries have recognised the clinical necessity of larger surgical units and have reconfigured their services along the lines proposed by the Safe and Sustainable proposals. Here in the United Kingdom, there are successful precedents for centralisation. In the past 15 years, the congenital cardiac services in Cardiff and Edinburgh have ceased heart surgery on children, as they recognised that their centres were just too small to be sustainable.
I also want to reassure Members about the integrity of the process that was followed in developing the options for consultation. In the past, concerns have been put to me in this House about mistakes in the assessment process, particularly relating to the Leeds service, and Members have referred to that again today. I understand that since our last debate in February or March of this year the chair of the joint committee, Sir Neil McKay, has written to the chief executive of the trust in Leeds to explain why mistakes have not been made in relation to the Leeds centre.
Members, including my hon. Friend the Member for Skipton and Ripon (Julian Smith) in his recent intervention, have also raised the issue of documents not being made available in a sufficiently wide range of languages, thereby excluding those who speak those languages from the consultation process. The relevant documents have for several weeks been available in 10 different languages, including Urdu, Arabic, Farsi and Punjabi. [Interruption.] The hon. Member for Leicester West (Liz Kendall) shakes her head, but I assure her that they have been available for several weeks, although I accept that they were not available from the first day of the review. That may be the point the hon. Lady was seeking to make, and I agree with her if she thinks they should have been from the first day. We cannot change the fact that they were not available from then, however, but they have been available from, I believe, 20 May, and the consultation process runs until 1 July, which gives sufficient time for people who need to access the documents in those languages to do so and to be able to input their views.
I hope to be able to reassure my hon. Friend the Member for Isle of Wight (Mr Turner) on retrieval times and access times from the Isle of Wight, given its unique geographical situation. It is my understanding that the joint committee of primary care trusts has agreed that Southampton University Hospitals NHS Trust has provided evidence on this issue that requires further consideration and has invited the trust to develop a detailed case regarding retrievals from the Isle of Wight, which the committee will consider as part of the evidence to determine the optimum reconfiguration.
Several Members raised the issue of the inclusion of black and minority ethnic communities in the consultation process. There have been a number of workshops and focus groups, many of which have been aimed specifically at the BME communities. Almost 2,000 community groups and organisations that have an interest in BME issues have been contacted and invited to take part in the proceedings. Public meetings have been arranged, particularly in Leeds, specifically for the Asian population of Yorkshire in partnership with representatives of local BME groups. The Leeds meeting is on 29 June, there is a meeting planned for Bradford on 30 June and a further meeting is planned for Kirklees. I hope that hon. Members who represent parts of Yorkshire and the surrounding catchment areas will be assured by that.
To abide by your rules, Mr Deputy Speaker, I will now conclude by saying that I am confident about the consultation. Everyone will accept that all consultations of this nature can be difficult, when tough decisions have to be taken. The decisions have to be taken for the right reasons, based on clinical evidence about the best way to improve and enhance care and the quality of care for patients. That is particularly true in this case because more often than not the patients are very young children with very complex needs—that is what makes this issue so difficult.
Let me reiterate that no decisions have been taken or will be taken until the joint committee has had an opportunity to consider the independent analysis of the consultation responses, reports from any local overview and scrutiny committees and a health impact assessment. Throughout, it will remain open-minded and flexible as to the number of centres. The only important consideration will be the sustainability of clinical excellence at the centres chosen. I doubt whether this is the case, but if any hon. Members have not taken part in the consultation I urge them to do so. I also urge them to ensure that their constituents and organisations in their constituencies with an interest in this matter take part in the consultation if they have not already done so, so that the committee can have the widest range of views, information and opinion before reaching what will, in any circumstances, be difficult decisions.
Children's Heart Surgery (Leeds)
Debate between Simon Burns and Julian Smith(13 years, 8 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Minister of State, Department of Health (Mr Simon Burns)
I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on securing this important debate. It is a strong reflection of hon. Members’ commitment not only to their local health service but to the Leeds hospital and its facilities and services that so many are present. I am particularly pleased to see my hon. Friends the Members for Harrogate and Knaresborough (Andrew Jones), for Elmet and Rothwell (Alec Shelbrooke), for Skipton and Ripon (Julian Smith), for York Outer (Julian Sturdy) and for Calder Valley (Craig Whittaker). I am also pleased to have heard from the right hon. Member for Leeds Central (Hilary Benn) and to see the hon. Member for Scunthorpe (Nic Dakin) here. Their presence reinforces their commitment to their local health service and the facilities in the local hospital.
Let me take this opportunity to pay tribute to the dedicated NHS staff who work in children’s heart services in Leeds and across the country. They do a fantastic job for which we are all incredibly grateful.
As I know my hon. Friends and Opposition Members will appreciate, this is a complex and, understandably, highly emotive area, but it is worth reminding ourselves of the genesis of this review. For years, experts in the field, including professionals and national children’s charities, have urged the NHS to review services for children with congenital heart disease.
Although there has been no specific problem, concerns have been raised about the risks posed by the unsustainable and sub-optimal nature of smaller surgical centres. Experts agree that, with small centres, there are issues with the recruitment and retention of surgeons and that there is a risk that those who are recruited find themselves working in isolation in units that are not up to date with modern techniques and clinical practice. Smaller centres struggle to train and mentor junior surgeons, making such units less attractive to the surgeons of tomorrow.
The provision of children’s heart surgery has been a cause of concern since the Bristol inquiry in the late 1980s. Understandably, there has been considerable pressure from national parent groups to ensure that children receive the best treatment. The Monro report in 2003 set out standards of care and pointed to the need for reconfiguration to concentrate expertise. That need has become ever-more pressing with the increasing complexity of treatment.
In the light of clinical concern in June 2006, Roger Boyle, the national clinical director for heart disease and stroke, and Sheila Shribman, the national clinical director for children, young people and maternity, chaired a consensus workshop of service providers, specialised service commissioners and relevant parent groups. The unanimous view was that there should be fewer, larger centres of excellence. The workshop concluded that the current service configuration was not sustainable and that a long-term national view of how services might be reorganised should be developed.
In 2008, the NHS medical director, Sir Bruce Keogh —a heart surgeon—asked the national specialised commissioning group to explore how the reconfiguration of children’s heart surgery services in England could improve the sustainability of the current service and lead to better clinical outcomes for children. The national review, known as “Safe and Sustainable”, aims to ensure that children’s heart services deliver the highest standard of care regardless of where patients live or which hospital provides the care.
I must emphasise that the review is clinically-led and that both it and the case for change are supported by parent and patient groups and by clinicians working in the service and their professional associations, including the Children’s Heart Federation, the British Heart Foundation, the Royal College of Surgeons, the Royal College of Paediatrics and Child Health, the Royal College of Nursing, the British Congenital Cardiac Association and the Society for Cardiothoracic Surgery in Great Britain.
Julian Smith
Does the Minister agree that, as well as the importance of the clinical need, distance is vital and that the points made in the debate for this most rural and sparsely populated area of our country must be taken into account in the decision?
Mr Burns
Distance is one of a number of factors that, of course, will be considered by those people who are involved in the consultation process, although I advise my hon. Friend that some of the organisations involved in such medicine have certainly told me—I have met some of them personally—that many parents think not so much about the distance that must be travelled as about getting the best treatment for their children. They are prepared to travel further to secure that fine treatment for their children than we may think from what our constituents who want to have district general hospital treatments tell us. The question of distance must be put into perspective, and it is not an overriding factor that secures any decision one way or another solely on that basis.
Julian Smith
I thank the Minister for giving way yet again. Given that PCTs are in the last phase of their lives, does he agree that it is concerning that PCTs, whose eyes may not totally be on the ball, are making this critical decision?
Mr Burns
I can see where my hon. Friend is coming from and I appreciate that he may have concerns. I hope that I can give him the reassurance that he seeks. I do not think that PCTs are in a situation where they have not got their eyes completely on the ball. First, from all the evidence that I see, day in, day out, of the work of PCTs up and down the country, they continue to be highly professional and to do a first-class job. Secondly, the date when PCTs will cease to exist because of the modernisation of the NHS is not so close that they will not be able to fulfil their functions properly. I have every confidence in the JCPCT doing a first-class job of carrying out the consultation and reaching its conclusions in a highly professional and acceptable way. I hope that reassures my hon. Friend.
Clostridium Difficile
Debate between Simon Burns and Julian Smith(14 years ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Minister of State, Department of Health (Mr Simon Burns)
I congratulate my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) on securing this debate on C. difficile. He has shown a strong interest in this issue for a very long period. Let me make it clear that the NHS should aim for a zero-tolerance approach to all health care-associated infections. I hope that what I say in my speech tonight will reassure my hon. Friend that we as a Government regard C. difficile as a priority and we will use all the levers at our disposal to support further significant progress in reducing this problem in our hospitals, care homes and other health facilities.
For most of the last decade, we saw unchecked increases in the number of MRSA and C. difficile infections, causing misery for thousands of patients and their families. However, in more recent years, the NHS has improved its infection prevention and control practices, which has led to a significant reduction in both C. difficile and MRSA bloodstream infections. I should like to take this opportunity to congratulate all NHS staff who were involved in turning the tide for their hard work in achieving that. From a high of around 56,000 infections in 2006, C. difficile infection has fallen to just over 25,000 in 2009-10. From almost 8,000 infections in 2004, numbers of MRSA have also fallen substantially to fewer than 2,000 in 2009-10. However, despite the progress that we have made, we can go further.
Mr Burns
I would be grateful if my hon. Friend allowed me not to, because I have very little time in which to say a lot in answer to the questions from my hon. Friend the Member for Enfield, Southgate.
Despite the progress made, we can go a lot further to reduce infections, particularly of C. difficile. The previous Government’s approach was to introduce a rather crude national target for reducing infection rates that placed no specific obligation on individual organisations to improve their prevention and control systems or to reduce their own infection rates. We therefore find ourselves in a situation where, despite significant reductions at a national level, many organisations have made little or no improvement on their position years ago. The job of controlling C. difficile infections in the NHS is far from complete, and the NHS, in both secondary and primary care, must continue to prioritise reducing these infections. We will expose those poor-performing organisations that were able to ride on the coat tails of others, and force them to put their house in order.
My hon. Friend asked about monitoring care homes. I can assure him that, as part of our commitment to a whole-health economy approach to infection prevention and control, last month the adult social care sector became subject to the code of practice on the prevention and control of infections. Adherence to the code is a statutory requirement, and we expect to see improvements in infection prevention and control practice in the social care sector as a result of its introduction, in the same way as has happened in hospital settings. In addition, we have strengthened Care Quality Commission powers to ensure that, where required, appropriate action can be taken to address poor practice. Care homes should report single cases of suspected C. difficile to the resident’s general practitioner, and a suspected outbreak should be reported to the local health protection unit. I am confident that this additional strengthening of the measures will go some way to help reduce the problem in care homes.
The Government expect the NHS and social care organisations to take a zero tolerance approach to health care-associated infections, as I said at the beginning of my remarks. When patients have the relevant information, they can be the most powerful agents for change. In line with this, one of the first things we did was to publish weekly MRSA and C. difficile infection numbers by hospital, and the data are now available within weeks rather than months, giving a far more accurate picture of what is happening at a particular hospital. Patients can now clearly see and take account of this when choosing where to have their treatment.
My hon. Friend asked about making more information available. I can reassure him that one of the key parts of the White Paper on health reform in the NHS is on empowering patients by providing even more information relevant to them from independent sources. That means it will be reliable and accurate. It will also be provided in a way that is easily understandable, so that patients can see the areas of health care—in whatever shape or form—that are of particular interest to them. I would encourage anyone to respond to the consultation on the information revolution document that my right hon. Friend the Secretary of State published recently, so that we can consider all views on how to get this right and empower patients with information.
We also made it clear in the coalition agreement that we will use quality outcome measures, including HCAIs, to drive improvements in the areas that really matter to patients. In the near future, I want all organisations to be operating at the level of the best today. The challenge, therefore, will be greatest for those who have so far made the least progress. We have also decided to extend mandatory surveillance beyond MRSA and C. difficile, to provide a fuller picture of HCAIs within the NHS, which the previous Government resisted. As my right hon. Friend the Secretary of State announced last month, we will extend mandatory surveillance to include MSSA—meticillin-sensitive staphylococcus aureus—with infections such as E. coli to follow in due course, based on expert advice.
I know that my hon. Friend the Member for Enfield, Southgate has a strong interest in the different settings where C. difficile infections occur. For some years, such infections were essentially seen as a hospital problem, with hospitals being the focus for both central and local efforts to tackle them. However, that focus is not sufficient, as he mentioned. An unfortunate outcome of the previous focus on hospital-acquired C. difficile infections is a lack of awareness of the risks in primary care. Although we have seen substantial decreases in C. difficile infections in acute trusts, those occurring in primary care trusts—referred to as community-associated infections—have decreased at a far slower rate.
The origin of community-associated cases is not clear and needs further investigation. A significant proportion may be due to previous contact with previous health care facilities. In other cases there may have been no known links to health care, while others may be associated with antibiotic treatment in the community by GPs. GPs have a vital role to play in reducing the inappropriate use of broad spectrum antibiotics—those that attack a wide range of bacteria, but which can increase the risk of contracting C. difficile. GPs need to consider C. difficile when prescribing antibiotics, particularly to at-risk groups such as those who have recently been discharged from hospital or the elderly, as my hon. Friend rightly mentioned. Because such antibiotics can increase the risk of contracting C. difficile, prudent antibiotic prescribing is key. Although only a small number of C. difficile infections emanate from general practice, this is not an excuse to do nothing—not when the impact on individuals can be so great.
We will increase GPs’ awareness of the impact of antibiotic prescribing on contracting C. difficile infections and increasing antibiotic resistance. As part of that, we will use antibiotic awareness day on 18 November to focus attention on the need to reduce the unnecessary use of antibiotics. As my hon. Friend showed in his speech, we have produced leaflets and other materials that GPs, pharmacists and other professionals can use to raise the issue with patients and the public. Those materials make it clear that everyone has a role in improving prescribing and patient outcomes. To improve the evidence base, we are considering how to improve the monitoring of community associated cases. That links into our concern about the large number of readmissions to hospital within 30 days of discharge, which my hon. Friend also mentioned. The action that my right hon. Friend the Secretary of State took in the summer to alleviate the problem will, I believe, go a long way towards helping to find a solution to it.
Let me now turn to some of the questions that my hon. Friends have asked in this debate. I am grateful to my hon. Friends the Members for Watford (Richard Harrington) and for Enfield North (Nick de Bois) for drawing to my attention the equipment, which came from America, that is currently being tested in Northwick Park hospital. As they may be aware, the Department has established a mechanism, known as the rapid review panel, by which new products can be evaluated for their effectiveness against infections. As they said, the equipment is currently being tested at Northwick Park hospital. We await with interest the results of those tests, to see whether the equipment would be useful in the constant battle against such infections.
My hon. Friend the Member for Enfield, Southgate also asked what more the Government could do to ensure that GPs are fully briefed on C. difficile and respond to such knowledge efficiently and consistently. As I mentioned with social care, the forthcoming application of the code of practice to primary care will give a significant boost to improving GPs’ awareness and knowledge of infection prevention and control. We will publish the code shortly, and although primary care will not be subject to the requirements of the legislation until April 2012, the registration process with the Care Quality Commission will start much earlier, with all the benefits that this will secure, through increased focus and awareness. I trust that that will go some way towards reassuring my hon. Friend.
My hon. Friend also spoke about requiring hospitals to provide information to patients leaving their care. As he said, Graziella, with the Department of Health, has produced a leaflet on C. difficile, which he has seen. The best way to protect patients against the infection spreading is to provide them with information. The intention is to give the document to patients so that they are aware of the risks, and know how to prevent other vulnerable people from catching the infection. However, although both she and I would like the leaflet to be distributed by every hospital and GP, there is no requirement for that, and many patients are sent home without the information that they need to protect themselves.
We believe, as does my hon. Friend, that it is important for patients to have access to information. I certainly expect hospitals to provide that information to all relevant patients on their discharge. It is important to ensure that such leaflets are available for the NHS to use, and copies are available on the Department’s Clean, Safe Care website, but we must be careful not to be prescriptive on decisions about patients’ care that are best made at local level. I trust that many practitioners and hospitals at local level will recognise the importance of the leaflets and ensure that patients have them drawn to their attention.
Time is running out, and on the questions to which I have not had the opportunity of replying I will write to my hon. Friend so that he receives answers. I say again that we treat the matter seriously, and in the short time remaining I shall answer the final question about careful monitoring of patients in the community. Guidance, entitled “Clostridium difficile infection: how to deal with the problem”, has been published by the Department of Health and the Health Protection Agency, and provides evidence-based advice on how to treat C. difficile. We will take the opportunity in the forthcoming publication of the code to reiterate the value of that to GPs in their decision making, and I hope that my hon. Friend will find that reassuring and helpful.
When patients enter a health care setting, they expect to be taken care of and to be made better, not to contract a potentially fatal infection. I hope that I have reassured my hon. Friend that the Government share his deep concern and are determined to see significant progress in reducing C. difficile infections further.
Question put and agreed to.