Skip to main content

Oral Answers to Questions

Volume 538: debated on Tuesday 10 January 2012

Health

The Secretary of State was asked—

Hospital Volunteers

The coalition Government recognise the tremendous contribution that volunteers play in enhancing quality and experience in health and social care, including within hospitals. We are working with partners, including the National Association of Voluntary Service Managers, to strengthen this role during service reform.

Mr Speaker, may I wish you and the House a very happy and healthy new year?

I thank the Minister for his response. I recently attended the local volunteering awards in the West Middlesex hospital in my constituency. Almost 400 volunteers do great work for patients and the hospital. What financial assistance is available to hospitals to support these volunteering projects?

I very much agree with the hon. Lady about the need for NHS trusts to consider their stance on volunteering. Indeed, I suspect Members of all parties have visited hospitals and worked with friends organisations over the Christmas period and have seen the good work that volunteers do in our hospitals. Our aim is to make sure that NHS trusts and commissioners of health and social care have the tools and information they need to make good judgments about investing in volunteering. That was the purpose of the volunteering strategy that we published last year.

We all recognise the huge contribution that volunteers make to the NHS, so will the Minister take this opportunity to recognise the contribution of Clive Peedell, the co-chair of the NHS Consultants Association, who is taking part in Bevan’s run today, highlighting concerns among the medical profession about the impact of the dreadful Health and Social Care Bill?

I would certainly wish that gentleman well with his run. I am sure that the contribution he makes through that charitable act is one that will stand us all in good stead in due course.

Is there a conflict between the big society, volunteers and localism if major retail stores are brought into hospitals to the detriment of friends organisations?

My hon. Friend raises an important point. I am aware that it is a matter of concern that over a number of years some hospitals have chosen not to use the WRVS or friends organisations’ services. These decisions have to be made by local NHS trust boards, but the purpose of the strategy we published last year is very much to make sure that when the boards make these decisions they are focused on the benefits—the benefits of volunteering for the volunteer, the organisation and the patients.

As far as I am aware, no assessment has been made to analyse the number of unpaid interns. What is very clear, however, is that when NHS organisations are using people to provide services as volunteers, that is clearly separate from what would be regarded as paid employment. That is clear in the strategy we set out last year and clear in the advice and guidance provided by the Cabinet Office as well.

Access to Drugs

2. What recent representations he has received on access by NHS patients to drugs invented and developed in UK laboratories; and if he will make a statement. (88267)

Representations received have strongly supported the Government’s “Strategy for UK Life Sciences”, which was published on 5 September. Speeding up clinical trials approval, enabling the unique NHS clinical databanks to support research, the early adoption of new medicines and other initiatives will bring NHS patients the fullest benefit from innovation and will promote growth in UK biosciences.

What steps are being taken towards closer collaboration between the NHS, industry and our world-class universities to drive improvement and innovation in the NHS for the benefit of current and future NHS patients?

I am grateful to my hon. Friend. He rightly highlights an area where we are clear that innovation can be considerably supported, and not only by the academic health science centres, which were established under the last Government. As the life sciences strategy set out in early September made clear, we want to create academic health science networks across the NHS so that higher education, industry and the NHS can work together to bring about the greatest possible innovation to the benefit of patients.

The current pharmaceutical price regulation scheme is able to recognise the fact that pharmaceutical companies based here and developing drugs here should be paid a little bit more for their drugs by the NHS on the basis of their worth for the general economy. Will the Secretary of State tell us whether his proposals for value-based prices will affect that?

The right hon. Gentleman will be aware that the existing PPRS does not in any sense directly fund innovation in the United Kingdom. Although it takes account of expenditure on innovation, it cannot identify that expenditure in the United Kingdom as a beneficiary through pharmaceutical pricing. As the right hon. Gentleman knows, we are continuing to discuss with the industry the shape of value-based pricing from January 2014, the purpose being to ensure that we fund the value associated with new medicines: the therapeutic value to patients, the innovative value—which will highlight the UK as a base for research and development—and the societal value.

Paediatric Cardiac Services

3. If he will take steps to ensure that the safe and sustainable review of paediatric cardiac services is fully inclusive. (88268)

The review of children’s congenital heart services is a clinically led NHS review, independent of Government. In conducting it, the Joint Committee of Primary Care Trusts has aimed to be as inclusive as possible in relation to all issues.

The Minister will be aware that the review has been called into question because the consultation has not encompassed other medical conditions such as respiratory problems. Will he intervene so that a consensus approach can now be taken?

As I have said, the review is clinically led and independent of Government, and I am afraid that it would not be appropriate for me, or my colleagues, to intervene. Moreover, the review is the subject of legal proceedings. It will be for the Joint Committee of Primary Care Trusts, on behalf of local commissioners, to decide the future pattern of children’s heart services on the basis of the best available evidence.

It seems nonsensical to deal with the provision of surgical services for adult and child congenital cardiac patients in separate reviews. Given the delay in the review of children’s services, does the Minister not agree that it is time to consider including them in the forthcoming review of adult services?

I am grateful to the hon. Gentleman for his suggestion, but I am afraid that I do not share his view. As he knows, there will be a review of adult services, but it has always been considered most appropriate to deal with paediatric cardiac services before adult care, and that is what we will continue to do.

Although the paediatric heart unit at Southampton general hospital is rated the best in the country outside London, it was included in only one of four options under the review. In the past, the Minister has helpfully hinted he might not be confined to considering only those four options. Can he expand on that?

I can expand on it by saying that it will not be me who considers the options. As I have told my hon. Friend before, this is an independent review. However, as he suggests, the JCPCT may decide on four, six or seven possible sites. It all depends on what the consultation produces, and the clinical decision on what is the most appropriate number of sites, which will happen eventually.

I congratulate my hon. Friend on his championing of Southampton general hospital as the local Member of Parliament.

Cancer Drugs Fund

4. What recent representations he has received on access to the cancer drugs fund; and if he will make a statement. (88269)

We have received a number of supportive representations regarding the cancer drugs fund. Indeed, the Rarer Cancers Foundation recently praised the fund for making additional cancer drugs available to almost 10,000 patients in England since October 2010. It contrasted that access to medicines in England with the lack of such access in Wales.

My right hon. Friend has cited the view of the Rarer Cancers Foundation. Does he agree that this policy has put patients and doctors back at the heart of decision making, and has transformed the ability of cancer patients to obtain clinically effective treatment so that they can gain precious extra time with their families?

My hon. Friend is absolutely right. In the summer of 2010, we learnt from Sir Mike Richards’s review that patients in this country were less likely to have access to the latest cancer medicines within five years of their introduction than those in many other European countries. I am proud that so far the coalition Government have been able, through the cancer drugs fund, to help 10,000 patients to gain access to the latest cancer medicines.

I thank the Minister for that response. Last year, Cancer Research UK revealed that cancer deaths were down 20% since 1985 and survival rates have doubled in the last 40 years. Does the Minister agree that we must continue to research proactively and thereby continue to reduce deaths and ensure continuity of life?

I am grateful to the hon. Gentleman, and he is absolutely right about that, of course. He will also be aware that Cancer Research UK highlighted not only the progress that had been made, but the variation in progress on different cancers. Harking back to the earlier point about innovation, we must focus on how some of these innovations will enable us to deliver improved survival rates for specific cancers, and I announced last month that we would be funding additional scanner facilities in this country—proton beam therapy scanning interventions—in order to enable some of the most difficult cancers, such as brain cancers in children, to be treated in this country effectively.

A cancer patient in my constituency faces an avoidable further round of chemotherapy having waited for the strategic health authority to make an individual funding request decision on the drug Plerixafor, which is not included in the cancer drugs fund. Will the Minister consider broadening the scope of the cancer drugs fund to include such drugs that are critical in cancer patients’ care, in addition to their other uses?

I should be grateful if my hon. Friend would write to me about that. The cancer drugs fund is focused on an identified lack of access to cancer medicines, but if a drug is of particular benefit to a cancer patient, such as in the instance he describes, it should be possible for SHA panels to include it within the scope of the fund.

Will the Secretary of State confirm whether those receiving treatment under the cancer drugs fund will also be guaranteed treatment under the new scheme?

The intention is that from January 2014 as new medicines are introduced through the value-based pricing system, the reimbursement price in the NHS will reflect their value and therefore, by extension, they will all be available through the NHS.

NICE-approved Drugs

5. What steps he is taking to ensure drugs approved by the National Institute for Health and Clinical Excellence are made available to all patients in the NHS. (88270)

The NHS is required to fund drugs and technologies recommended in NICE technology appraisals, in line with the NHS constitution. The NHS chief executive’s report “Innovation, Health and Wealth” sets out plans for the introduction of a compliance regime to ensure rapid and consistent implementation of NICE technology appraisal recommendations throughout the NHS.

I greatly welcome the Government’s recent announcement on swift and proper implementation of NICE guidance that allows patients access to innovative treatments. In order for cost-effective treatments to secure NICE guidance approval, in the first instance will the Secretary of State ensure that NICE’s methodology review reinforces the importance of appraisal appropriately reflecting clinical practice when assessing new treatments?

I am grateful to my hon. Friend, who clearly understands that NICE is responsible for the methods it uses in the development of its guidance and that it is undertaking a review of its appraisal methods. I expect that that will be published for consultation this year. NICE should issue final guidance only after careful consideration of the evidence and public consultation with stakeholders, including patient and professional groups.

It is sometimes hard to follow the Secretary of State as he can get lost in his own jargon. Just to be clear: if NICE says that a drug should be available to patients on the NHS wherever they live and whatever their clinical commissioning group, will they get it? Can he give that guarantee today?

The right hon. Gentleman knows perfectly well that that did not happen under the last Government. The NHS chief executive’s innovation report of early December made it clear that we will make certain that when NICE gives a positive appraisal for a medicine, it is automatically included in formularies, and also that we will establish an effective compliance regime in respect of NICE appraisals and establish a new NICE implementation collaborative to make it happen. As the right hon. Gentleman knows perfectly well, the legislation is clear: when NICE gives a positive appraisal, a medicine should be available across the NHS. That was not achieved under his Government. We will achieve that, and the NHS chief executive is setting out to show how that will happen in the future.

Under the current regime of primary care trust commissioning, my constituents in Warwickshire often complain to me that drugs approved by NICE are not always available locally but are available in neighbouring commissioning areas. What steps are being taken to ensure that new NHS commissioning boards and local commissioning groups promote the NHS constitution and the right of patients to access NICE-approved drugs?

My hon. Friend makes exactly the right point, in that what the last Government said happened did not happen: such medicines were not available, and there was a postcode lottery in accessing many of them. That, among other reasons, is why the chief executive of the NHS published his report, which will introduce the NICE compliance strategy. We will require all NICE technology appraisals to be incorporated automatically in the local drug formularies, and the NICE implementation collaboration will support the prompt implementation of NICE guidance.

Last week in my constituency, a community pharmacist refused to issue a blind patient with dosage packs unless they paid an additional fee. What redress will such patients have in the newly reorganised NHS regarding actions such as this by community pharmacists, which in my view are against the Disability Discrimination Act?

I should be grateful if the hon. Lady wrote to me about that case and gave me the opportunity to look at it, which I would be pleased to do. From my point of view, we do not countenance such requirements, through charging, denying patients access to any NHS treatment.

In addition to approving drugs, NICE has also approved acupuncture for lower back pain. Should this not be widely available on the health service now?

Of course, my hon. Friend will know very well that choice of treatment is a shared decision between patients and their clinicians. NICE appraisals are about whether treatments are available in the NHS and giving information to clinicians about their relative clinical and cost-effectiveness, not prescribing that treatments should be available in specific circumstances.

Fuel Poverty

6. What discussions he has had with ministerial colleagues on the effects of fuel poverty on health. (88271)

I and my officials have worked closely with the Department of Energy and Climate Change on the development and implementation of the cold weather plan for England, which aims to reduce the health impacts of cold weather on vulnerable people. We have also put £30 million into the warm homes healthy people fund to fund local authority projects to reduce the impact of cold weather.

The Marmot report confirmed that cold homes are bad for our health. My local newspaper has highlighted the case of a low-income working family who have to choose between food and heat every day, with no help from their energy provider. Will the Minister ensure that energy companies do more to tackle fuel poverty, so that the NHS does not have to foot the bill for their profit?

As I said, my colleagues in DECC are working closely with the energy companies. I point out to the hon. Gentleman that this coalition Government are the first to put in place the cold weather plan to reduce those 27,000 excess winter deaths. Perhaps his local paper would like to contact the Welsh Assembly Government to see what they are doing.

Fuel poverty clearly shows the link between housing, health care and well-being. Last week, the Prime Minister called for a merger of health and social care. Does the Minister agree with me that if we are to have a true merger of health and social care, housing—through health and wellbeing boards and other mechanisms—has to be a key ingredient of that?

Of course, my hon. Friend is absolutely right that the integration of health and social care is critical, particularly for issues such as this. The changes we are making to public health and the movement of public health into local authorities will only ensure better integration, so that we can reduce those 27,000 excess deaths.

Suicide Prevention

The Department of Health funds the national confidential inquiry into suicide and homicide by people with mental illness. The Department is funding an investigation of self-harm, and the National Institute for Health Research is funding a range of further research relevant to suicide prevention.

The Minister will be aware that core funding for research into the causes, effects and geographical spread of suicide and its frequent precursor, self-harm, is essential. More than 200,000 people present at accident and emergency with self-harm. I am very concerned to hear that the ongoing funding for the multi-centre study of self-harm is potentially at risk. Will he agree to meet me and the research project leads to discuss this and ensure that that research continues?

The hon. Lady chairs the all-party group on suicide and self-harm prevention. She does a lot of important work in this House in that regard, and I would be only too happy to talk to her about research priorities in this area. The Government are examining the research priorities to support the new strategy, which we plan to publish in the near future.

I pay tribute to the hon. Member for Bridgend (Mrs Moon), who has done fantastic work on the prevention of suicide. It is not the Department of Health’s job to regulate the worldwide web, but what work has the Department done on examining the link between the watching of violent websites—and, indeed, looking at websites that promote or facilitate suicide—and the actual carrying out of suicide?

My hon. Friend makes a very important point, which has been raised by a number of charities, including Papyrus, during the consultation on the draft strategy. It is important to stress that the internet industry has been willing to engage in positive initiatives, not the least of which is Facebook and Google’s work with the Samaritans to make sure that whenever anyone types in “suicide” a link to the Samaritans always appears first. However, more needs to be done and we need the industry to tackle those darker sides of the internet to make sure that they do not prey on vulnerable people and do not peddle suicide.

Given the crucial role that the chief coroner was to have had in monitoring and advising the Department of Health on the incidence of suicide across the nation, will the Minister liaise with the Lord Chancellor to ensure that a chief coroner is appointed speedily and that powers are put in place quickly to make sure that this work can be done?

Telecare and Telehealth Services (Congleton)

8. When he expects residents in Congleton constituency to benefit from investment in telehealth and telecare services by the NHS. (88273)

I am pleased to say that patients in Congleton who have health conditions such as heart failure or chronic respiratory disease can already benefit from these technologies. I am committed to supporting the use of telehealth and telecare services by working with industry to improve the lives of 3 million people across the country who are living at home with long-term conditions.

I thank the Secretary of State for that reply, and indeed innovative schemes in my constituency and across the Cheshire East council area, such as DemenShare, are already using this technology. But what other schemes and advances will the Government introduce for an area that has the highest level of elderly people per population head in the north-west of England and where the number of over-65s will grow by 50% and the number of over-85s is set to more than double by 2025?

I am grateful to my hon. Friend for her question. She rightly talks about this increasing number of older people in the community and rightly says that we want to support them to be independent and to improve their quality of life.

The whole system demonstrator programme was the largest trial of telehealth systems anywhere in the world. In the three pilot areas of Kent, Cornwall and Newham, it demonstrated a reduction in mortality among older people of 45%; a 21% reduction in emergency admissions; a 24% reduction in planned admissions to hospital; and a 15% reduction in emergency department visits. Those are dramatic benefits, which is why we are so determined to ensure, over the next five years, that we reach out to older people who are living at home with long-term conditions and improve their quality of life in this way.

Group B Streptococcus

9. If he will consider proposals to introduce a national screening programme to detect group B streptococcus in pregnant women. (88274)

The UK National Screening Committee is reviewing the evidence for screening for group B streptococcus carriage in pregnant women, and I am sure that my hon. Friend will be pleased to hear about that. The committee will review the international literature, and a public consultation on the results will open in spring 2012.

Group B streptococcus is the UK’s most common cause of life-threatening infection for newborn babies. Will my hon. Friend agree to meet me and Group B Strep Support, the excellent campaign group, to see how calls for a national screening programme might best be advanced?

I am certainly happy to meet my hon. Friend. I should point out that the Royal College of Obstetricians and Gynaecologists is updating its guidelines and that NICE is also developing guidance. The issue is complex, however, and even testing is not 100% effective. Women who produce a positive result during pregnancy might be negative during labour and, more importantly, those who are negative during pregnancy might be positive during labour. It is important that we get the most up-to-date evidence and ensure that we reduce the tragic consequences of this infection.

I welcome the Minister’s statement, but may I urge her to consider carefully the kind of testing, as the false negatives and positives to which she refers come with the current testing and there are better tests? About 340 babies are affected every year of which one in 10 dies and one in five is permanently disabled. This is a very serious matter and I hope she will do all she can to deal with it.

I will certainly do all I can to deal with it. As the right hon. Lady says, the consequences are tragic but this is a complex area that has changed quite rapidly. I think the US is now at a similar level of infection to us, but what remains a challenge is ensuring that we have an effective test that does not produce false positive or, more seriously, false negative results and that we have effective treatment that works in 100% of cases.

NHS Reorganisation Cost

The cost of the NHS modernisation is estimated to be between £1.2 billion and £1.3 billion. That will save £4.5 billion over this Parliament, and £1.5 billion per year thereafter. We will reinvest every penny saved in front-line services.

I am grateful for that answer. The Minister will be aware that the figure he has given is about half what the primary care trusts believe they are required to keep back to fund the reorganisation: they put it at £3.4 billion. Given his answer today, will he write to South Birmingham primary care trust to tell it that it no longer has to hold back £25 million for that purpose and that it can use that money to cut the 18-week waiting list, which has risen by 36% since he assumed office?

May I say, in the nicest possible way, that I think the hon. Gentleman is a tiny bit confused? I think he is confusing the one-off costs of the modernisation with the 2% hold-back figures used by the PCTs, which put aside money—a process instigated by the right hon. Member for Leigh (Andy Burnham), which we carried on—that can be used if a PCT gets into financial problems. If it does not get into financial problems, it can then use the money to invest in front-line services.

The Conservative-led coalition should be congratulated on introducing a measure that will get rid of red tape and bureaucracy by getting rid of strategic health authorities and primary care trusts. Do the Labour Opposition not look like dinosaurs when they try to defend those bodies?

I am very grateful to my hon. Friend and I am always reassured when he congratulates the coalition Government, as it suggests to me that we are getting something right. My hon. Friend is absolutely right. As everyone who understands health policy in this country recognises, the NHS must evolve to meet changing needs and we are improving effectiveness and efficiency and saving money by cutting out administration and bureaucracy so that we can reinvest in front-line services to look after the health interests of all our constituents.

Figures revealed to the Opposition under freedom of information procedures show that GPs will receive up to £115 an hour for commissioning health care services on top of their existing salary. It makes no sense at all to take GPs away from patient care to become part-time accountants. When the NHS needs every penny it can get, patients will be astounded to hear that the Government plan to pay GPs twice. This comes at a time when 48,000 nursing posts are being axed and £3.5 billion is being set aside for the Minister’s bureaucratic upheaval. Will he now accept that the NHS can ill afford for money to be wasted on a top-down reorganisation that few want? Is it not now time for him to scrap the Bill?

It is nice that the hon. Gentleman got the mantra in at the end—I have been expecting it all through this Question Time. He is wrong; what is important and what this modernisation has at its heart is the need for GPs to commission care for patients, because GPs are best equipped to know the needs of their patients. That is the way forward. Also, we are cutting bureaucracy and administration by 45% so that we can reinvest that money in front-line services. We want to spend money on health care and on improving outcomes, not on managers and bureaucracy.

May I congratulate the Secretary of State and the Prime Minister on the productive ward initiative? The NHS document “Top Tips for spreading The Productive Ward” says:

“Set a realistic time scale. Take your time and do not rush. Take small steps and complete them before moving on to the next.”

Is this advice generally applicable to NHS reform?

As the hon. Gentleman recognised at the beginning of his question, this is important and excellent advice for nurses and other health care professionals to give care, consideration and attention to all patients so that they can be looked after in an appropriate and caring way. That is the way forward to making the health service more responsive to the needs of patients and to the improvement of health outcomes.

The hon. Lady raises an extremely important point. The whole purpose of the modernisation of the NHS is to enable it to meet the challenges of an ageing population, an increased drugs bill and new medical procedures, so that we can ensure that patients get their treatments, within the responsibilities of the NHS constitution, and do not have to wait undue lengths of time for treatment.

Health and Social Care Bill

The Government have listened to representations throughout the passage of the Health and Social Care Bill. In addition to the consultation on the White Paper, the NHS Future Forum has undertaken two engagement exercises. The first involved 6,700 people directly and received more than 28,000 comments and e-mails, and the second involved more than 12,000 people at more than 300 events. Ministers have also continued to meet and to receive representations from a range of interested parties on a regular basis, and we will continue to do so.

I thank the Minister for that response. May I ask what specific representations he has had on children’s well-being? Is he aware that the Children’s Society will this Thursday publish its 2012 “Good Childhood” report, which will include a specific report on how central and local government could improve and promote positive well-being among children? Will the Minister and the Secretary of State meet the Children’s Society to discuss that important report?

Throughout the consultation process there have been comments and responses to proposals across the whole of the health area, including on children’s health and well-being. Obviously, I cannot comment on a report that will not be published until later this week, but I or one of my ministerial colleagues would be more than happy to meet the Children’s Society once the report has been published if the society thinks that a meeting to discuss the report’s contents would be worth while.

Against the background of the recommendation of the NHS Future Forum that a key priority for the future is greater integration between health care and social care—a priority that was explicitly endorsed last week by the Prime Minister—does my right hon. Friend agree that the key opportunity in the Bill, through the health and wellbeing boards, is to drive that agenda, which has been much talked about for many, many years now, and actually to start to deliver on that rhetoric?

My right hon. Friend is absolutely right; of course, when he was Secretary of State he did a considerable amount of work to lay the ground rules for the move towards greater integration, because that is the way forward. My right hon. Friend makes a very valid point: it is the way forward and we fully recognise that. We are deeply committed to achieving that aim, and that is why my right hon. Friend the Secretary of State has added an extra £150 million to the existing £300 million, to facilitate progress towards it.

May I tell the Secretary of State and the Minister that he will receive more representations on his Bill later this week from two hospital doctors who, early this morning, began a 160 mile run to protest against his Bill, from Bevan’s statue in Cardiff to his Department? [Interruption.] The Secretary of State should listen. Let me remind him why people are so angry. Nobody voted for the Bill. It was ruled out by the coalition agreement, and it is now the unelected House deciding the future of the NHS, passing amendments that he was too scared to table in this House.

Will the Minister today have the courage to admit that it is now the Government’s intention to allow NHS hospitals to make 49% of their income, effectively devoting half of their beds, from the treatment of private patients?

May I say a happy new year to the right hon. Gentleman as well? I believe that his analysis of the support for the Bill is flawed, because there are a number of areas where a number of organisations warmly welcome its contents. For example, the BMA voted in favour of GP commissioning at its special general meeting last year.

On the question of 49%, the shadow Secretary of State has been uncharacteristically forgetful, because of course he will appreciate that the cap applies only to foundation trusts, not to non-foundation trusts, and that is no different today from what it will be after the modernisation—and it was a policy that his Government brought in.

No, it was not. That policy would never, ever have come forward under a Labour Government—and I know that the right hon. Gentleman has not denied it. We, the Opposition, will now make it our business to tell every single patient in England about his plans for the NHS. People can finally see the Bill for what it is: a privatisation plan for the NHS. England’s hospitals will never be the same again if the Bill gets through: an explosion of private work; longer waits for NHS patients; profits before patient care. Will not the only choice on offer for patients be the old Tory choice in the NHS: wait longer or pay to go private?

I am afraid that the shadow Secretary of State is just totally wrong. This Government have no intention to and will not privatise the national health service. We want to improve patient outcomes and the patient experience. The right hon. Gentleman should look again at the 49% that he talks about, because we are not changing the situation, particularly because it does not apply to trusts at the moment; it is only for foundation trusts.

The right hon. Gentleman says it is garbage. I think that is confusing from him, because I remind him that of course it was in the Labour party manifesto at the last general election to remove the private patient cap.

Bowel Cancer Screening

The IT system to support the pilots of flexible sigmoidoscopy screening is under development and local bowel screening programmes will be invited to become pilot sites shortly. We remain determined to deliver our cancer outcomes strategy commitment of 60% coverage across England by March 2015.

The Government rightly chose two out of the three pathfinder sites to be in the north-east, at South of Tyne and Tees. When will the date be given for local screening centres to be invited to bid to become pilot sites and have patients as a future part of that bowel cancer screening programme?

We debated these issues before Christmas. I can confirm that advice to local bowel screening programmes on bidding to become pilot sites will be published shortly and the process of recruiting pilots will start this month.

NHS Reorganisation Cost

13. What estimate he has made of the cost to the public purse of NHS reorganisation in (a) Birkenhead constituency and (b) England. (88279)

The cost of the NHS modernisation is estimated to be between £1.2 billion and £1.3 billion. That will save £4.5 billion over this Parliament, and a further £1.5 billion each year thereafter. [Hon. Members: “It is a different question.”] It is the same question. We do not have a local breakdown of these figures, as that will depend on local decisions.

Perhaps the right hon. Gentleman will ask the House of Commons Library for the answer so that he can give it to me next time, and also look at the increase in the number of managers in Wirral over the past five years. The number has gone up by more than a quarter. With that size increase, why are those staff not being used to pilot his reorganisation?

The right hon. Gentleman is absolutely right. There was a significant increase in managers in the NHS in the last two or three years of his Government. Since we came to power, there are just under 15,000 fewer managers and administrators, and 3,700 extra doctors.

The Minister is well aware of the reforms to the NHS in my English constituency, but many of my constituents question whether they are getting value for money in view of the expansion of population in Newark over the next couple of years. Will he look again, please, at the Newark health care review?

If my hon. Friend would be kind enough to write to me with specifics on the situation in Newark, I would be more than happy to look into it in detail and respond to him.

A and E and Maternity Departments

14. How many (a) accident and emergency departments and (b) maternity units he expects will be (i) downgraded and (ii) closed between May 2010 and May 2015. (88280)

The reconfiguration of local health services, including A and E and maternity services, is and will remain a fundamentally local process. What matters is that decisions about service changes are clinically driven, and that patients and the public are involved in those changes to ensure that they get the highest quality care.

I refer to the answer that the Minister just gave to the hon. Member for Newark (Patrick Mercer). The buck stops with the Minister. Would he like to congratulate the SOS Save Our Services group in Bassetlaw, which in the past two months has overturned the proposals to downgrade A and E and maternity services at Bassetlaw hospital? Is that not a good example of the real big society?

As the hon. Gentleman knows, on 20 May 2010 my right hon. Friend the Secretary of State brought in the four conditions that had to be met for reconfiguration, which included paying attention to the views of local stakeholders and the medical profession. So, as the hon. Gentleman rightly says, the decision has been taken not to proceed with the changes at Bassetlaw hospital. No doubt he also welcomes the £900,000 that is being invested to expand and improve Bassetlaw hospital’s A and E facility.

The whole House will note that the moratorium on hospital and ward closures has clearly ended, but as my hon. Friend the Member for Bassetlaw (John Mann) rightly said, the NHS risk registers held by regional and local health boards around the country clearly showed the risks associated with closures and the downgrading of hospital wards. The Government’s Health and Social Care Bill poses risks to the safety and quality of services, yet the Secretary of State has appealed against the Information Commissioner’s ruling that the NHS national risk register should be published. Members of both Houses may be denied the opportunity to scrutinise the real risks that the Bill poses to the NHS before they are asked to vote on it for a final time. Will the Minister give a binding commitment that the risk register produced by his Department will be published in full before the Bill returns from the Lords?

The right hon. Member for Leigh (Andy Burnham) did not publish a risk register during his tenure. His predecessor, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), did not publish the risk register on two occasions during his tenure. The bits relevant to the Health and Social Care Bill have been made public, but we will not be publishing the risk register because, as the hon. Gentleman knows, my right hon. Friend the Secretary of State is appealing, as he is entitled to do, against the Information Commissioner’s decision—[Interruption.] We have a right of appeal, which we are exercising, and we will have to wait until a decision has been reached on appeal. Until then, no we will not be publishing the risk register, because it is not necessary or appropriate.

Early Intervention

15. What steps his Department is taking to prevent ill health and its associated costs through early intervention. (88281)

The public health reforms have at their very heart the prevention of ill health and its associated costs, and the hon. Gentleman in his question clearly recognises the critical impact that intervening early can have. The health visitor work force are an important part of early intervention. We picked up a very demoralised and depleted health visitor work force, so I am pleased to report that training commissions for health visitors are up 200%, and we plan to double the number of family nurse partnerships available by 2015. We are also developing a vision for school nursing.

The introduction of the family nurse partnership and the enhancement of the amount of money available to it is a great credit to the previous Labour Government and the current coalition Government. It enables single teen mums to get one-to-one help from a health visitor. Given the economic circumstances, does the Minister accept that we need to be a bit more inventive to ensure that that very good scheme goes even further? Will she discuss with the city of Nottingham and its health service a payment-by-results system to extend the family nurse partnerships further?

Yes, we are supporting the development of social investment and outcome-based funding models, and I am pleased that the hon. Gentleman has raised the issue of being innovative about how we do that, because it is important. We had a rather static situation previously, so I welcome his interest in developing and testing a payment-by-results scheme in Nottingham, and we will be interested to see his detailed proposals and how that develops locally soon. What matters are the results that we get from the schemes.

I pay tribute to the hon. Member for Nottingham North (Mr Allen) for his work on early intervention and applaud the efforts made by the Minister to recruit more health visitors, but when will the Government be able to deliver the additional health visitors on the ground, trained and in service, in order to reverse the cuts in the health visitor service under the previous Government?

My hon. Friend is right; we picked up a very depleted and demoralised health visitor work force. We have 26 health visitor early-implement sites and, as I said, a 200% increase in planned training commissions for health visitors. Turning this round takes a long time. I am sorry that we could not get started on it earlier, but this will have the critical impact: 4,200 health visitors by the end of this Parliament will give us the results that we need in turning round the fortunes of some of the most vulnerable families in this country.

Early intervention can transform health for children and young people and prevent bigger and more expensive problems down the line, yet the Government have cut funding for early intervention programmes, including Sure Start, teenage pregnancy and mental health in schools, by 11% this year and 7.5% next year. Is not the reality that it is this Government who are depleting and demoralising the health visitor work force, and that their short-sighted, short-term policies will make it harder to prevent poor health and cost us all more in the long run?

The reality is that the Government are picking up a very depleted health visitor work force. School nurses, health visitors and the family nurse partnership are all critical. We picked up a very sorry state of affairs. The hon. Lady is right; early intervention matters, which is why we are doing it. I am just sorry that the previous Government did not take the action that was needed.

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.

My right hon. Friend will be aware that a significant number of private clinics that fitted women with Poly Implant Prothese breast implants are no longer in business. Will he advise the House on how he plans to strengthen not just the regulation of clinics offering cosmetic surgery, but the products that they use?

I am grateful to my hon. Friend. I not only laid before the House a written statement this morning, but will, with permission, make a statement on the subject tomorrow. We have been very clear about the support the NHS will give to women who have had implants through the NHS, and we expect private companies to do the same. Not all will do so, and to that extent I make it clear that the NHS is there to support women in their clinical needs, whatever their circumstances.

The Secretary of State will be aware that thousands of women are worried and frightened about this issue. The statements he has made are welcome, but what practical help can he offer women whose private providers have not yet committed to offering free replacements?

This is important, as the hon. Lady says. All the way through we have wanted to be absolutely clear that any woman who is worried should be able to go to her general practitioner. The NHS is there to support any women in their clinical needs, whatever their circumstances. I have made it clear that I expect private providers to match the NHS support through information and access to specialist advice, imaging and investigation, as necessary, and through the removal of implants if it is decided that that is necessary. If private providers will not do that, let me be clear, as I will explain further tomorrow, that the NHS remains available to support women in their clinical needs.

T5. Does my hon. Friend the Minister believe that the Government’s aim of stopping people smoking is in any way helped by the chairman of the all-party group on smoking and health, the hon. Member for Bristol West (Stephen Williams), using a private letter that I sent to him, and copied to the Minister, to castigate me and make untrue allegations in my local newspaper last Thursday? (88295)

Order. I was doing my best to listen attentively—it is very difficult to hear clearly when there is so much noise. If there is to be a reference to another right hon. or hon. Member, advance notice of it should be provided. These courtesies must be observed. They are there for a good reason.

I remind my hon. Friend that smoking kills over 80,000 people a year in the UK. We have published our tobacco control plan, are implementing the display ban and hope to consult soon on the future of plain packaging. The important thing to remember about improving public health is that it is not a party political issue. I cannot comment on the specifics of the case he mentions, but this is a matter that interests everyone across the House.

T2. The people of Newcastle are more likely to die early from cancer, health disease and stroke. On average, a child born in Newcastle today is expected to die five years before a child born in the Secretary of State’s constituency, so why is he changing the health funding formula so that in Newcastle we will lose 2.5% of our funding, whereas his constituency will see a rise of 2.1%? (88292)

Let me remind the hon. Lady—she might not have noticed this—that before the Christmas recess I announced funding for the next financial year for all primary care trusts in England, and the increase for all primary care trusts is 2.8%. In contrast to the previous Government, we are setting out to reduce health inequalities, not least by focusing resources on public health on the basis of an objective measurement of disparities in health outcomes.

A BBC Essex investigation into Rushcliffe’s Partridge care home in my constituency has uncovered shocking allegations of abuse and neglect. Will the Minister urge the Care Quality Commission to step in now with an inquiry and take whatever legal action is necessary to protect the elderly residents? Will he meet me and my constituent Lesley Minchin who has a relative who has suffered as a result of what has been going on in the care home?

I certainly share my hon. Friend’s concerns. BBC Essex’s reports of abuse and degrading treatment in that care home are cause for concern. The CQC is due to publish a report shortly and I am certainly happy to meet my hon. Friend to discuss the matter further. The Government are determined to shine a light on abuse wherever it is found and to root it out of the system to ensure that people are treated with dignity and respect and get the care they need.

T3. Does the Health Secretary agree with the Prime Minister that our nurses need greater supervision by patients’ groups on the ward to ensure that they are doing their jobs correctly, or does he recognise the tremendous job that they and their professional clinical managers are doing despite the huge cuts that the Health Secretary has forced on their numbers? (88293)

I do indeed agree with the Prime Minister, but I would not characterise what he said in the way that the hon. Gentleman does. I was very interested to see a number of letters in The Times just this morning that highlighted that in the past, under patient and public involvement forums and community health councils, there was a direct public interest in seeing what happened in hospitals and in inspection. Through the Health and Social Care Bill and the establishment of HealthWatch, we will enable the public—representatives of patients—to be involved directly in assessing the quality of the environment in which patients are looked after. They will not supervise nurses. Nurses will be responsible for the experience and care of patients, but the public have a right to be participants in inspection—

When the Government introduced the Health and Social Care Bill a year ago, they did so with the claim that the NHS fails in comparison with its European counterparts with regard to patient outcomes. Now we know that that is not the case, will the Government withdraw the Bill?

I do not agree with that characterisation of why we instituted the Health and Social Care Bill or of the current situation. For example, the OECD published in October its latest assessment of health in a number of countries. In too many respects—for example, in relation to serious respiratory disease—we have very poor outcomes relative to other countries. What we are setting out to do in any case is to deliver continuously improving outcomes and to get among the best in the world. In too many respects we are not yet among the best in the world.

T4. If the Prime Minister really wants to help nurses to focus on patient care, should the Secretary of State not listen to those nurses and drop this barmy, unnecessary Health and Social Care Bill? (88294)

It is precisely because the Prime Minister and I listen to nurses that we met them and made it clear that we will support best practice. The hon. Gentleman and his colleagues should support nurse leadership on the wards. Nurses can see—through best practice, if they talk to patients about their experience every hour—that they can deliver better care. We will support nurses to deliver better care; he should support us in doing so.

I know the Secretary of State cares deeply about outcomes in health. Will he add his support to the campaign for a minimum price for alcohol in England and Wales?

The Government will shortly publish our alcohol strategy, which will set out how we hope to deliver continuing success in the reduction of alcohol consumption and abuse.

T6. In a written answer on 12 December, the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), who has responsibility for care services, told me that the Government felt that:“Local community hospitals provide a vital community resource to support patients in need of rehabilitation, recuperation and respite care”—[Official Report, 12 December 2011; Vol. 537, c. 560W.]What steps will the Government take to prevent the closure of the Chaloner Ward at Guisborough hospital and financially secure that hospital’s vital future? (88296)

I am grateful for that question. I will certainly be happy to write to the hon. Gentleman on Guisborough hospital—I will not delay the House with the detail. I have those details, and will be happy to correspond with him.

The Prime Minister speaks of the “health and safety monster”; does the Minister believe it is right that advertising for personal injury lawyers should be displayed in hospital A and E departments, which many might think would feed the monster and make it bigger?

I am very grateful to my hon. Friend for raising that, because it is an important issue. As he might be aware, there are rules and regulations: it is not acceptable for that sort of advertising in NHS hospitals. I would hope that any trusts behaving in that way immediately review their procedures.

T8. Yesterday, I had a meeting with Patricia Osborne, the chief executive of the Brittle Bone Society, a UK-wide organisation that is headquartered in my constituency. It was made clear to me that given the current funding squeeze across the voluntary sector, the society is concerned about its ability to provide the vital services that it currently provides. Also troubling the society is the lack of support for adult sufferers of osteogenesis imperfecta. What can the Secretary of State tell me about the Government continuing to support that important society, and what more can they do to support adults with that condition? (88299)

The hon. Gentleman will know that the Department of Health continues to support the voluntary sector considerably through section 64 funding and related support. If he wishes to write to me about the specific circumstances of the Brittle Bone Society, I will be glad to reply to him.

I recently made a freedom of information request to all 170 acute trusts asking for the estimated total cost of missed out-patient and surgery appointments. So far, 61 have come back to me, and the cost is already over £1 billion. Will the Secretary of State seriously consider what we can do to tackle the enormous cost of missed appointments in the NHS?

Yes. My hon. Friend makes an important point, and it is something the NHS must focus on. There are considerable opportunities through new technologies substantially to reduce the extent of missed appointments, including through things such as text messaging. What is frustrating is that, sometimes, appointments are missed because patients have not been adequately contacted by hospitals. As for people who abuse the NHS, I hope we will give them no excuses for not meeting their obligation to attend appointments.

Can the Secretary of State intervene with those involved with the health for outer north-east London programme to get them to allow the Barking, Havering and Redbridge University Hospitals NHS Trust to use the births and maternity capacity at King George hospital to take pressure off Queen’s?

As the hon. Gentleman knows, following the independent reconfiguration panel report, which I accepted in full, the Barking, Havering and Redbridge Trust is looking to manage safely its maternity services, while improving the quality at Queen’s. It is doing that in close co-operation with NHS London and, indeed, with the advice of the Care Quality Commission, following the commission’s inspections. I will continue to be closely involved in that, and we will continue to support the Barking, Havering and Redbridge Trust in improving services for the hon. Gentleman’s constituents and others.

In north Northamptonshire in 2010-11, there were 6,164 alcohol-related hospital admissions. That is four times the number just eight years before. What more can be done to tackle this horrendous increase in booze drinking?

Time does not permit me to mention all the things that could be achieved, but let me just say that we are clear about the need, for example, to tackle below-cost selling of alcohol, and we are doing that; to stimulate more community alcohol partnerships, and we are doing that; and to accelerate public understanding of the consequences of alcohol abuse, and we are doing that, not least through Change4Life, additionally, during this year. There is more, but we will say much more in our alcohol strategy soon.

When the Secretary of State, together with the Prime Minister, visited Salford Royal hospital last week to praise the nurse leadership, was he aware that the hospital has cut 200 posts this year and is about to cut a further 200 posts over the next two years as a result of having to take 15% out of its budget? Does he not agree that nurse leadership is important, but that we also need the nurses on the wards to be able to deliver effective patient care?

Of course I had an opportunity to talk to the chief executive, the nursing director and others at Salford Royal, and I was tremendously impressed, as was the Prime Minister, by the quality and leadership of the nursing, which demonstrated what he was saying about nursing—that there is best practice inside the NHS, and we need to spread it. The right hon. Lady is confusing a cost-improvement programme with a cut. I think Members on both sides of the House understand that the NHS is having to make efficiency savings, which involves shifting some resources from the acute sector and hospitals into the community. Right across the NHS, we have an increase of over £3 billion this year; next year, we have a 2.5% or 2.8% increase everywhere.