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.
I thank the Secretary of State for that answer. Will my right hon. Friend reassure me, and my Lincoln constituents, that whatever the outcome of the Government’s consultation, our NHS still requires some measure of reform—and that if a provider is qualified to deliver NHS standards at NHS costs, and if patients, with the support of their doctor, want to be treated there, this Government should do nothing to stand in their way, regardless of any political posturing by our flip-flopping coalition partners? [Hon. Members: “ Ooh!”] And further to—
Through the listening exercise and in response to the report of the NHS Future Forum, which we hope to see shortly, we hope to be able further to strengthen the principles of the Bill and its implementation of the White Paper, so that patients can share in decisions about their care and access the services that give them the best quality. That includes, in many instances, patients having access to a choice of providers as well.
T5. Doctors, nurses and PCT staff in my area tell me that the Government’s pausing of the health reforms has had no impact whatever on the ground, and that implementation of the Health and Social Care Bill is proceeding just as it was before. Does the Secretary of State believe that that is wrong—and if not, does it not mean that this whole consultation period is an absolute farce? (57840)
No, not at all. We were very clear—indeed, I was clear to the House on 4 April when I announced the pause to listen, to reflect on and improve the Bill—that it was specifically related to achieving in the legislation the necessary support for the many changes happening across the NHS. It cannot be right, however, that people across the NHS who are engaging in delivering improved care, redesigning clinical pathways—or designing clinical services to deliver the best outcomes for patients—should be told to stop making those positive changes. They are engaging with those positive changes and we are not preventing them from doing so.
T2. I am wearing neither sandals nor flip-flops, Mr Speaker. Given that local GPs typically charge £500 a day, what action is the Minister taking to ensure that GP consortium board members do not cost the NHS as much as £25,000 each a year for just one day’s work a week? (57837)
Among the intentions that we have made clear from the outset is our intention to reduce the running costs of management in the NHS. We propose to cut administration costs by a third in real terms, including the running costs of the commissioning consortia when they are established. There will be a constantly tight envelope for running costs, which means that whoever is working for a commissioning consortium, it must deliver value for money.
T7. For the 200,000 people in the country with dementia who are currently in residential care, the recent horrific events at Winterbourne View and the financial problems at Southern Cross have caused huge anxiety. The Minister is now proposing to make local authority safeguarding boards mandatory, at a time of huge cuts in social care budgets. What extra resources will he make available to ensure that the system works and protects the most vulnerable people in our country? (57842)
I think that Members throughout the House share the right hon. Lady’s concern about the events that were revealed in more detail last week. We will deal with an urgent question on one of the other matters later this afternoon. She also asked about funding for social care. In last year’s spending review we not only secured additional resources enabling us to put safeguarding boards on a statutory basis, but ensured that by 2014 an additional £2 billion would go into social services. Much of that will come via the NHS to ensure much closer working between health and social care services, which is an essential prerequisite for the delivery of better outcomes for people with dementia.
T4. One of my constituents, a vulnerable young adult with complex needs, was recently sectioned under the Mental Health Act 1983, taken from the family home, and placed in Winterbourne View. The mother was very concerned about her child’s care there, and contacted me. However, I was told by adult social services that I could not know the details of the case because of data protection. When reviewing the regulations involving vulnerable adults, will the Minister ensure that questions from Members of Parliament about such cases can be answered, so that they can stand up for even their most vulnerable constituents without their express written permission? (57839)
I am grateful to the hon. Lady for highlighting that issue. I think that Members in all parts of the House experience the same frustration from time to time when they feel that they are unable to discharge their responsibilities on behalf of constituents and obtain the information that they think they need in order to do that job. I will certainly undertake to examine the issue again. Patient confidentiality is complex and we must respect the confidentiality of individual patients, but we should not let that get in the way of ensuring that good-quality care is delivered.
T8. When I asked the Minister about Southern Cross on 2 December, he replied:“The responsibility for providing or arranging publicly supported residential accommodation under section 21 of the National Assistance Act 1948 rests with councils with adult social services (CASSRs), not the Department. Any discussions regarding continuing provision for residents of care homes should take place between care providers and CASSRs.” —[Official Report, 2 December 2010; Vol. 519, c. 1014W.]Does the Minister now regret that complacent and wholly inadequate reply, which lost vital months in which the crisis could have been dealt with? (57843)
No, because it was an accurate statement of the legal position, which is what the question required.
Since these issues became a cause for concern many months ago, the Department of Health has been very much engaged with them at both official and ministerial level. We have also ensured that all parties—the local authorities, the Care Quality Commission and others—are clear about their responsibilities. I should have thought that that was what the hon. Gentleman would expect us to do, and it is what we have done. We are ready for any eventuality.
T6. Croydon University hospital recently took on responsibility for community care, which will allow much better integration of acute and community services. What scope does my right hon. Friend think exists for wider application of that model in our NHS? (57841)
As my right hon. Friend the Prime Minister made clear today, we continue to believe that we can achieve more integrated services for patients, and we are determined to do so. That must be at the heart of the way in which reform and modernisation of the NHS deliver improving outcomes for patients. For patients, the results of care, and indeed their experience of it, will be greatly enhanced if it is designed and integrated to meet their needs. We know that that is effective, we know that it works for patients, and we are determined to make it happen. My hon. Friend has given just one example, and an important one, of the way in which hospital and community services can be integrated.
The Prime Minister has stated this afternoon that competition will be an integral part of patient choice. How will the Secretary of State ensure that all patients are able to make a fully informed choice of treatment when market forces fully exist?
I do not accept the hon. Lady’s premise. We do not intend that there should be an unrestricted market—or a free market, as she described it—in the NHS. It is a regulated, social market with powerful regulations governing how the participants in the provision of care meet their responsibilities. We are very clear that competition is a means to an end. It is not an end in itself; it is there to support the integration and delivery of services in the best interests of patients, but it does include giving patients choice. The hon. Lady highlights an important point. In our consultation earlier this year on the information revolution in the NHS, we set out how we felt we could empower patients, including those for whom in the past the NHS has provided a rather impenetrable route to getting the best treatment. I hope that when we respond to that consultation, we will demonstrate how we will make that better for all patients.
Certainly I agree that MS patients should have access to clinically effective and cost-effective treatments. The National Institute for Health and Clinical Excellence has not issued any guidance on the use of Sativex, and it is for primary care trusts to make funding decisions based on the available evidence and the individual patients’ circumstances. Following consultation, NICE expects to make a decision later in the year on whether to update its clinical guidance on MS, and whether to re-evaluate Sativex as part of that.
There are 12 Southern Cross homes in Aberdeen, nine of which are in my constituency. Just in the past month, one of them, Eastleigh in Peterculter, received a damning report from the Scottish care commission. Is it any wonder that relatives of the people in those homes are concerned that the company that runs them is in financial difficulty, and that the quality of the care provided may suffer as a result? Over the past few years I have also been approached by constituents about self-funders facing unfair cost increases in order that their home might be able to overcome its financial difficulties.
As I said earlier, the key concern of this Government—and, I think, of all Members—is to ensure the continuity and quality of the care of residents in Southern Cross homes. That has been the purpose of the Government, and of all the other agencies involved, throughout our engagement with Southern Cross. It is also important that the quality inspectorates in both Scotland and England continue to discharge their role of making sure that the essential standards of safety and quality are being maintained.
As the public health White Paper recognises, building positive self-esteem is important for children’s health and well-being. Yesterday, the Bailey review highlighted many parents’ concerns that exposure to very sexualised imagery in our visual culture fuels children’s anxieties about their bodies and reduces self-esteem. How do the Government plan to tackle that as a growing public health issue?
I thank the hon. Lady for her question. She raises an important point about children’s exposure to such imagery from a variety of media sources. It is crucial for the future public health of our country that children get help and support over this and are able to learn the skills they need, and we are determined to get that right. Many of our plans are laid out in the White Paper, and we look forward to seeing them become a reality.
Can the Secretary of State or the Minister confirm whether they will take up the offer from my Front Bench for bipartisan discussions about the future of adult social care—or will he put political interests before the public interest?
We were very clear that the commission that we established, led by Andrew Dilnot, should look at the reform of long-term social care funding in such a way as to secure maximum understanding, consensus and agreement. Andrew Dilnot has gone about that process in an exemplary manner, and the right thing for us to do now is await his report, which should then form a basis for taking things forward.
I am sure that my hon. Friend is aware of the evidence—for example, in reports published by the London School of Economics and by Imperial college, London—on this country’s experience of the Labour party’s implementation of choice in elective care and the impact that had on the quality of services. What is clear from that evidence is that where there was an NHS price—a tariff structure—the more competitive areas of the country secured greater improvements in quality.
I thank the Secretary of State for writing to me on 12 May about the listening exercise and its cost, although he could not quantify that. Now that the listening exercise is over, can he say how much the cost to the public purse has been?
I will, by all means, write again to the hon. Lady. The cost is not dramatic. Many organisations and people across the NHS have participated, giving freely of their time. Some 8,000 people have participated in the listening exercise events, of which there were more than 250. This has been immensely valuable; its value far exceeds any costs involved.
A constituent of mine who suffers from bowel cancer has so far failed to be funded for Avastin on the NHS via the east midlands cancer drugs fund. She has already spent more than £40,000 of her own money. Her oncologist has written before on her behalf to appeal, but as not one of his appeals has been successful, for her or for any of his other patients, he is reluctant to write again to appeal for her, although she desperately needs this. What assurance can the Secretary of State give my constituent and her consultant?
My hon. Friend is assiduous in representing her constituent, and I will gladly discuss this matter further with her to see what the situation is. I should, however, emphasise that these are decisions being made in the use of the resources to deliver access to new cancer medicines for patients by clinical panels in each region—in each strategic health authority. To that extent, I am not seeking to substitute my judgment for that of the senior clinicians involved. None the less, if it would help my hon. Friend I will also arrange for the national clinical director for cancer services to have a discussion with her constituent’s consultant to examine this case.
I share my hon. Friend’s concerns, and those of his constituents, about the appalling situation whereby not only were ISTCs paid more than the NHS, but they were paid considerable sums for doing no work at all. It was a sham and a waste of money that could have been spent on front-line services, and I can give him the categorical assurance that it will not happen under this Government, or under my right hon. Friend the Secretary of State.