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Oral Answers to Questions

Volume 533: debated on Tuesday 18 October 2011


The Secretary of State was asked—

Organ Donation

Sustained work at national, regional and local level has seen an increase in donor rates by some 28% since 2008. We continue to work with a large number of organisations, such as the Give and Let Live initiative in schools, which is run by NHS Blood and Transplant. Other initiatives include requiring people to answer a question about organ donation when applying for a driving licence and to sign on the organ donor register when applying for a European health insurance card or for a Boots advantage card. We also have specific initiatives within the black and minority ethnic populations, such as working with faith groups and local radio stations.

I recently met young campaigners from Sign Up, Speak Up, Save Lives whose organ donation campaign features on Channel 4’s “Battlefront” programme. Will the Minister please meet Hope, Abby and me, together with the Minister responsible for constitutional reform, so that we may discuss with them both our idea of inviting people to join the organ donor register at the same time as they will soon be asked to join the electoral register?

I congratulate Sign Up, Speak Up, Save Lives. I am happy to meet Hope, Abby and the hon. Gentleman, along with the Parliamentary Secretary, Cabinet Office, my hon. Friend the Member for Forest of Dean (Mr Harper). The electoral registration form has been used as an opportunity. In 2000 there was a campaign called Vote for Life, which was stopped after about 15 months because of problems with the Representation of the People Act. I would be happy to revisit it and would enjoy an opportunity to discuss the matter further. Anything we can do to get those rates up matters.

The reorganisation of NHS procurement has been described in a National Audit Office report as fragmented and poor value for money. The report shows—

What discussion has the Minister had with Welsh Ministers who are bringing forward legislation for an opt-out system of organ donation? If she has had such discussions, what conclusions has she drawn?

The Government will examine thoroughly the detail of any Assembly Bill when it is laid before the Assembly, but I urge Wales to look at the evidence. We can look back to what happened in Spain, where there was presumed consent for 10 years without any shift in organ donation rates. The issue is more complex than that. It is about organ donor transplant co-ordinators and increasing donations from emergency medicine. A number of measures need to be put in place to increase those rates.

Will my hon. Friend be kind enough to meet Mr Adam Crizzle, who was the original inspiration behind the Give and Let Live organ donation programme in schools, to see how the promotion of this excellent scheme might be further improved?

I would be very happy to meet that gentleman. There is no doubt that promoting this in schools has a profound impact and is an opportunity to change people’s attitudes to organ donation and, more importantly, makes families discuss it, which is critical. It is not just about signing on to the register.

Last week I had the opportunity to meet members of the Ticker club, an organisation of former heart patients who continue to provide support to patients at Wythenshawe hospital, a specialist centre for cardiac and thoracic surgery, including heart and lung transplants. They have strong opinions on organ donation, so will the Minister agree to involve such groups in ongoing campaigns to raise awareness of the benefits?

I thank the hon. Gentleman for raising that issue. My right hon. Friend the Secretary of State has visited that hospital, and I am happy to work with any group. I reiterate the fact that we particularly need to work with black and minority ethnic groups, in which the rates of donation are truly dreadful: 23% of people on waiting lists are from black and minority ethnic communities, but only 1.2% of those on the register are from that same group. We need to do everything we can to improve those rates.

NHS Hospital Indebtedness

The national health service is forecasting a surplus for 2011-12, but the previous Government left a legacy of up to six hospital trusts whose private finance initiative payments are a risk to their financial sustainability and up to 24 trusts with such high levels of debt, following years of bail-outs, that they might not meet tests of their future financial sustainability. We are working with all of those to identify their individual needs so that we can help trusts to achieve consistent standards of quality and financial sustainability, and I will make an announcement on that later this year.

I thank my right hon. Friend for spelling out the appalling debt that some parts of the NHS inherited from the previous Government. Can he assure me and the House that this Government will deal with the root causes of hospital debt, rather than with the continuing bungs and bail-outs that the previous Government left?

My hon. Friend is absolutely right. We are determined to root out poor performance, by which I mean not only that we should deal with waste, inefficiencies and poor value for money in the NHS, but that we must identify where standards and quality of care are being met. Both are equally important, and one depends on the other. He will know from the Royal Berkshire NHS Foundation Trust how important it is to sustain finances and quality through foundation trust status. We are seeking to ensure that many NHS trusts reach foundation trust status, something that the previous Government failed to achieve and we aim to achieve.

The Secretary of State will be aware of the indebtedness of the Royal Cornwall Hospitals NHS Trust, and that Cornwall as a whole has suffered a disadvantage for many years as a result of the previous Government’s funding formula, having actually received less than the Department’s target budget for many years. Does he agree that such factors should be taken into account when deciding how to reschedule the debts of such trusts?

My hon. Friend will know, from our conversations and from my visit to Cornwall and the Royal Cornwall Hospitals NHS Trust, the steps that we are taking alongside other NHS trusts to bring them up to high standards of care and financial sustainability. In that regard, the 3.1% increase in revenue allocations for the Cornwall and Isles of Scilly primary care trust between last year and this year will help Cornwall as a whole towards greater financial sustainability.

I am grateful, Mr Speaker. On indebtedness, the National Audit Office has produced a report on NHS procurement in England, which it describes as “fragmented” and “poor value for money”. The report shows that £500 million could be saved each year if trusts came together to buy products more collaboratively. Is this further evidence that the Government are wrong to pursue an agenda of competition, rather than co-operation?

I am afraid that the hon. Gentleman is completely wrong about that. In procurement throughout the NHS, what we have had is fragmentation, and what we need is better co-ordination. That is precisely why, since the election, for example, we have instituted a consistent bar-coding system, allowing procurement throughout the NHS to be undertaken more effectively; and why under the quality, innovation, prevention and productivity programme, the improvement in procurement —reducing the costs of procurement—is intended to achieve those savings and more.

Labour is proud of its legacy, with more than 100 new hospitals built to replace the crumbling Victorian buildings that we inherited in 1997, and it is not just the National Audit Office that has blown a hole in the Secretary of State’s assertion that 22 hospital trusts are on the brink of financial collapse due to PFI. John Appleby of the King’s Fund said:

“The…pressures on hospitals are not to do with PFI but…the need to generate £20bn worth of productivity improvements.”

Is not the real issue that the Secretary of State has tied up the NHS in a distracting and wasteful reorganisation that will cost more money than it will save, and take money away from patient care?

I welcome the hon. Gentleman to the Opposition Front-Bench position. We are looking forward to the exchanges with him and his colleagues, including during questions today.

Twenty-two trusts have told us, in the course of our looking at where the impediments are to their financial sustainability for the future, that the nature of the PFI contracts entered into by the previous Government is a significant problem in this respect. It is absolutely right for the NHS to build hospitals, which is why we are, for example, building a new hospital at Whitehaven in the hon. Gentleman’s constituency. [Interruption.] I beg his pardon—in the constituency of the hon. Member for Copeland (Mr Reed); we are building so many new hospitals. The nature of the PFI projects we enter into must be to provide value for money and be sustainable in the future. That is something that the previous Government failed to achieve.

Urgent Care

3. What representations he has received on the reorganisation of urgent care in the past six months. (74849)

A search of the Department of Health’s database revealed that 131 items of correspondence, and five parliamentary questions relating to the reorganisation of urgent care were received in the past six months. In addition, I have received three requests to meet MPs on this subject.

Wycombe hospital is currently going through a consultation on a change to urgent care services, and it is doing so in the context of the betrayal felt after “Shaping Health Services” in 2004, which removed our accident and emergency department. I would like to escape this cycle through mutuality. What is the Government’s position on mutuality? Will the Minister join my call for directly owned community health services?

The Government have supported the right to request, which has enabled 45 staff-led social enterprises to be established. This policy has supported approximately 25,000 staff into social enterprises, with contracts of roughly £900 million. NHS staff have been assisted by a wide-ranging programme of support from the Department.

Has not the Government’s so-called moratorium on the reconfiguration of services put back improvements to urgent care by several years? The Minister inherited perfectly coherent plans for every region in England under the auspices of Lord Darzi’s next-stage review. How many lives have been lost and how much money has been wasted by the tearing up of those plans?

I am afraid that the right hon. Gentleman is wrong. It is not holding back the national health service; it is moving it forward with things such as the establishment of the 111 service and the reconfiguration proposals, which are based on the four tests that my right hon. Friend the Secretary of State introduced in May last year. That not only links reconfiguration to the needs of the local health economy but takes into account the wishes and needs of the local community and medical staff.

Does my right hon. Friend agree that the improved delivery of urgent care right across the health service is one of the great challenges facing the new commissioning structure and one of the great opportunities to deliver more integrated services that deliver better value and better quality to patients?

I am extremely grateful to my right hon. Friend; speaking with the authority of the Chair of the Health Committee, he is absolutely right. It is the way forward to drive improvements in service, raise standards and ensure that there is high-class, quality care at an urgent care level and across the acute sector.

Public Health

4. What assessment he has made of the potential effects of NHS reorganisation on the protection and improvement of public health. (74850)

Our reforms put public health at the heart of the new system. The creation of Public Health England, alongside significant new functions and, for the first time, ring-fenced budgets for local authorities, will give public health an unprecedented level of priority. The new local authority role integrates public health with other local authority functions that impact on people’s health.

Under the previous Government, NHS Hull saw excellent results in improving public health. Under the current Government, Kingston upon Hull’s teaching primary care trust has seen a 2.6% cut this year compared with Kingston upon Thames PCT getting a 2% increase—and Hull city council has a 9% cut in its funding as well. What does the Minister think will happen to public health in areas such as Hull with those kinds of cuts?

I think that public health in areas such as Hull will do exceptionally well. I point out to the hon. Lady that under the previous Government, what happened in practice was that public health budgets were raided constantly and we did not get improvements. If she looks at the figures, she will see that inequalities in health widened.

Does my hon. Friend agree that despite the previous Government’s good intentions on public health, health inequalities have widened, as she has rightly said, obesity rates are going up, smoking among young girls is going up, and alcohol abuse is a serious problem? Does she agree that it is right to deliver services with local authorities and to get into local communities and schools if we want to address these big public health challenges?

My hon. Friend is absolutely right. Local authorities have a long and proud tradition of improving the public’s health. Public Health England will bring together a fragmented system and strengthen our national response on emergencies and health protection. It will help public health delivery at a local level with proper evidence and leadership.

Contrary to the Minister’s statement that the Health and Social Care Bill will put public health at the heart of the health service, 40 directors of public health and 400 public health academics, including Michael Marmot, wrote to The Daily Telegraph to say that the Health and Social Care Bill will

“widen health inequalities; waste much money on attempts to regulate and manage competition; and undermine the ability of the health system to respond…to communicable disease outbreaks”,

and that it will

“disrupt, fragment and weaken the country’s public health capabilities.”

How can the Minister put her judgment against that of those doctors and experts? Is not the proposal that more than 40 specialist neonatal units may lose staff in the coming year an example of the weakening of public health that is involved in the Bill and the Government’s proposals?

I draw the hon. Lady’s attention to the fact that the Health and Social Care Bill proposes for the first time a duty on the Secretary of State to have regard to health inequalities, which, I repeat, widened under the previous Government. I also point out to her that the letter to peers signed by Professor Marmot and others welcomed the emphasis on establishing a closer working relationship between public health and local government. I suggest that the hon. Lady gets out more, because she would hear from public health doctors and local authorities on the ground who welcome these changes.

NHS Hospital Finance

5. What steps he is taking to reduce the burden on NHS hospitals of (a) PFI repayments and (b) debt. (74851)

A study conducted by the Treasury has identified savings opportunities of up to 5% on annual payments in NHS PFI schemes. The Cabinet’s Efficiency and Reform Group is rolling out a programme of work to secure savings of up to £1.5 billion across the 495 PFI contracts in the public sector in England.

Contrary to the earlier complacent comments of the Opposition spokesman, some national health trusts are paying up to 20% of their revenue to PFI contracts. What steps can we take to ensure that the payments are reduced and that the same terrible financial situation never happens again?

I am grateful to the hon. Lady. I, too, recognise the small number of organisations that are reporting financial challenges. The Department is continuing to work with strategic health authorities to ensure that those organisations have robust plans in place for financial recovery, while ensuring the quality of services for patients.

On the subject of financial pressures on hospitals, does the Minister recall the circular to hospitals from Monitor that was smuggled out on the eve of the royal wedding, which raised the requirement for efficiency cutbacks on hospitals from 4% to 6.5%, which is more than £1 billion in this year alone? Will he admit that the service cutbacks that we are seeing in many hospitals around the country are deeper, as that circular confirms, directly because of the Government’s policies?

No, I do not recognise that, because the figure that the right hon. Gentleman has used is an upper calculation, not an actual figure. I say to him that we are making efficiency savings, and that trusts should be cutting not front-line services but inefficiency, waste and excessive management, and reinvesting every single penny in front-line services.

Treatment Options

6. What steps he is taking to ensure that patients receive accurate and unbiased information on treatment options. (74852)

The NHS constitution gives people a right to information about their treatment options. I want everyone to get timely, trustworthy information such as patient decision aids, so that they are involved in their care decisions. The Health and Social Care Bill will ensure that the commissioning board and clinical commissioning groups secure that.

In the light of that answer, will the Minister condemn the decision by GPs in Haxby to use NHS data to tout the services of their own private company and give wrong information to patients? Or is that simply a foretaste of what will happen under the Health and Social Care Bill when clinical commissioning groups decide what services are necessary, leaving private companies in which they may have an interest to pick up the slack in a privatised, marketised NHS in which patients come last?

The hon. Lady is spreading yet more myths and misconceptions about the reforms that this Government are making. If she had researched the matter more thoroughly, she would know that there is a code of conduct for the promotion of NHS-funded services, which makes it clear that providers of primary medical services cannot directly or indirectly seek or accept from any of their patients payment or other remuneration for any treatment. As a result, the PCT is questioning that clinic about how it has used patient information and will continue to pursue the matter.

Does my hon. Friend agree that many patients look to NHS Choices for accurate and unbiased information? Is he aware that its site on homeopathy is both biased and inaccurate? As the Department has had a long-standing review that has not reported, will he—

If the hon. Gentleman would care to write to me setting out where he believes there are inaccuracies, we will examine them.

It is good to be back. I see that in my absence, the Secretary of State has at last made some progress with his plans for a US-style health care system.

I have a letter sent by the practice that my hon. Friend the Member for Warrington North (Helen Jones) mentioned a moment ago, in which it wrote that

“we can no longer offer your procedure as one of our NHS services…I am writing to make you aware of some of the options that you have to have the procedure completed as a private patient.”

Helpfully, it enclosed a leaflet announcing the practice’s new private minor operations service. Can the Minister point me to any part of the Health and Social Care Bill that will prevent that practice in future?

I wonder whether the right hon. Gentleman could have pointed me to any such arrangements in current legislation. There is none. However, Dr David Geddes, the medical director of NHS North Yorkshire and York, has stated:

“We have some concerns about the activities of the Haxby and Wigginton health centre in York and we will be discussing these issues with them directly as a matter of urgency. These concerns are around possible breaches of the Data Protection Act and the accuracy of the information sent to patients. For example, of the eight procedures they list, three are routinely funded by NHS North Yorkshire and York”.

Let us be clear that when he was Secretary of State, that PCT was in a worse financial state.

That is total bluster, because that vision is precisely what the Government want to do to our NHS. As my hon. Friend the Member for Warrington North said, it is a terrifying glimpse of a Tory NHS in future—not a national health service but a postcode lottery writ large, in which, as we read today, random rationing is taking place around the country. The NHS is in chaos because the Secretary of State made the mistake of combining a £2.5 billion reorganisation, at a time when every ounce of energy should be focused on the NHS front line. This Secretary of State has placed our national health service in the danger zone, and he has lost the confidence of GPs, nurses and midwives. Is it not time that he stopped digging in, listened to NHS staff and dropped this damaging Bill?

That was a good example of bluster—perhaps that is what we will see from the Opposition under the right hon. Gentleman’s stewardship.

The right hon. Gentleman ought to be aware, because it happened on his watch, that primary care trusts and strategic health authorities have seen their management costs increase by more than £1 billion. There was a 120% increase from 2002 to when this Government took office. That is why we are determined to cut overhead costs in the NHS, so that we can reinvest every penny in the front line.

Heatherwood Hospital, Ascot

7. What recent representations he has received from Berkshire East primary care trust on the future of Heatherwood hospital in Ascot. (74853)

My constituents are shocked to discover that yet again, the future of Heatherwood is under threat. I have had sight of a major petition, and I am actively campaigning with hard-working local councillors, activists and residents to uncover why Heatherwood’s future is under threat when the funding from the Government to the region has increased. Does my right hon. Friend agree that the Berkshire East PCT must cut its bureaucracy costs and introduce efficiencies before threatening the money to Heatherwood hospital and other local services?

I am grateful to my hon. Friend and completely understand what he is saying. In this financial year compared to the previous one, revenue available to Berkshire East PCT increased by £16.3 million. That is just one part of the £3.8 billion increase in revenue resources available to the NHS this year compared with last year.

Although I very much welcome the shadow Secretary of State to his new position, we will miss his predecessor. We welcome the new shadow Secretary of State not least because he might begin to explain to the NHS why he thought it was irresponsible to increase resources to the NHS in real terms by about £3.8 billion—

Order. I am grateful to the Secretary of State, but we have a lot to get through. He will resume his seat—and I know he will do so happily.

One reason for those increases in resources is the growing birth rate in that part of Berkshire. Slough mums who want to use the Ascot birthing centre at Heatherwood have been locked out since the end of September because of a lack of midwives. If the Government had provided the 3,000 midwives they promised, that centre would not be shut. What does the Secretary of State say to that?

As the hon. Lady knows, I am very familiar with Heatherwood, because I have two daughters who were born there in the days when it had an obstetrics service, which disappeared under the previous Government. She also knows that I visited Wexham Park in September last year to announce support to the trust in the form of loans, based on commercial principles, totalling £18 million. There is no shortage of midwives under this Government compared with the previous one. Since the election, 522 additional midwives have been recruited, and we are maintaining a record level of midwifery training places.

Decisions made locally are a matter for local commissioners. If they seek to change services, they must meet the four tests that I set out shortly after the election.

The hon. Member for Windsor (Adam Afriyie) is absolutely right to raise concerns about the future of Heatherwood hospital, as are Members on both sides of the House who raise such concerns about their hospitals, such as Chase Farm.

The Health Service Journal reports that the Department of Health is discussing a hospital closure programme, and yet the Prime Minister has promised to fight bare knuckled against any hospital closures. Will the Secretary of State tell us today categorically—yes or no—whether it is still his policy to have a moratorium on hospital closures? If so, for how long will the moratorium last?

I welcome the hon. Gentleman to his position. The Government are rebuilding his hospital, so it is slightly ironic that he attacks us on that point.

The answer to the hon. Gentleman’s question is that the Government are pursuing no plan for hospital closures. We are doing precisely what I said we are doing: we are working with hospital trusts across the country to ensure that before they reconfigure their services, they must meet key tests on patient access and choice, local authority support, commissioners’ views, and the clinical safety and evidence base. We are working with many of the NHS trusts that the previous Government left in a serious position to ensure that they reach quality and financial sustainability.

Children’s Heart Surgery

8. When he expects to make a final decision on the safe and sustainable review into children’s heart surgery units in England. (74854)

This is a clinically led, independent review, within the NHS. The joint committee of primary care trusts, on behalf of NHS commissioners, will make decisions on the future pattern of children’s heart surgery services in England. The review is expected to report before the end of the year.

I am sure that the Secretary of State recognises the huge and spirited campaign by local people to retain the children’s heart unit at Leeds general infirmary. Will he confirm that option E, which would retain the Leeds unit, will receive full and equal consideration by the joint committee of primary care trusts?

The review will develop the recommendations to ensure that children’s heart surgery services deliver the very highest standard of care for children and their families. The joint committee of primary care trusts will consider all the relevant evidence before making a decision on the future configuration of children’s heart surgery services, and I hope that that will reassure my hon. Friend.

I should emphasise that no aspect of this review is driven by money: it is entirely about how to ensure sustainable high-quality surgery. The issue is in how many and which centres surgical teams should be based in order to maintain that high-quality care.

There is a deep-rooted belief that this review is biased against the survival of the Leeds unit. Will the Minister therefore please assure the House that the decision will be made purely on the evidence, and not on the basis of any preconceived idea of which units should survive and which should not?

It is an independent review and I can assure the hon. Lady that that is indeed the case. It will be based on the evidence. I am sure that she will have heard the response to a debate earlier in the year by the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), who said that while the review has put forward options for consideration, it should not be constrained to consider only those options.

Will my right hon. Friend confirm that the criteria for the review remain the same; that the rather strange remarks—about more people having voted for one option but more organisations having voted for another—have not affected them; and that those criteria will be used to judge the decision?

This review came about as a result of the tragic Bristol heart babies scandal in the 1990s, and it is a measure of the quality of services at Bristol children’s hospital that it is now being considered for all four options under the consultation. A few weeks ago, I abseiled down the children’s hospital for Wallace & Gromit’s Grand Appeal, which is an excellent charity. However, will the Secretary of State assure me that, with the move to fewer and larger specialised units, they will be properly funded and will not rely on MPs throwing themselves off tall buildings?

I am grateful to the hon. Lady. All the representations that we have received in the debates in this House are ample evidence of the high regard and support that Members have for their children’s heart surgery services. None of this is about saving money or resources. It is entirely about what delivers the best quality surgical services for children with cardiac problems. To that extent, the intention is that those services—once the decision has been made—are fully funded.

Foreign Nationals (NHS Services)

9. What progress he has made on reducing the number of foreign nationals using NHS services without payment. (74855)

We have updated and simplified regulations and guidance on identifying and charging visitors who must pay. Immigration rules now before Parliament will allow the UK Borders Agency to refuse entry to visitors with an unpaid debt to the NHS, and we are now reviewing this area more fundamentally to identify further improvements.

I thank the Minister for that answer. On 19 July, I spoke in the House about foreign nationals using the NHS without payment and, having entered a freedom of information request to each foundation trust and PCT, I now have a more accurate picture of the sums involved. It suggests that some £15 million has been completely written off. Will the Minister meet me to discuss the findings and what possible solutions might be found to tackle this important issue?

I share my hon. Friend’s concerns about this important issue and challenge for the NHS. I would be more than happy to see the results of his FOI request, and I or a colleague would also be happy to meet him to discuss the matter further.

There is a relatively painless way to deal with this. At the time that the visa is applied for, the person should sign an undertaking that they will pay the costs of NHS treatment. Will the Minister talk to the Minister for Immigration to see whether it is possible to introduce such a requirement?

I am grateful to the right hon. Gentleman. We are looking at a range of options and I am more than happy to pass on his suggestions to my hon. Friend for them to be considered.

Care Sector (Uniforms)

10. What representations he has received on the need for effective and clear distinction in uniforms worn by fully trained nurses and other workers in the care sector. (74856)

The Department receives occasional representations from individuals and groups about uniforms, including the need to distinguish between staff groups. Guidance is available to help employers set sensible policies and, in line with Government policy to reduce central control, we expect decisions on uniforms to be made locally.

There is real concern about the lack of distinction between the uniforms worn by qualified nurses and care workers. The latter are free to wear whatever uniform they like and often give the impression that they are medically qualified. This presents a risk to patients, especially because more and more vulnerable elderly patients are being treated in their homes. Will the Minister look again at this to see what action could be taken to clarify the situation?

My hon. Friend has written to me about this matter on behalf of a constituent. The responsibility sits in three places: first, providers have a responsibility to provide clear information to people receiving services from them about who is providing that service; secondly, commissioners have a responsibility for how they contract for those services; and thirdly the Care Quality Commission has a responsibility to regulate those services. Undoubtedly, however, I would be more than happy to look further at the points he makes.

Neuromuscular Services

11. What assessment he has of the provision of ventilation machines and related equipment for patients with muscle-wasting diseases who experience respiratory difficulties; and if he will make a statement. (74857)

Local health bodies have responsibility for ensuring that adequate provision of health services is made available to those living with neuromuscular conditions. All specialised commissioning groups have now completed their reviews of neuromuscular services, which are a priority in the annual work plans of each of the specialised commissioning groups in 2011-12.

I thank the Minister for that answer, but will he also outline the steps being taken to ensure that there is adequate knowledge about neuromuscular conditions among general practitioners and health professionals in Lincoln, so that referrals to the specialist respiratory service in Nottingham can be provided as appropriate?

My hon. Friend is right to raise the issue of ensuring sufficient awareness of the pathways that exist for people to gain access to those services. I understand that the east midlands specialised commissioning group has recently carried out a review of non-invasive ventilation services. I shall ask the group to write to him in more detail.

NHS Service Access

The NHS constitution gives patients the right to make choices about their care. The Government are committed to empowering patients. Our goal is for patients to have more choice of treatment.

What steps is my hon. Friend taking to ensure that my constituents requiring cardiac services will have access to the care that they need in Leeds?

My hon. Friend raises an important and controversial issue, as he will have heard when listening to my right hon. Friend the Secretary of State earlier and the debates that he has attended in the House on this subject. We are determined that proper facilities will be made available, based not on money but on the high quality of care, particularly for children. An independent review is being carried out by the joint committee of primary care trusts, which is expected to announce its recommendations later this year.

Has the Minister considered exchanging expertise with the regions of Scotland, Northern Ireland and Wales? That exchange could take place without any charge.

The hon. Gentleman raises a valid point. The NHS in England has regular contact and discussions with the NHS in other parts of the United Kingdom, and will continue to do so because both the UK and the devolved authorities can learn a considerable amount from sharing views and practice.


The Minister might know that the midwife-led unit at Salford Royal hospital is due to open in the next few weeks, and I want to put on the record my thanks to the midwives there who carry the heaviest work load in the north-west and are doing a brilliant job. She will not know, however, that last year there were 2,500 extra births in Greater Manchester that were neither expected nor planned for, that there are current vacancies for midwives at St Mary’s hospital and that mothers are being pressured to leave hospital sometimes within two or three hours of giving birth. What assurances can she give me that the same standards of safety and quality applying at Salford Royal will be available to Salford families in the future?

We need to ensure that they are, which is one of the reasons we have asked the Centre for Workforce Intelligence to undertake a pretty in-depth study of the nursing maternity work force during 2011-12. I can reassure the right hon. Lady that the current number of midwifery students entering training is at a record level—more than 2,500—and I join her in paying tribute to our midwives.

After the recent inquiry into the Furness General hospital maternity unit, will the Minister confirm that she will give full support to midwives across the Morecambe Bay trust area and that the excellent midwife-led unit at Westmorland General hospital in Kendal will be protected?

I always give my full support to midwives, but we must not forget that this is about teamwork as well. There has been an increase in the number of maternity support workers, who also play a critical role, as do the obstetricians and gynaecologists, all of whom have increased in numbers as well.

Hospital-Acquired Infections

The NHS is making significant process toward the zero-tolerance approach that we have made it clear it should adopt in respect of all avoidable health care-associated infections. Over the past 12 months MRSA bloodstream infections have fallen by 29% and C. difficile infections have fallen by 17%.

I thank the Secretary of State for his reply. Will he confirm that the Government will continue with the zero-tolerance approach to hospital-acquired infections as the only sure way to resolve and eradicate this problem?

Yes, my hon. Friend is absolutely right; indeed, we are extending the range and frequency of the publication of data relating to infections to support the NHS in that work. With his commendable consistency, my hon. Friend asked a question on exactly this subject on 8 March, when he raised the issue of the Barking, Havering and Redbridge trust. I am pleased to be able to report that in the past five months C. difficile infections in the trust have fallen by 57% in comparison with the same five months of 2010, while MRSA bloodstream infections have been reduced by 25%. I expect the trust to continue to bear down on those and other infections in future.

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.

In the wake of the former Defence Secretary’s resignation and the fact that 40 peers who voted on the Health and Social Care Bill have private sector health interests, and given the Secretary of State’s known connections with private health care companies, can he assure the House that he has been as transparent as possible about the influence of private health care companies on the passage of the Bill?

I am sorry, but I think the hon. Lady should withdraw that. I have no connection with private health care companies, and if I did, I would have entered it in the register of Members’ interests.

I am grateful to the Secretary of State, who has put the position very explicitly on the record.

T2. The coalition agreement states:“Doctors and nurses need to be able to use their professional judgement about what is right for patients and we will support this by giving front-line staff more control of their working environment.” That being the case, can my right hon. Friend explain why, despite national clinical guidelines, GPs in my constituency face financial penalties if they do not meet targets for reducing the cost of the drugs that they prescribe? (74873)

I am grateful to my hon. Friend, and I understand that Kent and Medway primary care trust is working to incentivise the optimisation of medicines usage. We provide advice through the National Prescribing Centre and in other ways, and we support that work with GPs through the structure of the quality and outcomes framework. However, this is about incentivisation for best prescribing practice, not about financial penalties.

Many families will be deeply concerned about standards of care for older people in hospitals following the Care Quality Commission’s recent report. Patients and the public must be confident that all the necessary steps are being taken immediately to tackle this issue. Months after its initial inspections, will the Minister confirm that the CQC has revisited only six of the 17 hospitals that were failing to ensure that older people had enough food and drink, and if so, can he explain why?

Let me make it clear to the hon. Lady, whom I welcome to her new responsibilities, that the reason the Care Quality Commission undertook unannounced nurse-led inspections in hospitals to look at issues of dignity and nutrition was that I asked it to. As an independent regulator, it must make its own decisions about what it does, but I have been clear in my conversations with the Care Quality Commission that it is moving from the tick-box regulatory approach inherited from Labour to one focused on going out there and finding out where there is poor performance. The CQC is shining a light—not least at our request—on poor performance and poor care in the NHS, and it will continue to do so.

Order. I remind the House that there is intense interest, and therefore there is a premium on brevity from Back and Front Benchers alike.

T4. Several of my constituents, including members of the Cure the NHS group, have raised concerns over the way in which “Do not attempt resuscitation” notices are used in hospitals. Will the Secretary of State tell the House what the NHS is doing to ensure that the national guidance is followed? (74876)

This is an area in which the medical director of the NHS, the General Medical Council and others issue guidance to the NHS. I will gladly write to my hon. Friend setting out the details.

T3. I know that I am not alone in being an MP who represents pharmacists who are struggling on a daily basis to access life-saving drugs to treat asthma, diabetes and cancer, even to the point at which some of them are running out of those products. What more can the Secretary of State do to ensure that manufacturers and wholesalers have those life-saving drugs that people’s lives depend on? This is not good enough. What more can the Government do? (74875)

The hon. Gentleman will know that we inherited significant supply problems to pharmacies from the previous Government, not least because of the exchange rate and the possibility of countertrade. We have worked with the industry to resolve those issues. The hon. Gentleman would be well advised to talk to the Welsh Assembly Government about the fact that patients in Wales cannot access the latest cancer medicines, as patients in England can do under the cancer drugs fund.

T6. Today is anti-slavery day, and our excellent Prime Minister will be hosting a reception at Downing street tomorrow to promote the new Government anti-trafficking strategy. That strategy includes a requirement for the health service to be proactive in identifying victims of trafficking. What progress has been made on that? (74878)

I am sure that we all share my hon. Friend’s view of the great importance of this matter. The Department of Health leads on ensuring that health care is available to people who have been rescued by the police from human trafficking. We also lead on promoting an awareness that local government has multi-agency safeguarding processes to assist in supporting people who have been abused and harmed. There is more to say, but I will write to my hon. Friend on the subject.

T5. In the evidence session on the Health and Social Care Bill, the Secretary of State told me that he was committed to reducing health inequalities. We also heard from the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton) on that subject a few moments ago. Will the right hon. Gentleman therefore explain why he made a political decision last December, against the advice of the Advisory Committee on Resource Allocation, to reduce the health inequalities component of primary care trusts’ target funding from 15% to 20%, in effect shifting funding from poor health areas such as my constituency to richer health areas such as his own? The Government are saying one thing— (74877)

I made no decision contrary to the advice of the Advisory Committee on Resource Allocation. If the hon. Lady cares to look at the increase in revenue allocations to primary care trusts across the country, she will see that many of the lowest allocations are in richer areas and the highest are in the most needy areas.

T8. Last week, a survey found that 80% of people want more choice in how and where they are treated. Does that not show that the Government are absolutely right to press on with modernising the NHS? (74880)

Yes, it was absolutely clear that the public wanted choice of treatment. That is one of the reasons that we have published some of the patient decision aids for the first time, and we will continue to do more. People want a choice in the consultant-led team that will provide their treatment, and in the hospital where that will happen. In the past few weeks, we have set out the details of how we are going to give patients the choice that they seek.

T7. I have noticed a growing creeping privatisation of cleaning contracts in the NHS this year. Does this signify a return to the old Tory days of longer waiting lists and dirty hospitals? (74879)

The hon. Gentleman seems to be somewhat confused. This is not about privatisation in a derogatory sense, as he is trying to suggest. For many years, including the 13 years of the Labour Government, hospital cleaning services in NHS hospitals were put out to tender, and many private companies provided the service. That is simply continuing.

T9. I am a long-standing supporter of independent sector treatment centres and of the need for commissioners to be able to bring in private and voluntary sector providers, as well as alternative NHS provision where existing services fail to improve—[Interruption.] I see that some Labour Members, including the hon. Member for Leicester West (Liz Kendall), disagree, but does at least the Secretary of State agree— (74881)

I will not interrupt the hon. Member for Leicester West (Liz Kendall) who is replying from a sedentary position. I agree with my hon. Friend. What we heard under the Labour Government appears to be very much at odds and not at all in keeping with what we hear from the Labour Opposition now. Let me remind my hon. Friend that the South Gloucestershire primary care trust has received a cash increase of £10 million, or 3%, this year. Like every other part of England, it is receiving increases in resources this year that the shadow Health Secretary opposed.

May I ask the Secretary of State to look back at issues of public health? What is he doing to provide leadership in this sector, especially when we talk to people at the top of the health service who say that there are real problems with obesity in nurses and smoking among doctors? Where is the leadership coming on those issues?

Let me just give the hon. Gentleman one or two examples. In the last few days, we have published an obesity call to action, which sets out national ambitions to reduce calorie consumption to a point where people can maintain a healthy weight or reduce their weight. We have set out a tobacco control plan, which is regarded as a leader across the world. About three weeks ago, I attended the United Nations General Assembly in order to join in debates with colleagues on reducing the tide of non-communicable diseases across the world. There is also the work of Sir Michael Marmot, which we share with him; he knows that we are taking it forward nationally and internationally to tackle the wider social determinants of health. That is why we have put local government leadership on health improvement at the heart of the Health and Social Care Bill.

Mr Paul Eccles is a constituent of mine. He is a qualified care assistant who wants to go freelance and set up his own business, helping people in their own homes. However, the annual up-front £1,000 charge of the Care Quality Commission is preventing him from starting this new venture. Will the Secretary of State meet me so we can find a way to help my constituent get his business off the ground?

My hon. Friend is absolutely right to highlight how well-intended regulation can sometimes be a way of blocking effective growth and the opportunities available for new people to set up businesses in the care sector. I would be very happy to meet my hon. Friend to discuss that matter.

Stockport is one of only five PCTs in the country that does not provide any in vitro fertilisation treatment—in spite of recommendations from the National Institute for Health and Clinical Excellence. Does the Secretary of State think it fair that my constituents, who pay the same taxes as everybody else, do not get the same access to this treatment as people living elsewhere?

The hon. Lady will know, I hope, that the deputy chief executive wrote to primary care trusts a few weeks ago further to remind them of the need to respond to NICE clinical guidelines. It was the hon. Lady’s Secretary of State, John Reid who, when NICE published its guidelines, told PCTs in 2004 that they should not follow them.

The news that the Woodhaven hospital in my constituency is threatened with closure only eight years after it was opened as a state-of-the-art mental health facility is causing great concern. Will my right hon. Friend endeavour to look into what is proposed for the closure of acute in-patient beds because the “hospital at home” alternative is simply not good enough?

I am grateful for the hon. Gentleman’s question and I would certainly be happy to look further into the matter and write to him accordingly.

When the Minister responsible for care services wrote to me about the closure of the Edale unit in Manchester, why did he not address the issue that the closure would cost more money than it saved or the fact that the police had expressed concerns about their access in emergency times, particularly during the weekend?

I am sorry if the hon. Gentleman feels that all the issues have not been dealt with following our telephone conversation and subsequent correspondence. I will check the correspondence again, and if I find that something is missing, I will certainly provide an answer.

I welcome the policy review of the entitlement of foreign nationals to free NHS care, but will my right hon. Friend assure the House that it will examine the options relating to charges for GP as well as hospital services?

My hon. Friend has asked an extremely reasonable question, and I can give him the assurance that he seeks.

PCTs in Staffordshire are pre-empting legislation by merging and reorganising now, which has led to plans to close the high street practice in Newcastle-under-Lyme simply because it is run by salaried GPs. Is that really NHS policy? If not, what will the Secretary of State do to help 5,000 patients rescue a much-needed surgery?

Nothing that is being done pre-empts legislation. What is being done in relation to primary care trust clusters is being done under existing legislation, and was necessary not least to enable us to achieve a reduction of £329 million in management costs in the first year following the election. In contrast, there was a £350 million increase in the year before the election under the hon. Gentleman’s right hon. Friend the Member for Leigh (Andy Burnham).

I do not know the circumstances of the centre to which the hon. Gentleman referred because the decision will have been made locally and will not have involved me, but I will gladly write to him about it.

The full roll-out of 111 services is now proceeding. Is the Secretary of State satisfied that imploding PCTs can get the procurement right in the time allowed?

I am confident that we will make the progress that we seek. If we are not ready in any location, we will not be able to proceed with that procurement, but the PCTs will act on the basis of an evaluation of four pilots. To that extent, the character of what they are procuring through the 111 system will be well defined through piloting.

What progress has been made since the launch of the Secretary of State’s tobacco control plan last March in changing the behaviour of people who smoke in cars in the presence of children?

The right hon. Gentleman has a long-standing interest in this subject. We are working on a number of areas, but I think that the extension of public health duties to local authorities will open up many opportunities to persuade parents to think carefully about where they smoke, whether it is in cars or in their own homes.

There is real concern throughout the country about the health inequalities left by the last Government. Will the Minister confirm that funding for areas with relatively large health inequalities will not be raided, as it has been in the past under Labour?

As my right hon. Friend the Secretary of State said earlier, the Health and Social Care Bill proposes the introduction of the first ever legal duty for the Secretary of State to have regard to the reduction of health inequalities. That covers both NHS and public health functions. We are also addressing the health needs of some of the most vulnerable people through the “Inclusion Health” programme.

My right hon. Friend the Leader of the Opposition and the officers of 12 all-party groups associated with care have urged the Government to commit themselves to the urgent reform recommended by Dilnot. Will the Minister update the House on the Government’s response to the Dilnot recommendations, and tell us when the cross-party talks will begin?

I know that the hon. Lady follows these issues closely. In September we published a plan for consultation on the proposals, which includes looking beyond the Dilnot commission’s recommendations at issues of quality, regulation, and many other aspects of how we can secure a comprehensive reform of social care. Today my right hon. Friend the Secretary of State wrote to Opposition Front Benchers with the aim of resuming the discussions across parties to ensure that we get the conversation going with the new Opposition Front-Bench team as soon as possible.

In a recent ministerial response, I was informed that public health services were a matter for the local NHS and that it would not be appropriate for Ministers to become involved or intervene. The transfer of staff from PCTs to local authorities excludes staff delivering services relating to weight management, smoking cessation, physical activity promotion, sexual health, community development and diabetes awareness-raising. How on earth can local authorities pick up the responsibilities without being given the staff who would enable them to do it?

The transition period is critical, and there is no suggestion that local authorities will not have all the tools in the box to enable them not only reduce to health inequalities, but to improve the public’s health. As we have stated many times, it is absolutely dreadful that under the last Government health inequalities increased rather than decreased.