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Oral Answers to Questions

Volume 527: debated on Tuesday 26 April 2011


The Secretary of State was asked—

Neuromuscular Services (North-West)

1. What progress the NHS North West Specialised Commissioning Group has made in reviewing neuromuscular services in the region; and if he will make a statement. (52548)

14. What progress the NHS North West Specialised Commissioning Group has made in reviewing neuromuscular services in the region; and if he will make a statement. (52562)

I understand that the North West Specialist Commissioning Group received a report from its neuromuscular services review group at the end of March, and that it has since circulated it to all primary care trust chief executives with a request that it is shared with board members and GP commissioning consortia leads.

The north-west has not seen the investment in extra services, such as transitional care and extra care advisers, that the report recommends, and now the Government’s proposed reforms are causing turmoil in specialised commissioning and real worries about how the commissioning of tertiary services will work in future, so will Health Ministers issue guidance to commissioners to ensure that the investment is made to cover those critical gaps in the north-west, and that emergency admissions are avoided?

I thank the hon. Lady for her question, but I reject her assertion that the changes to the NHS—the modernisation of the NHS—have thrown the process into difficulty. Clearly, she feels that there is a problem in the first place. As I am sure she will agree, however, it will be down to the commissioning of the GP consortia and the primary care trusts to decide the best way to provide services in the light of all the information that they have. I understand that the commissioners will feed back to the specialised commissioning group on how they will deal with the recommendations.

The report highlighted that, for an investment of less than £30,000, Manchester primary care trust could ensure that all muscular dystrophy sufferers, including my constituent Ben Dale, have access to specialist care adviser support, saving an estimated £5 million in hospital admissions costs. Does the Minister agree that that investment would be excellent value for money, given that it would help my constituent Ben to live a more fulfilling life and save money for the NHS?

The hon. Gentleman specifically mentions a constituent of his, and I have every sympathy with people coping with muscle-wasting diseases, and indeed with their families. The burden can be quite considerable. The multidisciplinary group that examined services throughout the north-west deserves our thanks for its work, but the fact is that it is for NHS commissioners, PCTs and the emerging GP-led consortia to consider the evidence that they have. Indeed, if money can be saved by commissioning services in a different way, so they should be, but that decision should be taken locally.

Acute Services (Trafford)

This is a matter for the local NHS. Every NHS trust has a duty to provide the best quality care for its patients. The Government believe that the delivery of health services should be led locally, with clinicians working with GPs and patients to ensure that their needs are met.

I am grateful for that answer and for the Minister’s letter to me last week, but, having already lost paediatric and maternity services recently, and with the decision not to provide trauma services in Trafford, local people are understandably anxious about further services being lost. Is the Minister confident that sufficient independent oversight is in place to ensure that the needs and wishes of local people are adequately met?

I hope that I can reassure the hon. Lady, because if there were to be any reconfigurations in the future—I put that in the conditional tense because the relevant trust is confident that there will not need to be any—quite clearly the four tests that my right hon. Friend the Secretary of State introduced last May would have to apply. There would have to be full consultation with local people and with clinicians, GPs and others in the health economy.

NHS Reform

3. What processes he has put in place to allow lay members of the public and elected public representatives to contribute to discussions on the reform of the NHS. (52550)

Following formal consultation last year, and as I told the House on 4 April, we are taking this opportunity to pause, listen, reflect and improve the Health and Social Care Bill. A total of 119 events have already been organised centrally, and the regional and local NHS will organise many more. Those events will allow us to hear a full range of views from professionals, the public and patients.

The Health Secretary knows that colleagues welcome the pause and the opportunity to reflect on what changes might be beneficially made to the legislation. Will he assure us that lay people and elected representatives, such as councillors and others, will be fully engaged in the process? The professionals have had their say, and they have very strong views, but the patients and elected people need to have their say, too.

Yes. I am grateful to my right hon. Friend, and I can give him that assurance. Indeed, one reason why it is important to pause and to listen now is not least that shadow health and wellbeing boards have been put forward by 90% of relevant local authorities in England, and it is an opportunity for them to be very clear about how we can improve patient and public accountability. I hope that they and others will take that opportunity. As my right hon. Friend knows, the Bill already substantially improves both the public and the patient voice in the NHS, and we have to ensure that we take every opportunity now further to improve it.

If the Government do come back with some major changes to the Bill, will those changes go out to public consultation, and will this House have the opportunity to oversee and to look in detail at any further proposals they may make?

I think I made it clear to the right hon. Gentleman in the House on 4 April that we were looking to pause, to listen, to reflect and to improve the Bill, and we are taking the opportunity to do so now, before Report and Third Reading.

Can my right hon. Friend confirm that in the listening exercise it is his intention, in addition to listening to representatives of local authorities and the public, to ensure that we fully take account of the views of representatives of the full range of clinical opinion within the health service—nurses, hospital doctors and community-based clinicians as well as GPs?

Yes. My right hon. Friend will know that we have done that in the past, and we continue to do so. Just as early implementers of health and wellbeing boards have an important voice in how local authorities will strengthen public accountability and democratic accountability, we also now have an opportunity that we did not have in the consultation last year for the new pathfinder consortia, as they come together—88% of the country is already represented by them—to have their voices heard. I hope that the public generally will exercise this opportunity too. I know that groups representative of patients are doing so and very much want to get involved in these discussions.

The Secretary of State will be aware that if Lib Dem MPs were seriously opposed to this reorganisation, they could have voted against it on Second Reading—so how can he expect the public to take these discussions and the listening exercise seriously? Are they not just a device to get the coalition through the May elections, and is he not determined to get away with as little substantive change as he can manage?

On the contrary—the hon. Lady should know, because I made it clear on 4 April, that my objective, and that of the Prime Minister, the Deputy Prime Minister and all of the Government, is further to strengthen the NHS, and we will use this opportunity to ensure that the Bill is right for that purpose. The reason Government Members supported the Bill on Second Reading, and Labour Members should have done so, is that, as the right hon. Member for Wentworth and Dearne (John Healey) said, the general aims of reform are sound.

As part of the listening exercise, will the Secretary of State confirm that the public, patients and medical professionals will be listened to? Many of them want to see root-and-branch reform of the NHS in order to improve its effectiveness and efficiency and improve patient outcomes.

Yes, my hon. Friend is right. We have an opportunity, which we want to realise to its fullest potential, to improve many of the ways in which patients and the public are involved. For example, we want to arrive at a point where patients feel that the invariable response of the NHS to their need is that there is no decision about them without them. We are proposing in the Bill to strengthen the scrutiny powers of local authorities. We are also proposing to bring in a patient voice through HealthWatch and HealthWatch England that has not existed since the Labour Government abolished community health councils, and we are going to strengthen substantially democratic accountability through health and wellbeing boards.


4. What his policy is on funding for a national framework and quality of service guidelines for diabetes patients. (52551)

To support the NHS in improving outcomes, the National Institute for Health and Clinical Excellence has published a quality standard for diabetes building on the existing national service framework, which provides an authoritative definition of good-quality care. Under proposals in the Health and Social Care Bill, quality standards will have a central role within the new system’s architecture.

May I declare my interest as someone who has type 2 diabetes, and remind the Minister that we currently spend 10% of the NHS budget—£1 million an hour—on diabetes-related illnesses? Does he agree that what is central to this framework is providing funding for prevention? If we can prevent and assess diabetes, we will save a great deal of money in the long run.

I certainly agree with the right hon. Gentleman that prevention is undoubtedly the right way forward, but earlier diagnosis is also very important. That is why we continue, as a Government, to support the roll-out of NHS heath checks for people aged 40 to 65 as a way of ensuring that we detect more readily and earlier so that we can provide the appropriate support.

Just 10 minutes ago, I met representatives of Diabetes UK, who want to see greater emphasis on integration and co-operation between and within services in the NHS Bill. Can I assume that they will not be disappointed?

As my right hon. Friend the Secretary of State has already indicated in today’s exchanges in this House, we are committed to listening and reflecting during this pause, and to ensuring that we come back with substantive improvements to the Bill to deliver its central purpose of improving health care for the people of this country.

Out-of-Hours Surgeries

5. How much his Department allocated to the provision of out-of-hours surgeries in the last 12 months for which figures are available; and if he will make a statement. (52552)

The Government do not allocate centrally how much money is spent by local NHS providers on out-of-hours services. However, in 2009-10, the last year for which figures are available, £403.8 million was spent on out-of-hours GP services in England and £1.6 million was spent on out-of-hours services in Coventry. We plan to give GPs and other health professionals greater powers to commission out-of-hours care to achieve high quality, integrated services that are focused on the needs of patients.

Given that waiting times in emergency units are increasing, what will the Minister do to protect out-of-hours clinics?

It was, of course, the hon. Gentleman’s Government who did so much to undermine the provision of out-of-hours services. We propose not only to review the existing framework, but to ensure that there are the real improvements that benefit patient care, which are so badly needed.

Will my right hon. Friend ensure that there are no artificial constraints so that GPs, even though they may be commissioners, can ensure that they provide out-of-hours services in combination with clinics and ambulance services?

I am grateful to my hon. Friend for raising that important issue. I assure him that there are mechanisms in the Health and Social Care Bill to provide protection so that there are not the problems that he anticipates.

Health and Social Care Bill (Cross-border Implications)

6. What discussions he has had with Ministers in the Welsh Assembly Government on the cross-border implications of the Health and Social Care Bill. (52553)

The Secretary of State for Health met Ministers of the Welsh Assembly Government on 1 December last year to discuss the future of the cross-border commissioning protocol, and I am meeting the Under-Secretary of State for Wales in the next few weeks. It was agreed that until the forthcoming changes in the Health and Social Care Bill are finalised, no substantial changes to the cross-border protocol should be introduced, as is right. The protocol, which expired on the 31 March this year, has therefore been renewed for one year with minimal changes.

More than 200,000 people from Wales, including people from my constituency, access services in England at the Countess of Chester hospital, Clatterbridge, the Christie, and the Walton in Liverpool. More than 50,000 people from England access health services in Wales. What guarantees can the Minister give me that the proposed changes in the Health and Social Care Bill will not wreck those arrangements?

There is absolutely no reason why they should. I thank the right hon. Gentleman for raising this issue. It is worth pointing out that there are many areas of commonality between the health services in England and Wales. Of course, it is up to the Welsh Assembly Government to decide what scale of finance and resource they provide. I am aware that there are some cross-border issues that clearly need to be resolved.

Will the Minister confirm whether funds will be held by the consortia or the GPs in the practices, because there is confusion among GPs in my constituency of South Dorset on that point?

I am grateful, Mr Speaker. I was going to make that point. Although Dorset is a long way from Wales, I assure the hon. Gentleman that GPs will not have the money in their personal bank accounts.

The Minister will know from the Welsh Affairs Committee report that there is considerable traffic of people accessing GP services across the border in both directions, with the net benefit going to England. Will she reassure me that the interests of people on both sides of the border will be served when the Health and Social Care Bill is finally enacted?

Yes, I assure the hon. Gentleman that the Health and Social Care Bill aims to resolve as many of the problems that we know about on the border as possible.

Social Care (Eligibility Criteria)

7. What estimate he has made of the number of local authorities which changed their eligibility criteria for social care in the last 12 months. (52554)

Decisions about eligibility criteria are a matter for local councils. As part of last year’s spending review, the Government committed an additional £530 million through the local government formula grant, and £648 million in direct support from the NHS, to support social care, as well as £150 million for re-ablement. By 2014, that will rise to £2 billion of additional support for social care.

Is the Minister aware that according to a recent survey by the Association of Directors of Adult Social Services, 19 local authorities including my own, Calderdale, have had to raise the eligibility criteria for social care because of the cuts that they have received from the Government? Does he stand by his statement of 21 October that there is

“no justification for local authorities to slash and burn or for local authorities to tighten eligibility”?

I certainly stand by the idea that the Government provided adequate resources in the financial settlement last year, alongside efficiency savings, to ensure that every local authority could choose to maintain the current levels of eligibility and services in its area if it so wished.

Will the Minister examine situations in which domiciliary care contracts are awarded under the EU public procurement directives, to ensure that especially when they are awarded on price, they are not dumbed down and the level of service reduced?

My hon. Friend makes an important point about ensuring that competition is always based on quality, not just price. If she would like to write to me with more details about the matter, I would certainly be happy to follow it up with her.

Since the Government are no longer doing an assessment of the provision of social care by local authorities, I have done it for the Minister. My survey has found that not only have eligibility criteria been tightened, but 88% of councils are increasing their charges, 63% are closing care homes and day centres and 54% are cutting funding to the voluntary sector. Now that I have told the Minister the facts, will he take back his comment that

“no councils need to reduce access to social care”?

Would he like to start being straight with the public?

I will take Labour facts with a pinch of salt. Under Labour, social care was always very much the poor relation. Under this coalition, social care has received a £2 billion spending boost and an unprecedented transfer of resources from the NHS—something that the hon. Lady’s party, if it had been in power, would not have been able to do, because it would have been busy cutting the NHS.

NHS (Rochdale)

My right hon. Friend the Secretary of State for Health visited the Pennine Acute Hospitals NHS Trust, which delivers services to the people of Rochdale, in June last year. There are no immediate plans to repeat the visit.

The reason I asked the question is that the people of Rochdale are extremely concerned about how Rochdale infirmary is being run and believe that the Pennine acute trust is not accountable. The Minister and the Secretary of State will be aware of the recent Channel 4 “Dispatches” programme, which showed the trust and its chief executive in a very poor light. The reconfiguration of services there has been handled very badly. May I ask the Minister, as a matter of urgency, to act upon all the concerns and investigate the management of the Pennine acute trust?

I thank the hon. Gentleman for his question. I am aware of the recent “Dispatches” programme and the fact that the Pennine Acute Hospitals NHS Trust is implementing a number of service changes in a number of areas, including Rochdale. Those changes are part of the “Healthy Futures” and “Making it Better” programmes, both of which have been subject to full consultation with local people. NHS North West has confirmed that both programmes meet the four tests for service change, but if the hon. Gentleman continues to have concerns, I am sure one of the ministerial team will deal with them personally.

Front-line Services

We are increasing funding for the NHS in each year of this Parliament, amounting to an increase of £11.5 billion over its course. Over the next few years, planned improvements in the efficiency of use of NHS resources, increasingly led by front-line staff, will support modernisation of the NHS to respond to rising demand and new technologies. Not least, we are cutting administration costs across the system by one third, saving £1.7 billion a year, every penny of which will be available for reinvestment in front-line services.

Will the Secretary of State join me in praising the work of chief executive, Glen Burley, and the excellent team of health professionals at Warwick hospital, who are improving community care while seeking to reduce management costs? Will the Secretary of State also take the opportunity to visit Warwick hospital to discuss how those things can be done at local level?

I am glad to endorse my hon. Friend’s congratulations to the staff and team at Warwick hospital. I hope to have an opportunity to visit that hospital at some future date. Across the NHS, we are setting out not least to increase productivity and efficiency, stimulate innovation, reduce administration costs and put more decision-making responsibility into the hands of those who care for patients, which the Labour party failed to do.

How can the Secretary of State convince people that he is protecting front-line services when a flagship Bill such as the Health and Social Care Bill is in such disarray? While he is pausing and listening and reflecting on that Bill, will he also consider whether the House will have a further opportunity to consider his reflections, because we are through the Committee stage? Will there be another Committee?

The hon. Gentleman misses the point that what matters to the public is the quality of services that are provided to them. When he asked his question, he might have reflected on the simple fact that the Labour party told us before the spending review to cut the budget of the NHS. We refused to do that, which means that this financial year, £2.9 billion more will be available for the NHS to spend than it spent last year.

A crucial front-line service is the provision of stroke care. Can the Secretary of State confirm that under his proposed reforms, local clinical practitioners will have much more influence over the location of those stroke services than in the current situation, when management can make somewhat arbitrary changes?

Yes, I can confirm that. We are looking for commissioning consortia not only to lead from a primary care perspective on behalf of patients, but to work on commissioning services with their specialist colleagues. Of course, the stroke research network has formed a strong basis upon which such commissioning activity can take place.

There have been many improvements in stroke care. Over the last year, we have seen a significant improvement in performance in relation to responses to transient ischaemic attack, and I hope we continue to see improvements in future.

Last year, the Prime Minister made a very clear pledge to protect front-line NHS services. Will the Secretary of State confirm that in the run-up to next year’s Olympics, which will bring around 1 million extra people to the capital, the London ambulance service is cutting 560 front-line staff? Will the Secretary of State also confirm that nationally, A and E waits of more than four hours are up 65%, that the number of patients waiting more than six weeks for their cancer test has doubled, and that more patients are waiting for longer than 18 weeks than at any time in the last two years? Will he now admit that the Prime Minister’s pledge to protect front-line care is unravelling even faster than the Secretary of State’s chaotic Health and Social Care Bill?

There were three questions there, but I know that the Secretary of State will provide a characteristically succinct reply.

Thank you, Mr Speaker. None of those questions reminded the House that the Labour party wanted to cut the budget of the NHS, nor that in Wales, a Labour-led Welsh Assembly Government are cutting the NHS budget in real terms—there is no increase at all.

Let me tell the hon. Lady that waiting times in the NHS are, on average, nine weeks for patients who are admitted and three and a half weeks for those who are not admitted. That is broadly stable.

The hon. Lady will know that the chief executive of the London ambulance service, Peter Bradley, has made it clear that the ambulance service, like the NHS, needs to maintain front-line services while continually improving efficiency. That will happen in the ambulance service and it will happen right across the NHS.

Health and Wellbeing Boards

Almost nine out of 10 local authorities have signed up as early implementers to press ahead with the setting up of health and wellbeing boards. Councillors, clinicians and local communities have told us that by working together through those boards, they can and will improve health and care outcomes for local people.

Does my hon. Friend agree that giving greater public health powers to the health and wellbeing boards will allow more targeted help in our local communities?

Absolutely. By bringing public health home to local government we will have the opportunity to ensure that many of the underlying causes of ill health can be tackled more effectively, and that is why we are making the reform in this way. By having a health and wellbeing board that brings together all the interested parties we can also ensure a far more integrated approach.

Will the hon. Gentleman persuade the Secretary of State to come to Yorkshire and perhaps speak to a small group of people—no more than 60—in a quiet room about what these boards are supposed to do? Who will be on them, how accountable and transparent will they be, and will they have any teeth?

My right hon. Friend of course is more than happy to go to all sorts of places to talk to people about the health reforms. However, local government fully supports this particular proposal and sees it as a vital innovation for the involvement of local government in the health service. It will be transparent because it will be part of the local authority and will meet in open.

GP Pathfinder Consortia

11. What recent assessment he has made of progress by GP pathfinder consortia in delivering improvements in NHS services. (52559)

I am delighted that nearly 90% of the country is now covered by pathfinder consortia, including my hon. Friend’s constituency, where the eastern Devon consortia chairs board pathfinder is up and running. I know that one area on which these emerging consortia are focusing is providing better, more flexible services for patients in community settings. We are supporting all the pathfinders through the pathfinder learning network, which is already showing a wide range of examples of where clinician-led commissioning is delivering benefits for patients.

I welcome the Secretary of State saying that the consortium in my constituency is up and running. Will he also take this opportunity to ensure that through these consortia patients can get better access to their doctors? Labour paid doctors a great deal more money, but patients actually got less access to their doctors.

That, indeed, will be one of the areas on which the quality and outcomes framework for individual GP practices will focus. In addition, however, through the commissioning outcomes framework for the NHS as a whole, one area in which we want to see continuing improvement in quality is patient experience and outcomes as reported by patients. GPs and their clinical colleagues will therefore be incentivised continuously to improve quality.

The Secretary of State knows that many of us have received e-mails from constituents, the majority of which have been cut and pasted from a left-wing website. The impression given of the role of the GP consortia bears little relationship to that of GP leaders in my constituency such as Elizabeth Johnston. Will he confirm that he will listen very carefully to the experience and expertise of my local GP leaders, and not a left-wing motivated campaign?

My hon. Friend will know, like I do, that his GPs in Reading have already commissioned a new care pathway for people with lower back pain, which means that instead of having to go to hospital appointments, patients can be seen in their own homes by physiotherapists or occupational therapists offering practical advice and assistance in managing pain. Those are practical steps led by front-line staff, the purpose of which is to improve care for patients.

Hospital Services

12. What arrangements he has made for continuity of provision of existing hospital services under his proposed reforms of the NHS; and if he will make a statement. (52560)

Commissioners would remain responsible for securing continued provision of NHS services to meet the needs of their local populations. We are proposing to support commissioners in this by introducing a comprehensive system of regulation at national level and additional regulation for designated services.

The Minister told the Bill Committee that some accident and emergency services might be undercut by private providers, which could force them to close. Will the Government bring forward amendments to the Bill to safeguard existing A and E services in all areas, including Merseyside?

I know that the hon. Lady does not want to mislead the House, but she is totally, factually incorrect in how she paraphrased what I said in the Health and Social Care Bill Committee. As any hon. Member who was there will know, I tried to be helpful to the hon. Member for Leicester West (Liz Kendall)—it is the last time I will—and gave her an illustrative example of how designated services would work. However, I did not say what the hon. Member for Liverpool, Wavertree (Luciana Berger) attributed to me.

Clinicians at the West Suffolk hospital in Bury St Edmunds are concerned that they will get the same tariff for an operation as a private sector provider, even though the NHS has to carry the cost of training whereas, on the whole, the private sector does not. What steps will the Minister take to address this perceived unfairness?

I should like to reassure my hon. Friend. As he will know, we do not propose to introduce price competition into the NHS; rather, we propose to introduce competition based on quality. His clinicians are correct that the price will be the same. However, they must remember that we are going to stop the practice of the last Government, who, with independent sector treatment centres, paid the private sector over 11% more per operation than they were prepared to pay the national health service.

I thought that the hon. Gentleman wanted to come in on this question. That is what I have been told, but never mind: we will wait to hear his dulcet tones in due course.

Non-Emergency Phone Number

15. Whether he has made an assessment of the effectiveness of the 111 non-emergency number; and if he will make a statement. (52563)

NHS 111 is currently being piloted in County Durham and Darlington, Nottingham city, Lincolnshire and Luton, and a full independent evaluation of these pilots will be available in spring 2012.

In Durham, 111 calls are being answered by telephone receptionists without any medical training. They run through a list of pre-scripted questions and frequently divert ambulance paramedics away from 999 calls. Clearly that is risky. Will the Minister look into that before the number goes nationwide?

I am sorry, but the hon. Lady is a little bit confused. She says, rather dismissively, that the calls are being answered by telephonists. These are non-medically trained people who have nurses and GPs available to give them help and advice as and when the callers demand it, because of the complaint or problem that they are raising. The beauty of the 111 service is that people do not have to wait to be called back, as they do with NHS Direct. Instead, the people trained to help callers will point them towards the appropriate care—which in some cases will be the emergency services—and they are right to do so when this has been clinically determined.

Can my right hon. Friend assure the House that 111 telephone operators will be trained to the same level as 999 telephone operators?

Health and Social Care Bill

As I told the House on 4 April, we are taking the opportunity presented by a natural break in the legislative process to pause, listen, reflect and improve our plans for modernisation of the health service. We will consider what amendments are required in the light of this.

The Health and Social Care Bill is undoubtedly one of the most controversial pieces of legislation being proposed by the coalition. May I push the Secretary of State a little further on some of the answers that he has given my hon. Friends and ask him exactly how he will ensure adequate parliamentary time to scrutinise the amendments that he will bring forward?

I am not sure that I necessarily subscribe to the hon. Gentleman’s premise. This issue is important and it warrants the kind of attention that we are giving to it, and there is an opportunity to listen, reflect and improve the Bill because we want to ensure that we can thereby strengthen the NHS. On strengthening the NHS, I am surprised that the hon. Gentleman did not take the opportunity to refer to the £12.9 million increase in the budget for Tameside and Glossop PCT this year—something that Labour would not have offered. The truth is that we are going to strengthen the NHS through the Health and Social Care Bill, as we are strengthening it through our commitment to the priorities of the NHS.

Has my right hon. Friend had any further thoughts on the effect of HealthWatch England’s representatives being included in local health and wellbeing boards? Does he think that the provisions are sufficiently robust to ensure that they have an impact on commissioning?

As my hon. Friend knows, we intend health and wellbeing boards to bring together HealthWatch, plus councillors, commissioning bodies and providers, as part of the process of local representation, so that we can link up NHS commissioning with public health and social care, to see how they collectively meet the joint strategic needs assessment led by the local authority.

I apologise to the hon. Member for Kingston upon Hull North (Diana Johnson). The change of mind on the part of the Opposition Front Bench fazed me, for which I apologise. The hon. Member for Halton (Derek Twigg) wants his opportunity to ask a question, and he should have it.

Thank you, Mr Speaker. I think there was some confusion between questions 13 and 16.

We obviously want to see important improvements to the Bill, including the deletion of part 3, which drives competition to the heart of the NHS, and of clause 150, which removes the private patients’ income cap. I also want to ask the Secretary of State a specific question. On 16 March, during the Bill’s passage through the House, the Prime Minister said to the Leader of the Opposition:

“Perhaps he would like to…support our anti-cherry-picking amendment.”—[Official Report, 16 March 2011; Vol. 525, c. 292.]

Will the Secretary of State tell us whether it is still the Government’s policy to table such an amendment in this House, or whether they intend to do so at a later stage?

As I said earlier, when we have completed this process of listening and reflecting, we will table amendments to the Bill. I will tell the House about them then, just as I told them on 4 April that we were going to go through this process. Let me make it clear that we are intending not to allow cherry-picking. We intend to make it absolutely clear to the private sector or anybody else that they must not be able to compete with the NHS on uneven terms because, actually, that is what the last Labour Government did. Under that Government, we ended up with £250 million being spent on operations in private hospitals that never took place because of the poor nature of the private sector provision that they put in place. We are not introducing competition into the NHS through this Bill. Why does the hon. Gentleman suppose that the last Labour Government set up the competition and co-operation panel, if not—

Local Authorities (Public Health Duties)

17. How much funding he plans to allocate to local authorities in order to perform their new public health duties in each of the next three years. (52565)

We want local authorities to have the powers and the resources that they need in order to make a real difference to the health and well-being of their local populations. Shadow allocations for the local ring-fenced public health budget will be announced later this year.

Hull’s Lib Dem council does not have a very good record on public health. It is currently slashing services delivered to children through its children’s centres and early years services. We all know that public health can be improved by that early investment. What is the Minister going to do to ensure that councils take their wider public health responsibilities seriously?

I thank the hon. Lady for her question. With resources come responsibilities. I am pleased that the hon. Member for Hackney North and Stoke Newington (Ms Abbott) has welcomed the shift in public health. There is no doubt about it: local authorities have a long history of delivering public health improvements, and this will give them the opportunity to see again some of the improvements that were long awaited under the last Government.

Children with Disabilities

20. What assessment he has made of progress in providing co-ordinated medical assessments for children with disabilities. (52568)

The Department for Education Green Paper, “Support and aspiration: a new approach to special educational needs and disability—a consultation”, was published in March and includes a proposal to develop a single new co-ordinated assessment for education, health and care plans by 2014. The consultation on the Green Paper continues until June 2011, and I hope that the hon. Lady will respond to it.

That was a very interesting answer, particularly as the Prime Minister told me on 30 March that this

“idea is rapidly becoming Government policy.”—[Official Report, 30 March 2011; Vol. 526, c. 340.]

Can the Minister tell us whether she intends to table an amendment to the Health and Social Care Bill to ensure that those crack teams of medical experts that the Prime Minister promised would be set up will be set up by GP consortia?

Families of children with disabilities and special needs will welcome the single, co-ordinated assessment. We have to see health and social care working more closely together, because those families bear a considerable burden of care. I would point the hon. Lady towards the consultation, and I suggest that she points her constituents towards it as well, as it is extremely important that we get their feedback.

Patient Choice

22. What steps he is taking to extend the choice that patients have over the treatment they receive from the NHS. (52570)

The Government have consulted on proposals to give patients greater choice and control over their care and treatment. We have deferred publication of our response to take into account the results of the listening exercise.

I thank my right hon. Friend for that answer and refer him to the King’s Fund paper, “Patient choice”, which was published in March 2010. Does he agree that people value being able to choose and that the exercise of choice raises standards and encourages NHS providers to design services around patients and their needs?

My hon. Friend is absolutely right. I am certainly aware of the King’s Fund publication. The report was cited as a key source of evidence in the consultation document, “Liberating the NHS”. The Department of Health welcomes this significant contribution to the evidence base, which will inform how we implement the choice commitments set out in the White Paper, “Equity and excellence: Liberating the NHS”.

When I was first elected, I regularly received letters from constituents who were concerned about how long they had to wait for treatment. During the years of the Labour Government, those letters went away, but they are coming back again. What I know from my constituents is that their main choice is not to have to wait. Is that a choice that this Government are going to offer them or will waiting times increase?

The choice this Government will offer them will make sure that they get the finest quality health care, where they can exercise their choice of which hospital to go to, which consultant to see, which GP to see, without having to wait unduly for that treatment.

Topical Questions

My responsibility is to lead the NHS in delivering improved health outcomes in England; to lead a public health service that improves the health of the nation and reduces health inequalities; and to lead the reform of adult social care, which supports and protects vulnerable people.

The Alzheimer’s Society predicts that by 2021, there will be a million sufferers from dementia in this country. Will the Secretary of State reassure my constituents that those people suffering from it will get the support they need—now and in the future?

Yes, I can tell my hon. Friend that the response to dementia is a key priority for this coalition Government. I think we have already demonstrated it in our commitment to dementia research. We need to improve both earlier diagnosis of dementia and the possibilities for treatment. We have demonstrated our commitment to improving standards in dementia care, both in hospitals and in care homes, and, indeed, in the further work we have done on reducing the use of anti-psychotic medicines.

How does the Health Secretary square the Prime Minister’s promise to pause in his changes to the NHS with the NHS chief executive saying a week later:

“I want to stress very firmly that we need…to maintain momentum on the ground.”

With the Government’s health Bill, are we not seeing both rushed pre-legislative implementation and confused post-legislative policy making? If the Prime Minister really gets cold feet about his NHS changes, let me ask the Health Secretary for a fourth time whether the Government will guarantee the extra time needed for this House to examine the changes fully?

Let me be clear about the right hon. Gentleman’s point. Both things are entirely compatible because there are 220 GP-led consortia that have come together as pathfinders to demonstrate how they can improve commissioning and the service to their patients; 90% of local authorities have come together in health and wellbeing boards; while at the same time, we have to deliver the challenge of improving productivity, quality and efficiency. All of that requires us, on the ground, to continue the momentum of improvement for patients. At the same time, we are listening not least to all those clinicians and members of the public who want to be sure that the Bill will provide them with the opportunities for involvement and the safeguards they are looking for in the NHS in the future.

The Health Secretary ducked for the fourth time this afternoon the question of whether he will do right by this House in allowing sufficient time for proper scrutiny of any changes to the Bill that come forward. While he is listening, will he consider the risks he is running with the NHS? The Prime Minister promised a real rise in NHS funding, yet this year more than nine out of 10 hospitals are faced with cutting costs by more than 4%; one in seven by more than 8%; while nearly £2 billion for patient care is being held back to cover the costs of the internal NHS reorganisation. Will he admit that this reorganisation is now piling extra pressure on NHS funding and services so that patients are seeing waiting times rise, operations cancelled and front-line staff jobs cut as the NHS starts to go backwards again under the Tories?

I find the hon. Gentleman’s cheek astonishing. It was his party which, before the election, announced its intention of making up to £20 billion of efficiency savings, it was his party which told us after the election that the NHS should be cut, and it is his party which is actually cutting the NHS in Wales. It is the coalition Government who have made decisions that will give the NHS £2.9 billion—a 3% cash increase—and, because of the way in which we are tackling the costs of management, will put more people on the front line. Following the election, there are 3,500 fewer managers and 2,500 more doctors and nurses.

T2. The Secretary of State is well aware of concern in the Yorkshire area about the review of children’s heart units, and I thank him for his recent letter, but does he accept that there is a contradiction between the logic applied to the south of England and that applied to the north, where 14 million people rely on the fact that the children’s heart unit in Leeds is only a two-hour drive away? (52574)

I should make it clear that the review is being led by the Joint Committee of Primary Care Trusts, not by the Department of Health, and that it is being conducted by an independent team who are employing an independent consultative process. My colleagues and I have made no decisions so far, but we will expect all the points made by the hon. Gentleman and others throughout the country about paediatric cardiac surgery to be taken fully into account in the consultation.

T4. The Secretary of State will be aware that, according to the quarterly monitoring report from the King’s Fund, waiting times have hit a three-year high. Does he accept that that is a direct result of his actions, particularly the abolition of the centrally managed target in June last year? (52576)

I can tell the hon. Gentleman that waiting times in the NHS are stable. The average waiting time for patients who are admitted to hospital is nine weeks, and the average waiting time for out-patients is three and a half weeks. I think that people in the NHS might reasonably say that it is not fair to cite February 2011, when patients waiting for elective operations could not be admitted because critical care beds were occupied in the immediate wake of a severe winter and the largest flu outbreak since 1999.

T3. According to recent press reports, hospitals have used money earmarked for front-line NHS services to pay salaries to trade union officials. Does my right hon. Friend consider it acceptable to spend taxpayers’ money on paying union hatchet people, and will he order an investigation? (52575)

The Government consider it right for NHS staff to have access to trade union representatives at work, but that should not be abused. Arrangements for reimbursing staff for trade union activities should be agreed locally between trusts and unions. There are no current plans to review union facility time.

T6. Given that, according to the King’s Fund, waiting times are increasing as a result of the reorganisation, does the Minister expect things to improve now that the financial squeeze is starting to bite? (52578)

As I have already explained, I do not accept the premise; but would the hon. Lady apply the same logic to the fact that the number of cases of hospital-acquired and health care-acquired infection has fallen substantially over the past year, the fact that access to services for strokes and transient ischaemic attacks has improved, and the fact that diabetic retinopathy and bowel cancer screening are improving? Would she argue that those developments are a result of our reforms? No, because our reforms have not been implemented., but we are making the investment in the NHS that the Labour party would not make, and we are giving the NHS the credit, which the Labour party would not do.

T5. There is some concern about whether GP consortia will be given enough specialist support when commissioning integrated cancer services. Will my right hon. Friend use the pause in the passage of the Health and Social Care Bill to consider extending the guarantee for cancer network funding from 2012 to 2014, when the transition period ends and GP commissioning comes fully into effect? (52577)

I am grateful to the hon. Gentleman for his question. The listening exercise is a genuine one, and we intend to bring forward appropriate changes as a result. I can certainly give the commitment that we will want to take on board such representations. We are, and consistently have been, committed to such clinical networks for the valuable contribution they make.

T7. If Bassetlaw council refers the reconfiguration of accident and emergency, paediatric and maternity services at Bassetlaw district general hospital to the Secretary of State, what criteria will he use to make a decision? (52579)

Under those circumstances, if a referral is made to me, I will wish to apply the kind of criteria that I set out last year for reconfigurations across the country for the first time: that they must meet the tests of being consistent with the result of any public consultation and with the public’s view, with the views of prospective future commissioners—such as the commissioning consortia that are coming together as a pathfinder in the hon. Gentleman’s constituency—and with the future choices made by patients about where and how they want services to be provided to them, and that they must meet clinical criteria for safety and quality.

May I join my hon. Friend the Member for Leeds North West (Greg Mulholland) in urging the Secretary of State to protect the children’s heart unit at Leeds hospital as it is a very worthwhile facility for people in Yorkshire, and does my right hon. Friend the Secretary of State agree with me that doctors should go to where the patients are, rather than the other way around by expecting patients to travel for many hours to get to such an important service?

I am grateful to my hon. Friend for his question, but in response I will simply reiterate what I said to our hon. Friend the Member for Leeds North West: that these matters are currently the subject of consultation by an independent group representing the primary care trusts collectively, and not by the Department of Health at this stage.

T8. Given the concerns of researchers and medical research charities and their belief that the research provisions in the Health and Social Care Bill should be strengthened, what discussions has the Secretary of State had with the medical research community during this pause? (52580)

The hon. Lady will know that the Health and Social Care Bill does make specific provision for NHS organisations to have regard to the needs for research. She will, I hope, also be very well aware that, by virtue of decisions made by this Government in the spending review, we have been able to sustain the level of research in the NHS. In particular, I was recently able to announce a new 30% increase in funding for translational research funded through the NHS.

When the consultation on the future of children’s heart surgery units is complete, will the Secretary of State bear it in mind that it would be a preposterous and perverse conclusion that the unit in Southampton, which is one of the two best in the country, should be threatened with closure?

I am, of course, aware of these issues, which have been raised by colleagues on both sides of the House. At this stage, may I simply reiterate that the consultation team should consider the points that I know my hon. Friend and others are making to it? After the consultation team has fully reflected on all the points, I hope Members will be able to see that it has fully taken them into account in whatever proposals it brings forward.

T9. The Secretary of State has just appeared to blame the rise in waiting times on, as it were, the wrong kind of snow. Can we infer from that that if waiting times continue to rise over the coming months, he will reinstate the targets that brought waiting times down and kept them low? (52582)

The point I made was that average waiting times are stable. Maximum waiting times continue to be a right of patients under the NHS constitution. I recommend that the hon. Gentleman should go to Luton and Dunstable hospital and discuss with the staff there how they dealt with a combination of circumstances that led to there being unprecedented pressure on critical care beds. He must know that if hospitals do not have critical care beds immediately available, it is not in the patients’ interests for the hospitals to bring some patients in for elective surgery. That had an inevitable consequence on waiting times for a small minority of patients.

I have received representations from constituents regarding the reclassification by the primary care trust of elderly relatives for continuing health care funding, with severe needs apparently becoming moderate over time. Does the Secretary of State share my concern about this, and how widespread is this practice in the current climate?

My hon. Friend’s point is important and I regularly receive correspondence about this from hon. Members from all parts of this House. If she wishes to write to me, I will be happy to discuss the matter with her further, once I have had a chance to look at the details.

Given that Department of Health officials are actively discussing the privatisation of my local trust behind closed doors and are signing secret documents, will the Minister publish all those documents and will he make a statement in the House about the Government’s plans to privatise some of our NHS hospitals?

I am afraid that I do not accept the premise of the question. May I tell the hon. Gentleman that this Government are not seeking and will not ever seek to privatise either the whole of the NHS or an individual trust? St Helens and Knowsley Teaching Hospitals NHS Trust is, like all other health trusts, currently agreeing plans to achieve foundation trust status by April 2014. That involves ongoing discussions with the North West strategic health authority and the Department of Health to determine the issues the trust faces and the actions needed to address them.

May I join my hon. Friends the Members for Leeds North West (Greg Mulholland) and for Shipley (Philip Davies) in supporting the children’s heart unit in Leeds? If the review fails to take full account of, and reflect on, the issues raised, what steps will the Secretary of State take to ensure that that is done so that we can fully understand the problems that would face families in Yorkshire?

I understand my hon. Friend’s concern and that of colleagues in other locations across the country. If—I repeat the “if”—the consultation were not to arrive at what he or others in any specific location regarded as justified conclusions, it would be open to them, as this is a service reconfiguration of the NHS, to seek a referral of the proposal to me as Secretary of State.

Diabetes UK has a strategy to reduce the number of people with diabetes across the whole UK. Will the Minister tell the House what discussions he has had with the Northern Ireland Assembly—the matter is devolved in Northern Ireland—to ensure that the strategy of prevention, awareness and education is followed across the whole of the UK?

The hon. Gentleman is absolutely right, because this strategy must contain four elements; it must be about prevention, earlier diagnosis and appropriate self care, and we also have to have world-class research. Discussions with the Northern Ireland Assembly are ongoing.

Professional autonomy need not come at the expense of transparency in the provision of public services. Given that the Department for Education was able to extend the Freedom of Information Act to academy schools, does the Minister agree that it would be healthy for the Act to apply also to GP consortia in the NHS?

I am grateful to my hon. Friend for that. The Health and Social Care Bill establishes the commissioning consortia as public statutory bodies and, as such, that Act will apply to them.

As part of his consultation exercise on NHS reform, the Secretary of State recently visited Liverpool, where he met nurses. When he was listening to the nurses at the Royal College of Nursing conference, what did he hear?

I heard many things, including the nurses’ concerns about front-line services, which I share; Dr Peter Carter has said time and again that he is very worried that the NHS might go through a process of trying to salami-slice services to the detriment of patients when it is actually possible to deliver greater efficiency through cutting out waste, administration and bureaucracy. I agree with many of the things I heard and I want to make sure, as a matter of urgency, that right across the country that efficiency is achieved and we do not act to the detriment of front-line services.

Will the Secretary of State join me in congratulating GP practices in Gloucestershire, all of which have decided to participate in the single consortium taking forward the commissioning of health services? Will he reassure those of my constituents who still have concerns that this whole process is about protecting front-line services and that it is absolutely not about the back-door privatisation of the NHS?

Yes. My hon. Friend makes an extremely important point and his pathfinder consortium in Gloucestershire is focused on how it can deliver more integrated services. One of the things that we are looking for is the integration of services, which has not happened sufficiently in the past. In Gloucestershire, both in the commissioning consortium as it comes together and in the work done by the local authority, we can see how, on the ground, there is determination and enthusiasm to make the modernisation of the NHS work for patients. We must ensure that the legislation supports it.

Order. I am sorry to disappoint colleagues but as is so often the case, demand has exceeded supply and we must now move on.