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Oral Answers to Questions

Volume 536: debated on Tuesday 22 November 2011

Health

The Secretary of State was asked—

NHS Staffing

We fully recognise how important front-line staff are to the provision of high-quality care. Local organisations are best placed to plan the work force who are required to deliver safe and high-quality services to patients.

The Prime Minister promised to cut the deficit and not the national health service. Can the Minister tell us what has changed?

Nothing has changed. As the hon. Gentleman will know, the NHS budget is a protected budget, and during the lifetime of the present Parliament it will receive real-terms increases. What the hon. Gentleman may not know is that the number of full-time equivalent clinical staff working in the NHS today is higher than it was in May 2010 and September 2009.

Over the weekend, the Minister will have seen a number of reports in the press that tens of thousands of NHS jobs were to go. Is he aware of any evidence that that is the case, or is it pure trade union scaremongering?

A deeply flawed survey is right in one respect: under the current Government, 14,000 administrative and managerial posts have gone from the health service, releasing money for front-line services.

The reality is, of course, that the report from the Royal College of Nursing revealed that thousands of front-line nursing posts are being cut, and that last night a leaked report on commissioning revealed further bad news for front-line staff: that the Government plan to privatise large swathes of the NHS, making GPs “bit-part players”. Does it remain Government policy to promote, in the words of the report,

“a strong and vibrant market”

in the NHS, and, in the words of the Prime Minister, to

“drive the NHS to be a fantastic business”?

The report that was published at the weekend is deeply flawed. It is outrageous for an organisation to seek to scare people for the sake of cheap publicity. That report is as flawed as the report that was published a year ago. Far from there being the 50,000 cuts to which it referred, since May 2010 the number of doctors has risen by 3,500, the number of consultants by 1,600, the number of registrars by 2,100 and the number of qualified radiography staff by 549. Moreover, the number of managers and administration officers has fallen by 14,000 to release money for improved health care.

Front-line staffing levels come under particular pressure in the winter months because of the incidence of winter flu. Does my right hon. Friend welcome the news that at Kettering general hospital, almost 60% of front-line staff have now been inoculated against flu? That compares very well with last year’s national average of 35%.

I join my hon. Friend in congratulating staff at Kettering general hospital on their responsible attitude, and urge other NHS staff throughout the country to follow their example. I am heartened to note that, as a result of the planning and activity that has taken place in the NHS, more staff are having flu jabs than did so last year.

Marmot Review

2. What plans he has to implement the recommendations of the strategic review of health inequalities by Professor Marmot. (81796)

The public health White Paper “Healthy lives, healthy people” gave details of our response to the Marmot review, and addressed the social determinants of health in people’s lives. I am sure that the hon. Gentleman has read it. Yesterday we launched the University college London institute of health equity with Professor Sir Michael Marmot as its director, supported by the Department. The institute will help to promote the findings of the review across the NHS, public health and local government, and will ensure that health inequalities remain a priority.

Parts of my constituency are more than 1,200 feet above sea level. We know about the impact of cold homes and fuel poverty on health. According to the latest figures, cold has caused 25,000 excess deaths in England and Wales. What discussions has the Minister had with the Chancellor about the need to invest in making our homes warmer to reduce the number of such deaths?

I thank the hon. Gentleman for that question. He will be aware of the 27,500 excess winter deaths that occur across the country, which is an increase of 17% on the deaths that occur at other times of the year. We have invested £30 million in total—£10 million to the Department of Energy and Climate Change and £20 million that local authorities can bid for—which will help to reduce those figures. It is encouraging that despite a very harsh winter last year the number of excess winter deaths has not risen.

There is an access issue when considering the rural dimension of health inequalities. The dispensing doctors play a huge role in meeting need in rural areas, yet there are concerns about changes in regulation that have affected them. Will the Minister or one of her colleagues agree to meet me and representatives of that group to discuss their concerns?

My right hon. Friend the Secretary of State for Health has already agreed to meet some people. The hon. Gentleman is right to say that health inequalities are not just something faced by the urban poor and deprived; they are also an issue in rural areas. We must make sure that people have adequate access.

The Minister will be aware of the emphasis that Professor Michael Marmot places in his review of health inequalities—which I have read, so I can quote it—on

“giving every child the best start in life”,

on creating

“fair employment and good work for all”

and on reducing “inequalities in income”. Yet, under this Government, 90% of local councils will be forced to make cuts to Sure Start, unemployment continues to spiral—it is at a 17-year high—and, far from reducing income inequality, the House of Commons Library has calculated that an area such as mine in Hackney, which is one of the poorest in the country, will lose at least £9.6 million in cuts to housing benefit alone and a further £2.84 million through cuts to child tax credit. However desirable some of the organisational changes in public health are in principle, how can the Government possibly make progress on tackling health inequality in that context?

How can the hon. Lady give Government Members lectures on health inequalities, given that those got worse under the previous Government? Life expectancy in Kensington and Chelsea is 85 whereas it is 74 in Blackpool, and that is after 13 years of a Labour Government. Family nurse partnerships have doubled and we are well on track to get the additional 4,200 health visitors. Through the public health Cabinet Sub-Committee we are determined to raise the standard of living for all, by providing new strategies on child poverty, social mobility, tax, pension retirement ages and so on. We are doing something, whereas the previous Government did nothing.

Children's Cardiac Services

3. What plans he has for the future of children's cardiac services in England; and if he will make a statement. (81797)

The review of children’s congenital heart services is a clinically led, NHS review, independent of government. The Joint Committee of Primary Care Trusts—JCPCT—on behalf of local NHS commissioners, will decide the future pattern of children’s heart surgery services in England. It is expected to make that decision next year.

I thank the Minister for his reply. In view of the Royal Brompton’s judicial review verdict, does he agree that it is imperative that the breakdown of the assessments of all centres and all areas is fully disclosed, so that confidence in the Safe and Sustainable review can be restored?

As the hon. Gentleman will appreciate, it is imperative that Ministers continue to remain totally independent of this review, so that we cannot be accused of interfering. As he knows, the JCPCT has said that it plans to appeal against the decision, and we will have to await the outcome of that.

I fully appreciate the degree of independence that Ministers must preserve, but is there anything that this Minister can say on the methodology of the review to reassure the children’s heart unit at Southampton general hospital, which is rated the best in the country outside London, given that the review was, at one stage, excluding the entire population of the Isle of Wight in its calculations as to whether or not the unit should be in more than one of the four options being put forward?

I am grateful to my hon. Friend for his question, although I will disappoint him by saying that I will not be led from my chosen path and start to voice an opinion. I will say, as I did say during the earlier debate that he attended, that of course it is not set in stone that there will be only four options chosen, as and when—the number could be more. That is dependent on the consultations and the decision of the JCPCT, but he will appreciate that I cannot seek to influence those decisions.

NHS Hospital Debt

Although the overall financial position remains healthy, we will continue to focus on the small number of organisations in the NHS that are struggling to manage their finances. We are working to help all NHS trusts to be sustainable providers of high-quality health care and move forward to foundation trust status. That will include, where appropriate, agreeing solutions to resolve the regrettable legacy of debt from the previous Government.

Despite the fact that the staff of the Royal Cornwall Hospitals NHS Trust have made big strides forward in improving patient care while delivering efficiency savings, the trust is saddled with historic debt, largely as a result of Labour accountancy measures. Does my right hon. Friend agree that that is grossly unfair and will he meet me to find ways of writing off the remaining Labour debt so that my constituents can stop worrying about the future of the only acute hospital in Cornwall?

I am grateful to my hon. Friend and completely concur. I have had the privilege of visiting Treliske hospital and seeing the good work that is being done there. In the course of the last financial year, the trust returned a surplus and it is projecting a surplus this year. As she knows, it has a legacy of debt that is being financed by a working capital loan. As with other NHS trusts, we are looking to ensure that through the process of becoming a foundation trust it will move from having legacy debts from the previous Government’s regime to being financially sustainable year-on-year while meeting the viability and balance sheet criteria for foundation trust status.

When will the Secretary of State get a grip and sort out the problems of PFI long-term funding—[Laughter]—given the fact that Ministers promised to do that six months ago and that we are no nearer a resolution than we were before?

I do not know whether Hansard will record it, but the mirth with which that remark was met is an indication from Members that they know perfectly well, as the hon. Gentleman ought to know, that the previous Labour Government left a terrible legacy of unaffordable PFI projects that were poor value for money when they were introduced. He knows perfectly well the position his local trust has been put in. We are working through that, and out of the work that has been done to resolve that poor legacy, we identified 22 NHS trusts which said that their PFI was an impediment. We are working with all of them to resolve that.

Public Health Funding

5. What plans he has to allocate resources to local authorities when they assume responsibility for public health. (81799)

9. What plans he has to allocate resources to local authorities when they assume responsibility for public health. (81803)

10. What steps he plans to take to ensure that the allocation of public health funding reduces health inequalities. (81804)

For the first time, public health money will be ring-fenced and from April 2013 local authorities will receive that ring-fenced public health grant, targeted at areas with high population need and weighted for inequalities. In the preceding year—that is 2012-13—the shadow allocation will be published to allow local authorities to plan for the following year.

As the Minister knows, public health problems are much more acute in areas of high deprivation. Wolverhampton primary care trust has been incredibly successful in reducing teenage pregnancies and increasing childhood nutrition. Will she reassure me in detail on exactly what weighting will be given to deprivation so that that good work in Wolverhampton can continue?

We have commissioned advice from the independent Advisory Committee on Resource Allocation and recently completed a survey of current NHS spend on public health. As the hon. Lady says, allocation needs to be weighted for inequalities and we are particularly keen that the committee develops a formula that captures within-area deprivation, which has been an issue in the past. Otherwise, affluent areas with pockets of deprivation tend to be ignored. If we want to improve the health of the poorest fastest, we must consider the heath need and deprivation.

Will the Minister reassure my constituents that when the money is transferred to local authorities, the staff will also be transferred from the NHS to those local authorities? Will there be sufficient resource within them to keep employing some of the excellent staff who currently work in the NHS?

The hon. Gentleman is right to draw attention to the excellent work that has been done despite the fact that public health budgets have not previously been ring-fenced. Indeed, what we have seen previously is PCTs raiding public health budgets for service provision, which is one reason why inequalities in health have got worse. It is extremely important that we transfer expertise, and employment law will ensure that all the transition is managed smoothly.

We are having problems getting reports published by the Department of Health. Will the Minister tell us about the public health outcomes framework by which we will measure progress in tackling and reducing health inequalities? What does the fact that the framework still has not been published say about the Government’s commitment to reducing health inequalities?

I am sure that the hon. Gentleman would not want us to rush this. It is extremely important that for the first time we will have a public health outcomes framework. There was no such framework under the previous Government, so it is important that we get it right. It will be an important signal to local authorities about what we expect them to achieve—with, as I have said, a focus on improving the health of the poorest fastest.

As we transfer public health responsibilities to local Government—something that has been very broadly welcomed—is it not important that in addition to a clear definition of the funds that are going to be transferred, subject to a ring fence, we also have a clear definition of the responsibilities that local authorities will be expected to discharge in the new world? When can we expect that definition to be put into the public arena?

My right hon. Friend is absolutely right. Conditions will be attached to the ring-fenced money to determine how it can be spent, but any expenditure will need to refer to promoting or protecting public health. I hesitate to use the word “shortly”, which the previous Government used on many occasions, but it will be published along with the outcomes framework. It is important that we get it right.

Will the Minister join me in congratulating Kent county council and Dover district council on their enthusiasm for taking over public health responsibilities and on the fact that they are looking at how to expand the resources that are available by considering the co-commissioning of social services with local GPs? Finally, may I inject a note of caution about the new community health trusts?

I am happy to join my hon. Friend in congratulating Kent county council. As he rightly points out, these moves have been welcomed by many local authorities, many of which already do much to improve the health and well-being of their populations. It is extremely important that councils are eager to start, as I know they are, and eager to get that money and see the public health outcomes framework so that they can build on some of the good work they have already done.

Harlow has one of the highest levels of obesity in the east of England. Will my hon. Friend ensure that the resources that are directed to local authorities are properly used to solve such problems?

Yes, this is not only about resources, as my hon. Friend rightly says. Some 60% of adults are overweight or obese, and those figures are even higher in some areas. It is extremely important not only that any money is followed by that public health outcomes framework, but that it is effective. This is not something we can simply chuck money at, as the previous Government did.

Care Standards

6. What steps he is taking to raise the standards of care provided by health care workers and care assistants. (81800)

I have commissioned Skills for Health and Skills for Care in partnership with employers, unions, regulators, educators and others to develop a code of conduct and minimum training standards for health care support workers and adult social care workers in England. This will give employers and patients confidence in the employment and standards of staffing at all levels. I expect the final report and recommendations by September 2012.

The Secretary of State knows that I believe in less, not more, regulation, but given the increasing role and responsibilities of health care assistants, particularly with the elderly, does he agree that the time has come both to recognise their increased responsibilities and to provide safeguards at a national level by requiring them to be on a national register?

My hon. Friend will know that health care and social care support workers do responsible jobs and that the responsibility for them lies principally with their employers and the staff who supervise them. We made provision in the White Paper we published last December for a process of assured voluntary registration. What I announced and referred to a moment ago will give a code of conduct and standards that will form a basis for an assured voluntary registration scheme in future.

One key care standard is the time that people have to wait for their treatment. Labour got waiting times down to an historic low, and we warned the Secretary of State what would happen if he relaxed the 18-week standard. Figures show that the number of patients waiting longer than 18 weeks is up by 43% and, despite the U-turn that the Government have made on the use of targets, is not the problem that they have been so fixated on their top-down reorganisation that they lost control of waiting lists? Surely it is time for them to drop the Health and Social Care Bill and focus on the things that really matter to the people using and working in the NHS.

I am sorry, but that was all completely synthetic anger on the hon. Gentleman’s part. The average time that patients have been waiting in the NHS for treatment continues to be between eight and nine weeks. It has been so ever since the last election. The operational standard under the previous Government and now for the 18-week waiting time is that at least 90% of patients who are admitted for treatment should be admitted and treated within 18 weeks, and 95% of outpatients. Both of those operational standards continue to be met. Last week I made it clear that whereas the previous Government abandoned people who went beyond 18 weeks—and there were 250,000 of them who went beyond 18 weeks—we will not abandon those forgotten patients. We will make sure that they, too, are brought into treatment as soon as possible.

Dental Services

8. What arrangements he has put in place to involve dental practitioners in the commissioning of dental services. (81802)

Responsibility for the commissioning of all dental services across primary, salaried and secondary care will sit with the NHS Commissioning Board. The vision for commissioning dental services sees dental local professional networks developing and delivering local service plans and quality improvement strategies across all dental services and providing clinical leadership and expertise at local level. This will enable dentists, working with commissioners and other local stakeholders, to ensure that all dental services are integrated and work together in the most efficient way.

I thank the Minister for that answer, but I still do not see why GPs are good enough to commission services locally, but dentists are not. Can he explain exactly how dentists are to be involved, in the same way as GPs are, in commissioning services locally?

I refer the hon. Lady to the answer that I just gave. The vision for commissioning dental services sees dental local professional networks developing and delivering local services and local quality improvement strategies. Beyond that, it involves local health and wellbeing boards working together closely, involving local clinicians through the networks that I referred to earlier. The answer is that local dental clinicians will be fully involved in the ways that I have just described.

Private Finance Initiative Payments

A Treasury review identified savings opportunities of up to 5% on annual payments in NHS PFI schemes. The lessons learned from the PFI savings pilot will be applied to all schemes in the PFI pipeline. The previous Government left a £50 billion post-dated cheque to pay for their hospital building programme. Much of it was unaffordable and poor value for money. We are dealing with that unfortunate legacy, including the 22 NHS trusts that identified this as a constraint on their future sustainability.

I thank my right hon. Friend for his response. PFI schemes have undoubtedly undermined the financial stability of many local health economies, as is the case in Coventry and Warwickshire. Can my right hon. Friend assure my constituents that any solution to assist PFI schemes, such as at the University Hospitals Coventry and Warwickshire NHS Trust, will not be to the detriment of my constituents who use the George Eliot hospital in Nuneaton?

Yes, I believe I can give my hon. Friend that assurance. Through the process of working with NHS trusts to see what is necessary for them to become foundation trusts—for example, we are working with University Hospitals Coventry and Warwickshire NHS Trust—it is clear that action taken locally with support can deliver viability and sustainability for the future. I hope the same will be true for the George Eliot hospital, but as a separate trust it will not be as a direct consequence of the steps that are taken at Walsgrave.

I welcome my right hon. Friend’s response to the original question. Poorly negotiated PFI deals for hospitals in the South London Healthcare NHS Trust are causing real financial problems and have led to the downgrading of Queen Mary’s hospital in my borough of Bexley. Does he share my concerns about this injustice, and will he ensure that my constituents get the first-class health care that they need and deserve and look again at this PFI situation?

Yes, of course. My hon. Friend understands very well indeed how difficult are the circumstances of his trust, which includes two PFI hospitals, and Queen Mary’s at Sidcup has suffered from the consequences of those PFIs. I am looking forward to the proposals on the future provision of health services on the Queen Mary’s Sidcup site. South London Healthcare is clearly an extremely challenged trust and we inherited very substantial problems there. We are looking to resolve them with it, but it will need additional national support.

In addition to struggling hospital trusts, many, many community hospitals throughout the country, such as Savernake hospital near Marlborough, are also labouring under the burden of an enormous PFI contract and having the indignity of vital local services hollowed out under that lot’s leadership on the Labour Benches. Will the Secretary of State please tell me what he will do to help those smaller hospitals with vital local services?

As my hon. Friend knows from her conversations with the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns), we are very sympathetic to her concerns. By devolving commissioning responsibilities to clinical commissioning groups, I expect the local clinical leadership, understanding fully the contribution that community hospitals can make, to be supportive of that in their commissioning intentions in her constituency and others.

Health and Wellbeing Boards

14. What plans he has to ensure balanced political and geographical representation on health and wellbeing boards. (81809)

The Health and Social Care Bill sets minimum membership for health and wellbeing boards. The boards will provide local system leadership, assessing need and setting the strategy for commissioning health, social care and public health. Ensuring that the board has the benefit of a broad range of opinion and geographical spread is a matter for local decision. However, the Department’s health and wellbeing board national learning network is developing and sharing good practice to inform those decisions.

Does my hon. Friend agree that the ability of a health and wellbeing board to represent democratically the interests of the people in its area would be boosted by having a reasonable number of councillors on it with both geographical representation across the area and political balance?

We are telling local authorities that they can have a majority of elected members on health and wellbeing boards if that is the appropriate way forward for their local community. My hon. Friend’s area, Cambridgeshire county council, recognises the importance of ensuring that there is a geographical spread and a full involvement of local opinion in those boards. There is a special event next January for stakeholders to get information about that, in which I hope my hon. Friend will take part.

Winter Pressures (NHS)

The NHS and social care systems are well prepared for winter. Our Winterwatch summary was first published last Thursday. It showed higher flu vaccination uptake, and I announced additional extracorporeal membrane oxygenation—ECMO—capacity, which will be in place by December. There is always more pressure on the NHS during winter. This year will be no different, but the preparations are in place.

Given the director of immunisation’s recent report on the take-up by medical staff of the flu jab and the local efforts of Dr Alastair Blair, the chair of the Northumberland clinical commissioning group, will the Minister expand on the need for patient protection in the form of flu jabs in hospitals and surgeries around the country?

I would like to take this opportunity not least to commend the work that the chief medical officer has done this year in encouraging health care workers to have their seasonal flu jab. The latest figures are that 29% have done so, compared with 11% at the same point last year. We heard earlier from my hon. Friend the Member for Kettering (Mr Hollobone) how well Kettering has done, and there are hospitals that are demonstrating that a higher level is entirely achievable. I urge staff across the NHS to have their flu vaccination. It is the ethical thing to do, not least to provide protection to their patients.

One of the things that makes the problem of winter pressures much greater is the NHS coping with the biggest reorganisation ever. The public have a right to know the risks that the Government’s policies are placing on our NHS. The Information Commissioner agrees and has judged that the Secretary of State must now release the risk assessments and register for his NHS reorganisation. Will he now obey the law and end his 12-month cover-up?

I have been very clear and published all the cost-benefit and risk information relating to the modernisation of the NHS, and the impact assessment was published when the legislation was presented to the House of Lords.

The Care Quality Commission and Monitor are looking into the affairs of the University Hospitals of Morecambe Bay NHS Foundation Trust. Will my right hon. Friend assure my constituents that whatever the findings, the Government will act upon them quickly?

I entirely understand my hon. Friend’s point. I of course will not prejudice whatever might be said in relation to that, but I will look at the report very carefully when it is presented.

Social care is vital for reducing winter pressures on the NHS by helping to keep older people out of hospital, but the Government are cutting funding for older people’s social care by £1.3 billion. Delayed discharges from hospitals are already up 11% from this time last year. The Minister responsible for care said in Westminster Hall on 10 November:

“cuts to front-line adult social care services are really beginning to bite.”—[Official Report, 10 November 2011; Vol. 535, c. 178WH.]

Does the Secretary of State agree?

I have to say to the hon. Lady that it was this Government who, through the spending review, gave priority to social care. More than £7 billion was added to the social care budget as a consequence of the steps taken by my right hon. Friend the Secretary of State for Communities and Local Government and by the NHS. This year the NHS is providing an additional £648 million specifically to support adult social care. In addition, I have announced our Warm Homes Healthy People funding for this winter, which will provide additional support for those most urgently in need.

Accident and Emergency Provision

16. How many accident and emergency departments have reduced their on-site service provision in the last 12 months. (81811)

This information is not collected centrally. It is for NHS commissioners to secure high-quality services for their communities. Where a substantial service change is proposed, decisions should be made against the Secretary of State’s four tests, including support from GP commissioners and clear evidence of patient and public engagement.

Broadening the definition of major trauma would have disastrous consequences for many A and E departments, not least those in Bassetlaw and the surrounding towns in south Yorkshire and the north midlands. Can the Minister give an absolute guarantee that the definition of major trauma is not being broadened, so that those hospitals and their A and E departments are not put in jeopardy?

The assurance I can give the hon. Gentleman is that the siting of A and E departments will be a matter of clinical judgment. I can also assure him that £900,000 will be invested in the A and E department at Bassetlaw hospital for improvements, including the creation of a three-bay resuscitation room, a larger waiting area for patients and other improvements to enhance the quality of care for his constituents.

At a recent surprise visit to my local A and E department, at the Conquest hospital, I was delighted to find a very high quality of care. Will the Minister reassure me that any local reconfiguration puts high-quality patient care at the centre of delivery?

I am grateful to my hon. Friend, and I am glad that she had such a positive experience visiting her local A and E. I can categorically tell her that reconfigurations must be carried out in accordance with the Secretary of State’s four tests and that clinical safety and quality of care are paramount.

Social Care

17. What discussions he has had with the Chancellor of the Exchequer on the future costs of long-term social care. (81812)

The Government are committed to publishing a White Paper and a progress report, responding to both the Law Commission and the Dilnot commission recommendations. As part of ongoing work, there have been numerous discussions throughout the Government, including with Her Majesty’s Treasury.

At least 5,000 families a month are having to make decisions about the long-term care of loved ones. Since the election, thousands have had to sell their homes and spend every penny on care. How many more people—and for how much longer—will have to be terrified about their future?

If the hon. Lady had prefaced her question with an apology for failing to sort out the problem for 13 years, I might have taken it more seriously. This Government moved urgently to establish the commission chaired by Andrew Dilnot, we are now actively working through his proposals, and we will come forward with legislation and a White Paper in due course.

Does my hon. Friend agree that the integration of health and social care should be leveraged by commissioners to encourage savings in the acute sector, to contribute to funding much-needed improvements in long-term social care?

There is no doubt that more integration between health and social care is a way of improving the quality of services delivered to the public, and of releasing resources that can then be reinvested in improving services. We know, for example, that the use of reablement services can reduce costs and improve the quality of life outcomes for the people who receive them.

Training (Nurses and Doctors)

Our reforms aim for excellence in education and training and for a better patient experience by ensuring greater accountability for employers in planning and developing their work force while being professionally informed and underpinned by strong academic links. I have always been clear that I want to see greater professional ownership of the standards of education and training, and greater employer engagement in getting work force planning right. We will publish more details on that when the NHS Future Forum reports shortly.

Does the Secretary of State share the concerns that I have picked up in my constituency? First, although we have very good nurses in Huddersfield, national stories about a lack of care for elderly people make all of us worried about the quality of training of some nurses in some institutions. Secondly, will he remember that, with his demolition of the health service, we are moving to a system in which no management training is given to any doctor or GP? Is that not a recipe for chaos?

On the latter point, I have been talking to those in training, and part of their education increasingly includes leadership. That is what we are looking for—clinical leadership, not to turn clinicians into managers. They will work with managers, but they will provide leadership.

On nursing training, the Care Quality Commission’s recent inspection reports, in particular, illustrated the sheer variability of care—sometimes even between wards in the same hospital. On that basis, we should not in any sense damn the quality of nurse training; we need to focus on the quality of nurse leadership—ward by ward, and hospital by hospital.

The new Government’s strategy on human trafficking requires the NHS to ensure that victims of human trafficking are recognised in hospitals and reported. One way of doing that is to improve training for nurses. I have just returned from Moldova, where nurses have a course on human trafficking as part of their training, so that they can recognise victims and help them. Is that something that we could incorporate here?

I am interested to hear my hon. Friend’s experience. I certainly look forward to hearing more from him about it, and to taking it on board in considering how we respond to those obviously tragic victims.

Strategic Risk Register

19. What assessment he has made of the effects of publishing his Department’s strategic risk register on his restructuring of the NHS. (81814)

Publishing the Department’s risk register would have implications beyond the Department of Health, and we are taking the time granted to us by the Information Commissioner before deciding whether to appeal against his decision requiring its release.

I think I thank the Minister for that response, which at least gives some indication of where the Government are coming from. But, given the widespread concern among the public about the risks posed by the Health and Social Care Bill, and given that the Information Commission has ruled that the register should be published, does the Minister not think that it should be published before Report stage in the House of Lords, so that at the very least the findings can be used to inform the amendments being tabled to rescue the Bill even at this late stage?

No, I do not think that the register should be published before then, in so far as we are still considering whether or how to move forward within the time scale that the Information Commissioner has given us—[Interruption.] Before the hon. Lady gets too pious, I must tell her—I do not say “remind her”, because in the previous Government she will have been too busy tweeting, as the tweeting tsar, to know what the Department of Health was doing—that in September 2009 the right hon. Member for Leigh (Andy Burnham) similarly blocked release of the Department of Health’s strategic risk register, using the non-disclosure provisions under section 36 of the Freedom of Information Act 2000, and that his predecessor, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), did the same on two occasions in 2008.

Two, or even three, wrongs do not make a right. Regarding an exemplary risk register, does the Minister consider that the mitigation plans for any risks identified there may serve to reassure Members of the other House, if it were to be published in advance of the conclusion of the Committee stage there?

If the hon. Gentleman had read it, he would know that the important aspect—[Interruption.] He says that he cannot read it, but if he listens for a minute, he will hear that the important parts that are relevant to the Health and Social Care Bill were published in January and September this year in the impact assessment for the Bill.

May I first commend the Health Secretary on his ingenious new approach to cutting delayed discharges? If his appearance on continuous loop on hospital TV does not cut length of stay, I do not know what will. One area where he has been noticeably less forthcoming is on the recent ruling by the Information Commissioner, which could not be clearer: Parliament and the public have the right to know what extra risks and threats his Department expects the NHS to face as a result of this top-down reorganisation. Let us give him one more chance to give us a clear commitment: will he live up to the Prime Minister’s words on transparency and openness and publish the report in full without delay?

The right hon. Gentleman may not have been listening to the response I gave to his hon. Friend, which was that the relevant aspects of the risk assessment have been incorporated into the impact assessments published in January and September. [Interruption.] Before he, too, gets too pious, may I remind him that it was he himself who, in September 2009, blocked the publication of his Department’s risk assessment?

I would happily have paid £5 to opt out of that particular pre-scripted loop message. Unlike the Minister and his fellow Front Benchers, I was not subject to a ruling from the Information Commissioner. People watching this today will be left wondering what he and the Secretary of State are so desperate to hide. He can hide the report, but he cannot hide the growing warning signs we are seeing in our NHS: waiting lists up, delayed discharges up, and nurses made redundant. The truth is that he has placed the NHS in the danger zone, with a destabilising and demoralising reorganisation when it most needed stability. He says he wants feedback, so why does he not listen to patients and staff, put the NHS first and drop his dangerous Bill?

It is marvellous how the right hon. Gentleman repeats his soundbite every time he discusses the NHS. I have to tell him that he is wrong. He knows that the NHS has to evolve. He knows that we have to improve and enhance patient care. I think he does himself a disservice by simply joining the ranks of organisations such as 38 Degrees, which is frightening people and getting them, almost zombie-like, to send in e-mails.

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.

Is the Secretary of State aware that plans to remove vascular services from Warrington hospital will threaten services such as diabetes care, renal cancer care and the co-operation on stroke that has been built up with Whiston hospital? What will he do to protect those services, or is this part of the plan he discussed in February with NHS North West to reduce the number of acute beds and increase competition?

I am glad that on Monday the hon. Lady will have an opportunity for an Adjournment debate where this subject can be—

I will of course answer the question. The answer is that this is entirely driven by clinical issues in a local context. I can tell the hon. Lady that it is very much about trying to improve vascular services, and the judgments being made are local and clinical.

T2. What leadership role do the Government expect the new health and wellbeing boards to play in determining significant NHS service changes in each local area? (81821)

The health and wellbeing boards will have a role not only in leading improvements in public health and social care but, through the joint strategic needs assessment and the strategy derived from that, in establishing how services should respond to the needs of the local population. The clinical commissioning group should respond directly to that, and any specific service configuration changes should form part of the commissioning plan. In addition, the local authority, through its scrutiny role, will have a continuing ability to refer those plans for review.

T4. Will the Secretary of State agree to meet me, and families living with muscle disease, to discuss the urgent problem of primary care trusts refusing to fund vital cough assist machines, which help to prevent serious and very costly winter respiratory infections for those who are unable to use their lung muscles to cough? (81823)

Of course I, or one of my colleagues, will be glad to meet the hon. Lady to discuss that. I might also say that it was important to have announced, as I did last week, the expansion of ECMO—extracorporeal membrane oxygenation—facilities across England. Those facilities present a life-saving opportunity for people with the severest respiratory disease.

T3. My apologies, Mr Speaker, for having missed my question on the Order Paper earlier.Every five minutes someone in the UK suffers from a stroke, and over 1 million people are living with the effects of stroke. That is why I welcome the establishment of the first “life after stroke” centre—a £2 million investment in my constituency. Will my right hon. Friend join me in welcoming this excellent initiative by the Stroke Association? (81822)

Yes, of course I will join my hon. Friend in paying tribute to all the work that I know personally that the Stroke Association has done over a number of years in raising public awareness of the importance of developing stroke services, which has had an impact inside the NHS. We have improving figures in terms of reducing stroke mortality, and I now want to go further in ensuring that we enable people not only to survive stroke but to recover as many as possible of their abilities afterwards.

T5. Will the Minister with responsibility for public health update the House on her plans to review the criteria whereby people with haemophilia who have been infected with hepatitis C can claim stage 2 payments from the Skipton fund? Specifically, will she tell us how she intends to involve patients and carers in that review? (81824)

I know that the right hon. Gentleman has campaigned hard on this issue. I can assure him that I recently met a group of MPs, and constituents of theirs who are suffering from hepatitis. As he knows, there is a wide spectrum of illness associated with chronic hepatitis C infection. We are aware that people could be suffering financial hardship as a result, and I would urge them to apply to the Caxton Foundation. The Department’s expert advisory group on hepatitis C will continue to keep the evidence under review.

T7. In a number of surgeries in my constituency, and in many across the country, physicians’ assistants play a very important role in enhancing capacity. Can my hon. Friend say whether there are any plans in the Department of Health to allow physicians’ assistants to be able to prescribe medication? (81826)

The medicines legislation governs the range of health professionals who can prescribe. The Government’s policy is that only registered and regulated health professionals should be able to train for that; physicians’ assistants are neither.

T6. After speculation about the future of the Department of Health’s free nursery milk scheme, will the Secretary of State assure families and nurseries that he recognises the value of free nursery milk in preparing young people for a good future and well-being in life? (81825)

I assure the hon. Gentleman that we do recognise the value of nursery milk. The only shocking thing is that the previous Government presided over a scheme whereby nursery milk is now costing double the retail price, and we urgently need to look at that. We are committed to continuing the scheme, but shocked at what has gone on before.

T8. An independent study of the patient assumptions of the Safe and Sustainable review has confirmed what many of us already knew: that, contrary to the review’s claims, most families in Yorkshire and the Humber will travel not to Newcastle but to Leicester or Liverpool. Will my right hon. Friend seek confirmation from the Safe and Sustainable review body that it will revise its options in the light of that new evidence? (81827)

I am grateful to my hon. Friend and I have heard the important point that he has made. No doubt the Joint Committee of Primary Care Trusts will also hear the point that he has made to me. I am sure that he understands that it would be totally inappropriate for me to give any view that might compromise the independence of Ministers on this independent review.

What is the Secretary of State’s estimation of the number of NHS doctors and nurses who, in an astoundingly demoralising way, are having their pay grades downgraded?

I do not have a figure for that. If the hon. Lady and others want to discuss it, I would be glad to see evidence of it—and so should NHS employers, because as part of the implementation of “Agenda for Change”, staff should be banded in grades according to independent criteria.

T9. Last year in Westminster Hall, the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton) rightly praised the work of midwives and the Royal College of Midwives. Does she share my concern that locally, there could be a downgrading of community midwives, leading to an overall reduction in the number of midwives in our area? (81828)

I thank my hon. Friend, and I will take this opportunity to praise again the work of midwives and the Royal College of Midwives. It was a pleasure to be at its conference only last week. I would point out that there are now more than 20,000 full-time equivalent midwives. That is an increase of 2.4% on last year. We have record numbers of midwives in training, with 2,493 this year and an increase on that next year. What matters is that we get the right services for women who are pregnant, ensure that they can exercise the choices that they need, and get the right skills mix.

Figures today reveal that older women are being discriminated against in breast cancer treatment, with some 20% of women over 65 receiving chemotherapy compared with some 70% of women under 50. Will the Minister assure the House that those who are over 65 will receive equitable treatment, and that this discrimination will stop?

I am grateful for that question, and I assure the hon. Gentleman that the Government are determined to root out ageism wherever it might be within the NHS. That is why we have made it clear that there will be no exemptions from age discrimination legislation—and that will have to be taken into account by clinicians when they make decisions.

The recent judicial review concerning the unit at the Royal Brompton hospital said that the Safe and Sustainable consultation was unlawful and the review should be quashed. Considering the concern about this matter and the flaws in the review, is it not time for the Minister to indicate when the Government might intervene? Otherwise, there could be further threats of judicial review.

The straightforward answer is no, because the Joint Committee of Primary Care Trusts has said that it intends to appeal. This is an independent review. It would be inappropriate for me or any other Minister to interfere in such a review, because we could be accused of compromising its independence.

The Prime Minister promised a bare-knuckle fight to save A and E and maternity units at King George hospital, Chase Farm hospital and other hospitals that the Secretary of State now plans to close. When will that fight take place, and where can hon. Members purchase tickets for ringside seats?

I heard what the hon. Gentleman said, and I was disappointed that we did not reach his question on the Order Paper earlier, because he has been extremely concerned about the A and E in his own area in Hartlepool. That decision was taken on safety grounds. Emergency care has been provided at the One Life centre. The decision was taken with the support of the local overview and scrutiny committee, which he will appreciate has democratic accountability. That was the right decision. Where there are clinical reasons for taking such decisions, they should be taken.

Has my right hon. Friend the Secretary of State or any of his ministerial colleagues been able to visit the People’s Republic of China to consider traditional Chinese medicine?

I thank my hon. Friend for that question. He must be psychic, because I recently visited China, and it was fascinating to meet Ministers there. He will also be very pleased to hear, as I am sure the whole House will, that I visited a hospital and community centre that combines western medicine and traditional Chinese medicine.

The coalition agreement states that public sector employees, including health care employees, will be given a new right to set up employee-led co-operatives to run services. Can the Minister detail how many NHS co-operatives have been established and how many employees are involved in them?

I will gladly write to the hon. Gentleman if my recollection is wrong, but I think that something in the order of 25,000 staff have been transferred into social enterprises since the election. That represents something like £900 million-worth of NHS activity across England.

Pension reform is important to those of my constituents who work in the public sector—and, indeed, to the taxpayers who do not. With that in mind, does the Secretary of State agree that the heath service unions should work constructively with the Government on public sector pension reform rather than go on strike next week, potentially putting patients’ lives at risk?

Yes, I am grateful to my hon. Friend. It is very important to me that NHS staff, and other public servants, are valued in their remuneration, including the pensions that they receive. That is precisely why I have myself engaged in discussion with the NHS trade unions and staff side and continue to be engaged directly in negotiations with them about that, on the basis of the conditional offer that the Chief Secretary to the Treasury announced to the House recently, which I think would be fair to NHS staff and to taxpayers. On that basis, I think it is completely irresponsible and unacceptable for some unions in the NHS—not the Royal College of Nursing or the British Medical Association—to intend to go on strike next week.

We are immensely grateful to the Secretary of State. He is testing the knee muscles of colleagues very considerably, and we are grateful to him for that, I am sure.

Today’s report by Macmillan Cancer Support showed that over the past 40 years there has been virtually no improvement in life expectancy for those diagnosed with a brain tumour. Brain Tumour UK and experts such as my city’s own Professor David Walker are calling for action to improve diagnosis and treatment. What action is the Department taking to address their concerns?

I am grateful to the hon. Lady for her question. Macmillan has done a very good job by highlighting the need to focus on survival rates with regard not only to brain cancers but to lung cancers. Through our outcomes strategy, we are focusing on earlier diagnosis and ensuring that the care pathway is faster and delivers the appropriate treatments at the right time.

There are 3,000 cases each year of early stage inoperable lung cancer, but as yet no national stereotactic body radiotherapy treatment for lung cancer. What number of patients does the Secretary of State consider to be the appropriate threshold at which he will instruct his Department to establish a national lung cancer tariff?

I am grateful to my hon. Friend for that question. I do not think I am in a position to say what figure is appropriate, but the national clinical director for cancer has already indicated to the NHS that he wishes us to develop a national tariff for stereotactic radiotherapy. A quarter of centres across the country already provide it, and our intention is to ensure that that is supported by a national tariff as soon as possible.

Regrettably, there are still many thousands of attacks by dangerous dogs every year that end up with people in A and E, and occasional fatalities. Has the Secretary of State carried out any assessment of the cost to the NHS of treatment for attacks by dangerous dogs? If not, may I ask him to instruct his officials to do so?

I do not have those figures to hand, but I will gladly see whether we have them available, and I will write to the hon. Gentleman.

Order. I apologise for disappointing colleagues, but Health questions are invariably box office, and usually a sell-out at that. We must now move on.