Health
The Secretary of State was asked—
Community Children’s Nurses
Developing high-quality community children’s nursing services is crucial to the provision of safe, integrated and comprehensive care in the home or close to home for children with complex or continuing care needs. We are embarking on a wide-ranging programme of action dedicated to transforming community services. Within this programme, we are taking forward a project looking at the benefits and the opportunities arising from investment in community children’s nursing services.
I know that the Minister is aware that a reception was held in the House earlier this month that was sponsored by the Royal College of Nursing, of which the Minister was a member, and the WellChild charity, which was intended to encourage primary care trusts to employ community children’s nurses in order to help not only children with long-term complex health needs, but their families. Will the Minister tell me what steps the Government are taking to ensure that these nurses are employed, as they will help children and their families to co-ordinate packages of not only medical but local care, which might help them to spend more time at home rather than commuting to hospital on a regular basis, as this is often painful to them?
I congratulate the Royal College of Nursing and WellChild on holding that reception, which highlighted some very important issues; as the hon. Gentleman said, we were both present. Government funding of £340 million established through our recent child health strategy will help local areas to support the development of more care packages in the location preferred by the child and family. To provide the safe, comprehensive and sometimes highly complex packages of care that these children need takes time to co-ordinate. There are no quick fixes, as was highlighted at the reception. In many cases, delays are caused by the time taken to resolve issues such as housing and adaptations rather than the lack of community nurses, but we are committed to the work force and to the planning of community children’s services. I believe that this area will be addressed in the Prime Minister’s commission on the future of nursing and midwifery.
Will the funding allocated to primary care trusts for community children’s nurses be ring-fenced? As we often see with PCTs, if the money is not ring-fenced, it can sometimes be diverted to other priorities. How will the nurses work and interact with the local authority, which often provides the child’s basic care needs in terms of getting the child up, ready and dressed?
As I was saying, the complexity of the package is very evident, so we have to co-ordinate not only with local authorities, but with other agencies. Commissioners need to consider how the new funding established through the recent child health strategy can enable the development of children’s community nursing services capable of providing a more all-round care package, including palliative care and, sadly, sometimes end-of-life care in the home or closer to home. It is for the commissioners to decide within the local community how best to manage those funds.
NHS Services (Economic Downturn)
The evidence from Britain and other countries is that demand for health services increases in an economic downturn. However, thanks to funding already agreed for the period to 2011, we believe that the NHS is in a strong position to manage this well.
As more and more families pull out of private health care, what pressure is the Minister seeing on primary care providers, and what assessment has he made of how well they are able to cope?
It is quite difficult to get reliable figures on how many people withdraw from private health care, as it is obviously a matter for the private sector itself. A few months ago, Laing and Buisson said—the hon. Gentleman may have picked it up—that there has been a 10 per cent. reduction in people deciding to pay privately for their operations, but that actually preceded the economic downturn. Laing and Buisson believes that it has more to do with the very short waiting times on the NHS: there is now almost no difference at all between waiting times in the NHS and waiting times in the private sector. We are confident that, given the increase in investment that the NHS will receive over the next two years, even if all the people in this country choose to use NHS care—I hope that they would like to do so, given the short waiting times—the NHS will be able to cope very well.
My hon. Friend will be aware of the problems that Brent primary care trust was facing a couple of years ago with a £25 million deficit, so will he join me in congratulating Brent for turning that deficit into a projected £12 million surplus this year, which means that more services are now being directed to the right people in my local area?
My hon. Friend is absolutely right that two or three years ago, Brent PCT was in a parlous state. In fact, as recently as three years ago, 104 NHS organisations were in deficit, whereas now the figure is just 3 per cent. There has been a remarkable turnaround, so I would like to pay tribute not only to the management of the PCT in my hon. Friend’s area—as he rightly says, the PCT will now be able to deliver sustainable and constantly improving NHS services to his constituents—but to all the managers throughout the country who have turned around their health care organisations in such a way.
Many of my constituents are very worried about the possibility that the proposed redevelopment of Hinckley and Bosworth community hospital will not go ahead because of the economic downturn. Will the Minister please look into the proposed public-private partnership, hold discussions with Leicestershire County and Rutland primary care trust, and then write to me?
I shall be happy to do that. It is worth mentioning that a week or two ago our ministerial colleagues in the Treasury made an important announcement about the PFI which I hope will prevent the outcome at the hospital that the hon. Gentleman fears, but I will happily write to him to confirm that.
My hon. Friend is aware of the effects of the economic downturn and the pressures that it has placed on the NHS, but is he aware that those effects are nowhere more evident than in the mental health service? People really do suffer, and we always feel that the mental health service is underfunded. Will my hon. Friend ensure that more resources will be provided if they are required, given that there will certainly be further pressure on the service in the future?
Yes. Labour Members certainly do not agree with the Conservatives that a recession is good for people’s health. We know from experience both in this country and abroad that when it comes to such issues as mental health, more men consult their GPs if they are unemployed. That can be an advantage, as men are notoriously reluctant to seek health care and advice. However, as my hon. Friend will know, mental health funding has risen by 40 per cent. in real terms in the last seven years. We do not think that the recession should just take its course, we do not think that it is a price worth paying, and we will be there to ensure that the NHS supports people who may be affected by the economic downturn.
If demand for the NHS is increasing during the economic downturn, it is even more vital for hospitals that have lost money in collapsed Icelandic banks to get that money back. Given the Prime Minister’s recent comments in Manchester about Christie hospital’s missing £7.5 million, what is the Department doing to ensure that Christie gets its money back?
We are working closely with both Christie and the other hospital that has money in Icelandic banks. We are also working to ensure that all charities that are eligible claimants under the Financial Services Compensation Scheme receive their money in full.
My hon. Friend is absolutely right to say that it is wrong to suggest that a recession is good for people, particularly an economic downturn of this kind. Can he assure us that he will continue to focus investment on public services such as the NHS, and will not be diverted into cutting taxes such as inheritance tax?
Yes. I think that we will face a clear choice at the next general election, between a Labour Government who are committed to continuing sustained investment in the NHS and a Conservative party which is committed to a tax cut for millionaires.
National Dementia Strategy
The first national dementia strategy was published on 3 February this year, and will be implemented over a five-year period. Improving services for people with dementia is a Government priority, and we have already identified it as a priority for the national health service in the operating framework. That will help to ensure that dementia is prioritised locally where further improvement may be needed.
The London borough of Bromley contains the highest percentage of retired people in London. What can I tell my constituents about the quality of the services that they can expect, and whether those services will be delivered through GP centres?
The national dementia strategy covers a range of services, but it emphasises the importance of early diagnosis. We intend every area in the country—including the hon. Lady’s constituency—to contain memory clinics, to which suitably trained GPs will refer people who show early symptoms of dementia. There they can be given an accurate diagnosis and assessment—as there are different forms of dementia—and then receive the specialist help and intervention that they require. We know that early intervention enables us to help people with dementia and their carers, and to ensure that people live much better with their dementia and stay in their own homes for longer.
The Minister is well aware that objective 13 of the national dementia strategy is to provide
“An informed and effective workforce for people with dementia”.
He also knows that two thirds of the care home population has a form of dementia. Does he agree that it will be important to provide training for the entire work force in the care home and, indeed, the home care setting? When the all-party group, which I chair, has completed its inquiry into work force skills in this area, will he meet me to discuss the inquiry’s conclusions and consider how they might be included in the implementation of the strategy?
The hon. Gentleman, as chair of the all-party parliamentary group, and I have met regularly. He and the all-party group have made their welcome for the new dementia strategy public, and I am grateful for that. I would be happy to meet him once his group has concluded its investigation into trainees. It is right that we need to ensure that people, whether in hospitals—nurses and doctors—or in care homes, have the right skills, knowledge and understanding of the needs of people with dementia and their carers. That is why the dementia strategy states that a senior member of the hospital or care home should be responsible for ensuring that all staff in the hospital or care home know and understand the needs of people with dementia, so that they can ensure that the response that people get is the best response to meet their needs. It is certainly a matter for both the NHS and social care sector that staff be properly trained. We will publish our work force development strategy for the adult social work force in the near future.
May I place on the record the fact that I am a trustee of a local dementia charity in Brighton and Hove supporting those with dementia and their carers? I am sure that the Minister will recognise the vital role of those caring for people with dementia in their own homes and know how welcome has been the additional funding for breaks for carers. What steps will he take to ensure that primary care trusts make use of the money to support breaks for carers, which is not ring-fenced? For example, in Brighton and Hove I think that £800,000 is available over two years.
I congratulate my hon. Friend on the work that he does in his constituency in support of people in need of social care and in support of people with dementia. He is right to draw attention to the fact that the best care we can give to people is in their own homes, where people are with their family, neighbours and loved ones. Interventions that help that to happen for as long as possible are always in the best interests of the patient. What we need to include, of course, is support for the carers. Respite care is critical. He is right to say that more money has been provided for the next two years. It has been put into PCT baseline budgets. We have announced more money for carers through the carers strategy. I hope that not only in his constituency but throughout the country local organisations will ensure that that money is spent and that respite care is provided for those people who support people with dementia in their own homes.
What extra support can the Minister give to general practitioners to ensure that they detect the early signs of dementia, which is vital?
My hon. Friend raises an important point because two thirds of people do not have their diagnosis of dementia undertaken formally. Many people therefore do not get diagnosed until two and a half or three years after they have contracted that destructive disease. Therefore, it is important that front-line staff such as GPs are better trained to spot the early symptoms. If they are not a specialist themselves, and many of them are not, it is important that they refer people to the specialist memory clinics in their areas, which can conduct a proper diagnosis. It is not just about conveying the diagnosis but about the way in which that is communicated to people with dementia and to their family, which can be an important part of coping and living well with dementia. We are ensuring that training for GPs is increased, so that they can spot the signs early, people can be diagnosed earlier, there is earlier intervention to help people to live with dementia better, and that that is the outcome across the country.
There is much to be welcomed in the national dementia strategy and I again ask the Government to find time for Parliament fully to debate that important strategy. But there is one notable gap in the strategy: there is nothing to tackle the grossly inadequate level of research into the various conditions that come under the dementia umbrella. How is the Minister getting on with persuading his colleagues the Chancellor and the Prime Minister to up the research budget for dementia? I know that that is something that the Minister is concerned about, and he knows that he has everyone’s support on that.
If the hon. Gentleman wants to debate the strategy in the House, he can use the usual channels to arrange for such a debate on a Liberal Democrat Opposition day, but I am very happy to debate the strategy because it is an excellent strategy that has been welcomed across the country. The hon. Gentleman is right to highlight the importance of research. The truth is that we do not have a cure for dementia; that is part of the tragedy of this disease. There is research happening not just in this country, but around the world, to examine what more can be done. But this is not only about cure; it is also about research into what helps people who have dementia and how they can be assisted to live with dementia better in their own homes and be treated better in care homes or in the NHS. I will be chairing a summit in July, where we will be bringing together people from different parts of the country and, indeed, from different countries, to look at what the state of research is and to see where the gaps in the evidence base are and what more we can be doing to improve that evidence base, drawing on the best knowledge not only in this country, but from countries around the world.
I welcome my hon. Friend’s reply to the hon. Member for Rugby and Kenilworth (Jeremy Wright), who chairs the all-party group, and I look forward to meeting him to discuss the report. As well as looking at work force development, will he be looking at what the regulators can do in their assessment of care in homes and the community, and also of training, to drive up improvement in skills in dementia care?
I am grateful to my hon. Friend for raising the important point that, as well as providing better services, we need to make sure we have inspection systems and regulation systems that drive up the quality of care. She will know that on 1 April the care quality commission comes into being, which will integrate the three current inspection and regulation organisations. That will help to integrate health and social care for patients with dementia, and their loved ones and carers, to ensure we have an integrated system of inspection and regulation to raise standards right across the health and social care system for patients with dementia.
The Minister knows how warmly I welcome the strategy, because he was good enough to meet my constituent, Sir Terry Pratchett, along with the Prime Minister and myself, at No. 10 Downing street to discuss it. I must press the Minister, however; he has just said that he will hold a summit in July, and that is very welcome, but the Government have already announced that there will be no new money for research into dementia. How can he justify that decision?
We had a good meeting with the Prime Minister, who takes a personal interest in these matters and who met Terry Pratchett. I must put on record the huge courage Terry Pratchett is displaying in allowing everyone to see how he is coping with the disease—with the diagnosis and then with living with the early stages. Indeed, many public figures have now been talking about their experiences. That is an important part of the process of raising awareness among the professions and the wider community about this disease and its consequences, and how we can help people live with it. On research, the Wellcome Trust is spending £30 million this year and more money is going into research. We need to ensure that before the summit we have done an analysis of all the research that is going on, and where the evidence base is insufficient or has gaps in it, so that we can plan and direct our resources to those areas where research will be most effective.
NHS Chief Executives
At the current time, I am aware of one NHS trust chief executive and one NHS foundation trust chief executive who are suspended from work. Chief executives and other executive directors are employees of their trusts, and suspension is a matter for the trust, acting in accordance with individual employment contracts and general employment law.
I am grateful to my right hon. Friend for his answer. In Stafford’s case, where a thorough and damning report is already available, why has the chief executive not already been sacked? If the answer to that is that there is still due process to go through, what assurance can my right hon. Friend give me that it will be brought to an end soon, so that we can stop paying taxpayers’ money—that is hospital budget money—for someone who is doing nothing?
I am sure my hon. Friend will accept that there is no point in acting in haste and then finding there is a tribunal decision against the Government. We have to have due process. I want everyone’s case to be considered properly. I am very pleased that the trust has called in Peter Garland, a former senior official and regional director in the health service, to help it with the investigation and to look not just at the chief executive, but at the responsibility of the whole board for the dreadful events that were catalogued in the Healthcare Commission report.
Will the Secretary of State take account of the fact that I am repeating my call for an inquiry into this whole matter under the Inquiries Act 2005? Will he also make it clear that all those in that trust who are culpable, as set out in the Healthcare Commission report—that includes other senior management besides the chairman and the chief executive at the time—must be removed and not merely suspended on full pay?
As I just said, the investigation will involve everyone who has any position of authority within that trust—the whole board and all the executive directors. It will be a proper investigation and it will be fair, and the action taken will result from that inquiry, not from any knee-jerk reaction by me or anyone else.
Will my right hon. Friend assure us that there is no suspension culture in the national health service? Would he like to hazard a guess as to how long the longest-serving suspended employee in the NHS has been suspended for? If not, could he please send me a note on that?
I do not believe that there is a culture of suspension in the NHS. There are 1.3 million staff in the NHS, and I cannot give my hon. Friend an answer on how many people have been suspended or what the longest period of suspension is. However, I shall see whether somebody can answer his quiz question and then drop him a line.
As I was in Northern Ireland on parliamentary business when the Secretary of State made his statement last week, may I make it plain that my constituents are acutely concerned about this report? We want to restore the confidence and trust that this hospital used to enjoy—it was a good hospital and it did have a good reputation. Would not the quickest way to do that be to have an expeditious public inquiry, so that all the facts and the reasons can come out and we can then go forward under a new regime?
I believe the phrase “expeditious public inquiry” is a contradiction in terms, but I accept what the hon. Gentleman said. Indeed, I was very moved by the contribution of the shadow Chief Whip, the right hon. Member for West Derbyshire (Mr. McLoughlin), at last week’s business questions—he pointed out that his mother had died in that hospital, having received excellent care. We have to ensure that the hon. Gentleman’s constituents and those of my hon. Friend the Member for Stafford (Mr. Kidney), and other people who use that hospital are reassured that what the Healthcare Commission has said, in terms, in its report—that there has been drastic improvement, not least because of a huge increase in staff; staffing was at the core of the problems—is indeed the case. That is why I have asked Professor Alberti to make a very swift report and to report back to Parliament in five weeks’ time.
Whenever the chief executive of a failing trust, such as the Mid Staffordshire NHS Foundation Trust, is suspended it raises questions about where responsibility really lies. Is not the Patients Association right to repeat the demand for an independent inquiry, looking particularly at the regulation and supervision of hospital care? Is that not particularly the case in the light of the letter in The Times today from Dr. Howard Baderman, a retired accident and emergency consultant who wrote two reports for the Department of Health? He talks of a “grave failure” by the Department to act on those reports in respect of other hospitals. Do we not owe it to NHS patients to ensure that all the lessons are learnt from this dreadful scandal?
We do need to learn all the lessons, but I point out to the hon. Gentleman that there was no independent regulator until we introduced one—the important word there is “independent”. The Healthcare Commission report is independent. The letter in The Times this morning is strongly disputed, not just by the strategic health authority, but by people in the Department of Health who worked with the person who wrote that letter. We put patient safety first—we put it at the forefront of everything. I believe that the Patients Association will be reassured, not just with the Healthcare Commission report but with the three other reviews that are going on, and with the clear demonstrable fact that there is a very clear focus on finding out what happened at Stafford and why it happened—there is still an awful mystery to much of that—and on ensuring that we put the problems right, so that local residents can be assured that they have a safe hospital.
How can my right hon. Friend ensure that any sacked chief executives, including the one at Stafford, do not receive financial benefits from their failures through some sort of golden pay-off?
In 2007, we issued instructions through the NHS Chief Executive, reminding trusts that if they plan to give any financial reward, payment or golden goodbye to any departing chief executive or anyone else, it requires approval from the strategic health authority and the Treasury. As far as I know, no one in those two organisations would give anything other than the statutory entitlement to individuals, because the Government—and, I think, the Opposition—do not want to see any reward for failure, which has been so apparent in other sectors of the economy, creeping into the health service.
On 15 October 2007, after the terrible events at Maidstone and Tunbridge Wells NHS Trust, the Secretary of State said that
“we should be spotting these issues much earlier and getting rid of incompetent chief executives or chairpersons who, fortunately, are in the minority, rather than waiting for a report such as this, by which time, frankly, most of the damage has been done.”—[Official Report, 15 October 2007; Vol. 464, c. 571.]
The Secretary of State knew about the failings at Stafford in May 2008, so why did he not intervene then and there?
I ask the hon. Gentleman to look at the Healthcare Commission’s report carefully. The difference between what happened in Stafford and in Maidstone and Tunbridge Wells, and the fact that the Healthcare Commission took into account those words and what others said at the time, is that as soon as commission staff went into Stafford and saw the problems—in May 2008—they immediately called the chief executive to a meeting, put their concerns to him, and started to see the process of improvement. That is the job of the Healthcare Commission while it carries out its inquiry. The staff cannot say at that stage that they have come to any conclusions, and it would be unfair, one day into an inquiry, to reach conclusions and say that heads must roll and recommendations must be made. We made that specific point to the Healthcare Commission at the time of Maidstone and Tunbridge Wells, so in Stafford staff immediately introduced measures to put things right, rather than wait for the end of the process and the report to be published—as I said they should do in that quote.
I put it to the Secretary of State that he should look at the appendix to the Healthcare Commission’s report and the letter of 23 May 2008 that was received by his Department. If he meant anything by saying that incompetent chief executives should be got rid of at the point at which one becomes aware of them, it should have been done then, but the Department failed to do it. The Secretary of State has to understand that there was a failure, not just within the trust, but within the agencies charged with commissioning, performance management and performance assessment, up to and including the Department itself.
The Secretary of State’s proposed reviews—he now has three—do not have the scope, the powers or the independence to investigate those failures fully and, therefore, to restore public confidence. Will he agree today to institute an independent inquiry in the terms in respect of which I have written to him today?
We discussed this last week and there was no mention of an independent inquiry by the Opposition. The hon. Gentleman refers me to the appendix: let me refer him to the powers that the House gave to the Healthcare Commission. The commission could have immediately put that hospital into special measures. Its decision—as an independent regulator—was not to do so. It would have been quite wrong of Ministers to rush immediately to dismiss or discipline a chief executive when we did not even have any evidence from the Healthcare Commission. It had not reached any conclusion because it had spent only one day in the hospital.
Imagine a giant quango, the independent NHS board, trying to tackle these problems. The whole basis of the Opposition’s policy is to try to remove politicians from these issues. That is quite wrong, and we are right to deal with these issues in the way that we have.
Of course our thoughts and hearts are with those who have suffered because of the debacle at Stafford, but campaigners have drawn attention to many difficulties at the hospital over a very long period of time. The problem is that the board is stacked with accountants and solicitors who are not elected or responsible and who take no notice of what is going on. That is why we have ended up with what can only be called a tragedy. Will my right hon. Friend accept that the structures and targets in place for hospitals, such as looking for trust status and so on, distract them from delivering the care that they ought to be offering people?
I do not think that any neutral assessment of the Healthcare Commission report would conclude that the answer to the problem at Stafford would be to get rid of foundation trust status. However, my hon. Friend is right that the manager and the board at Stafford were seeking foundation trust status. To achieve that, incidentally, they had to put the trust into a proper financial position and save £4 million. They decided to save £12 million, and that is why there was one consultant and not four in the accident and emergency department, and why the hospital had three rather than 12 matrons. It is also why in the emergency assessment unit there was one nurse for every 15 patients, whereas most hospitals of that size have one for every six. Given that 85 per cent. of foundation trusts were considered to be excellent in their provision of services, it would be quite wrong to smear them with what happened in a badly managed and under-staffed hospital.
Children (Complex Health Needs)
The Government’s policy is to provide co-ordinated support as close to home as possible for children with complex health needs and their families. “Healthy Lives, Brighter Future: the strategy for children and young people's health”, which was published in February of this year, built on previous commitments.
While I welcome the child health strategy, what plans do the Government have to increase the number of health visitors to assist children with long-term, complex needs? I understand that the numbers of health visitors have been cut over the past four years, so when will they be back to 2005 levels? What plans does the Minister have to provide adequate respite care for parents and other children in the family?
I know that the hon. Lady follows these considerations very closely, and I commend her for that. She will know that the Government have committed extra finance, to a total of some £340 million over this spending cycle, through both the Department for Children, Schools and Families and the Department of Health. We have also made clear the future priorities for both the operating framework and the present structure. First, we need to address the issues of palliative care and short breaks. Secondly, we need to look at the clinical pathways and put in place individual care plans. That addresses precisely the point that the hon. Lady made about health visitors, for instance, and the complex needs of these young people. Finally, we must address the question of managing medicines in schools. Those three sets of priorities have been identified by parents, people in the voluntary sector and the young people themselves. [Interruption.] If the hon. Member for South Cambridgeshire (Mr. Lansley) would just stop talking from a sedentary position, I would be able to answer the question. The day that the Conservative party provides answers to anything will truly be a damascene conversion.
I return to the final point made by the hon. Member for Congleton (Ann Winterton) about health visitors. I can confirm that the work being taken forward by the Government in the spring of this year will concentrate on the valuable role that health visitors play in meeting the complex needs of these young people.
Does my right hon. Friend agree that, when we talk about improving the care provided for children with complex care needs, we should focus particularly on respite care and day care, for the parents as well as for the child? The press covers far too many cases of parents whose lives have come to tragic ends because of the enormous stress and strain associated with providing care, over a very long period indeed, for a child with the extensive disabilities that we often see. We need to focus on the parents as well, do we not?
I entirely agree with the points that my hon. Friend makes, which relate particularly to the work being done on end-of-life care, and specifically to the requirements on which primary care trusts have been asked to focus, with regard to short breaks, and palliative and end-of-life care, for very vulnerable young people and children.
One group of children and young people with complex health needs consists of those who require high-tech, expensive communication aids to express their hopes, needs, fears and interests. I welcome the proposed joint commissioning pathfinders, to which the Government have sensibly committed. Will the right hon. Lady confirm that they will be taken forward with all due haste, and that the Government will look at other aspects of joint commissioning, and models for the provision of alternative and augmentative communication for children who are desperately in need of it?
I commend the hon. Gentleman on his excellent report, the recommendations of which the Government accepted. I can confirm that we will act on the specific points relating to the individual, and the very important support and care that individuals may need. We will also look at his recommendations on wider issues to do with speech, language and communication, and so at the collaboration that needs to take place beyond the health service, particularly through local area agreements, to make sure that we deliver on the recommendations that he rightly made.
The Secretary of State pledged in his first speech as Health Secretary to meet the care needs of people with a learning disability, but in the light of today’s shocking findings by the ombudsman on the NHS’s failures in long-term care for young people with learning disabilities, when will the Minister of State and the Secretary of State convert the words of January’s strategy—itself an admission of the failure of the Government’s 2001 “Valuing People” document—into the action that is so urgently needed if we are to avoid a repeat of the shocking discrimination and damage suffered by those with learning disabilities?
I absolutely agree with the hon. Gentleman; the report is shocking. The Government are determined to make progress by accepting recommendations previously made to us, by concentrating specifically on care plans, and by working with GPs on identifying issues, early intervention and providing the correct support. The Minister of State, my hon. Friend the Member for Corby (Phil Hope), has today clearly indicated our determination to make sure that the very highest standards are available to all those who access our health services.
Mental Health Services
The level of funding for mental health has never been higher. Since 2001, real-terms investment in adult mental health services has increased by 44 per cent., and the national health service spent £5.53 billion on adult mental health services in 2007. We have 64 per cent. more consultant psychiatrists, 71 per cent. more clinical psychologists and 21 per cent. more mental health nurses than we had in 1997, and are providing better care and support for people with mental illnesses.
I thank the Minister for that answer. I have consulted locally with constituents about the NHS in our area, and in general the feedback has been very good. I visited an excellent, fabulous facility for young people with acute mental health needs that is attached to my local hospital, but constituents have raised with me the issue of community support for young people with mental health needs. What progress is being made to provide community support for those young people in the area, and what I can tell my constituents on the issue?
I had the pleasure of visiting my hon. Friend’s constituency a few weeks ago. Newham was in fact a national demonstrator site for the development of new psychological therapies and a whole range of new services, and I was extremely impressed by what I saw. I congratulate her on the work that she does in her constituency to support the development of those services. In Newham, 16 staff are part of an early intervention team that helps young people between the ages of 14 and 35 with assessment and care. In particular, it tries to prevent those young people from being admitted to hospital at the first onset of psychosis or some other form of mental illness. Those new early intervention teams—a major investment—are matched by other teams that handle crisis resolution in homes, and outreach in the community. I hope that when she goes back to her constituents in Newham, she will congratulate them on the pathfinding work that they are doing, and assure them that the NHS in her area is seeking to work with other providers to meet the needs of young people and others in the community.
The picture around the rest of the country may not be not quite so rosy. Figures show that the number of people admitted to hospital for intentional self-harm has increased by a third in the past five years, from 74,000 to 97,000. More than 4,000 of those admissions were of children under the age of 14. One in eight women admitted to self-harm in 2007, an 80 per cent. increase since 2000. Figures released by the National Society for the Prevention of Cruelty to Children yesterday show that the number of suicidal children ringing the helpline ChildLine has tripled in the past five years. Is the Minister not ashamed of these appalling figures and the Government’s failure to turn the tide on the country’s deteriorating mental health?
I understand the hon. Lady’s concerns; it just surprises me sometimes when Opposition Front-Bench spokespersons reel off a list of statistics without asking questions and, more importantly, without acknowledging the substantial extra investment that this Labour Government have put in place and which her party voted against in every Budget since 1997. The issues that she highlights are serious and need to be addressed. I am pleased that the suicide rate in England continues to fall. It is now at its lowest since records began in 1861, and is among the lowest in Europe. I am also pleased that the World Health Organisation said:
“The ambition and pace of change in England has been remarkable over the last 10 years, and mental health services here are increasingly being seen across Europe as a model to follow.”
That is a record that the Labour Government are proud of, but we know that there is more to do and we will continue to press forward to improve services across the country.
In his reply to my hon. Friend the Member for West Ham (Lyn Brown), my hon. Friend the Minister said that there had been a 70 per cent. increase in clinical psychology—I think the figure was 70 per cent.—but he will know, as I do, that that was from a pretty low base. Can he assure me that he will redouble his efforts to ensure increased numbers of clinical psychologists? Too often people who have been prescribed clinical psychology have to wait for it.
My hon. Friend is right to say that we inherited a pretty poor show from the Conservatives after they were in power for 18 years. We are endeavouring to increase the quality of mental health services. This year is the last year of the national service framework for mental health, and it is the year in which we intend to look forward to establishing a new strategy for mental health services. Building on the success that we have had so far, we will be launching our New Horizons project to go out to consultation to enable us to hear throughout the country what more we can do to embed success in our mental health services, and to go further to ensure that we have mentally healthy communities more widely so that the public health system, as well as specialist services, reach the quality of care that we wish every individual to be able to receive across the country.
NHS Dentists
I was assured by NHS South West and Gloucestershire primary care trust this morning that the PCT is in the process of inviting tenders for dental services with a total value of £6 million over the next two years—that is, £3 million in 2009-10 and £3 million in 2010-11. This investment will be used for building purpose-built practices as well as refurbishing community hospital sites to enable them to provide dental services, focusing on areas of most need in Gloucestershire. This investment has the potential to offer access to a dentist to approximately 95,000 people.
It is difficult to calculate how many people are registered with an NHS dentist since the new contract was established. Perhaps the Minister could give us some idea of how many people are registered in Gloucestershire and nationally. Registration is patchy. In my Tewkesbury constituency a relatively small number of people are registered with NHS dentists, even when compared to other constituencies in Gloucestershire and especially when the national figure is taken into account. What can the Minister do to help the local PCT to increase that number?
We have just announced the money, which will give access to an extra 95,000 people. I am sure that the hon. Gentleman would like to welcome that and congratulate the strategic health authority and primary care trust on the great leadership that they have shown on dental practice. I have been advised by the South West strategic health authority that Gloucestershire commissioned three new dental practices, all of which became operational in October 2008—in Forest of Dean, Cirencester and Tewksbury. The SHA has advised that in 2009-10 the tender is expected to be let for schemes in the areas of Gloucester city, Cheltenham and Stroud. The plan is for them to be fully operational by 2010-11.
The 90,000 extra places for patients that the Minister has just announced will go part of the way to addressing the issue of the 1.1 million people who would like an NHS dentist. Professor Steele is currently doing his review. Will his report be published in full, and will the Government accept all his recommendations?
The report, of course, will be accepted in full.
“Accepted in full.” Thank you.
No, it will be published in full; all of us on this side of the House are humble enough to say when we have made an error. I only wish that the hon. Gentleman would be as honest when Conservative Members do. Like any sensible Government, we will look at the review when it is published.
Topical Questions
The responsibilities of my Department embrace the whole range of NHS social care, mental health and public health service delivery, all of which are of equal importance.
I suspect that neither the Secretary of State nor the Government will want any surprises in early August. So will the right hon. Gentleman ask all the chief executives of hospital NHS trusts to report to him personally by the end of May on their ability and preparedness fully to implement the European working time directive? I suspect that such reports will demonstrate the need for some more middle-grade doctors if we are to continue with existing services.
We debated that issue during an Opposition day a few weeks ago. Everyone is aware of the need to comply with the European working time directive by 1 August; I trust that Opposition Front Benchers are now aware that every individual has the benefit of the opt-out.
Yes, I can. I saw my hon. Friend’s comments; obviously, I am particularly sensitive to how he, as the local MP, feels this inquiry is going. George Alberti has not only national but international renown on accident and emergency. As the Healthcare Commission report points out, accident and emergency is where the problem is in Stafford hospital. I assure my hon. Friend that there will be no no-go areas for Professor Alberti as he conducts his inquiry.
Order. Topical questions should be snappy, and three supplementaries is just not on.
Unless my memory is fading, I met the hon. Gentleman and the hon. Member for Sutton and Cheam (Mr. Burstow) very recently. But let me say this: services locally in their area have to be determined on the basis of what is best for patient care. I will become involved in the issue only if local politicians on the overview and scrutiny committee refer it to me. That is the right way for those issues to be resolved.
Since my right hon. Friend has been in post, has the Department of Health has ever lobbied the Treasury to put up the price of alcohol for health reasons?
I obviously cannot comment on the representations made in Government prior to each Budget.
There are a number of bits of analysis on this. The one that struck home more than any other was the Foresight report conducted by some of the world’s most eminent scientists and epidemiologists about the effect of obesity, which is a major driving factor in type 2 diabetes, cardiovascular disease and, indeed, cancer. They said that if we do nothing about this, by 2050 not only will there be an enormous burden in terms of disease but enormous costs—they estimate the cost will be around £50 billion to the NHS and to society more generally. That is why we are introducing the abdominal aortic aneurysm ultrasound check from this year, the vascular check for every adult between 40 and 73, call and recall, and many other initiatives to deal with prevention. The hon. Gentleman raises a crucial point about what we have to do now to prevent this disease burden in future.
Last week, I attended a celebration of the Ear Foundation, which is a charity that was set up to fund the first cochlear implant procedure in the city of Nottingham. Now that the National Institute for Health and Clinical Excellence has decided that it is a good idea for profoundly deaf children to have implants for both ears, can the Secretary of State tell me what he is doing to ensure that primary care trusts listen to that advice?
The recommendations from NICE with regard to implants must be complied with within three months of the guidance being issued, which was 28 January. PCTs are required to do two things. First, they must make available the funds for clinical decisions to be taken on the patients who should receive that treatment. Secondly, where there are patients who have already been treated but would now benefit from the NICE recommendations, they must ensure that a proper assessment is made of whether they should have that treatment provided to them.
I would be very willing to look at the situation in the hon. Gentleman’s own area. The roll-out of the IAPT—improving access to psychological therapies—initiative, described by Professor Layard as the most important reform in mental health since the NHS was created, will affect the hon. Gentleman’s area as well as others. With 3,600 psychological therapists, on the back of a very successful trial in Newham and Doncaster, and the announcement made last Monday for the very reasons that he mentioned—the health problems associated with the global economic recession—we are bringing forward to this year the money, and recruitment, that was to be spent in 2010-11. That will make an enormous difference to the availability of psychiatric services.
In the private sector and in the public sector, those at senior levels who fail are too often allowed to walk away with money, not fired. Can the Minister tell me how many NHS chief executives and trust board members have been fired since 1997?
No, we do not keep those figures centrally. We know how many non-executive directors have been fired—seven since 2001, when the Appointments Commission took over the role and kept statistics. Executive directors are the responsibility of each employer and each trust, and we do not hold those figures centrally.
We are actively recruiting midwives, and working very closely with the Royal College of Midwives. If an expectant mother were turned away from a unit it would be for reasons of safety—for the mother and the birth—because there was not enough capacity. We have an escalating birth rate and an active recruitment programme of midwives. We are also encouraging return to practise. I am sure that the hon. Gentleman would agree that the safety of the mother, and the circumstances of the birth, is paramount and it is better for a mother to travel elsewhere than for her to be admitted and made unsafe. It is unfortunate when a woman has to travel further to give birth, but it is a matter of safe practice.
What can the Secretary of State do to encourage NHS chief executives to listen to and take note of staff whistleblowers so that they do not feel that they are putting their jobs and careers in jeopardy?
The hon. Gentleman raises an important point. Some of the evidence from Stafford—and we do not have it all yet—shows that staff were raising complaints, but they were never reported to the board. Indeed, the board, when it discussed such issues, met in private, and all the indications are that it did not consider individual cases. It dealt with high-level issues.
The hon. Gentleman will accept that the NHS constitution, which has a substantial section on staff responsibilities, and the Public Interest Disclosure Act 1998, which was introduced by this Government, ensure that if there are whistles available, someone to blow them and something to be blown about, that should happen, and we should know about it. One of the great abiding mysteries of Stafford is that no such whistle was blown.
Will the Secretary of State look into the situation where Newcastle hospitals have withdrawn from the joint partnership on laundry services with the Queen Elizabeth hospital in Gateshead in my constituency? They are now transporting laundry to Leicester—364 miles there and back. That is a ridiculous thing to do when the cost of the contract is exactly the same.
At face value, that seems rather strange, environmentally as well as financially. If my hon. Friend contacts me about the matter, I would be willing to look into it.
I share the right hon. Gentleman’s view on that. For 150 years, the chief medical officer has been producing such reports—not the same person, of course—that have made a huge contribution to public health in this country, sometimes years after a report has been published. I respect the integrity of the chief medical officer, as I am sure the right hon. Gentleman does, but I just happen to disagree with that solution.
Incidents of methicillin-resistant Staphylococcus aureus in my three local hospitals have drastically reduced in the last few months, but will the Secretary of State look at the methodology currently used for determining incidents of MRSA in hospitals? In Barnsley, we had an incident where a patient had an infection after his pacemaker had been fitted in an independent treatment centre. Because it took some time to discover how he had been infected in the hospital, the infection was counted as three separate incidents of MRSA for that same patient. That seems a bit unfair to me, so will my right hon. Friend look into that?
My hon. Friend is right to point to the 65 per cent. reduction in MRSA against the baseline of 2003-04, and there has been a 47 per cent. reduction in cases of clostridium difficile compared with the same quarter last year. He raises an important point, and one case of MRSA, clostridium difficile or any hospital-acquired infection is one case too many. We must consider sensible points such as his to see whether we can eradicate another source of health care-acquired infection.
I know about that case, because the hon. Gentleman dropped me a note about it after the debate last week, and I am looking into it. As he did not mention the hospital, neither will I, but the fact that he has now placed the matter on record allows me to respond to him more formally than I would otherwise have done.
I do not understand why clinicians whose primary role is the safety of their patients are somehow concerned about whistleblowing. Indeed, knowing the number of people in various occupations who are not slow to make people aware of such difficulties, it amazes me that that did not happen at Stafford. The hon. Gentleman has taken a great interest in the matter, and I shall make absolutely sure that the issue that he has raised with me is thoroughly examined. Incidentally, I would also like to talk to the consultant concerned to find out why they were so frightened to raise the matter.
We are waiting for the latest statistics, but we want no children under the age of 16 with mental health problems to be treated on adult wards. There is a discussion about what is in the best clinical interests of adolescents aged 17 and 18 to meet their needs, but until those statistics are published I am unable to comment on the specifics. I am happy to examine the details that the hon. Gentleman mentions.