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Volume 546: debated on Tuesday 12 June 2012

The Secretary of State was asked—

Clinical Commissioning Groups

This year, developing CCGs have delegated responsibility for more than £30 billion of local commissioning. Clinical leadership is using NHS resources more effectively, as part of improvements in care. In particular, we are seeing many improvements in community-based services—for example, a pulmonary exercise programme in Durham; a community spinal service in Reading; and a new musculoskeletal service in the Vale of York CCG.

I thank the Secretary of State for that reply. During the Easter recess, I helped to organise a number of health question times in my constituency, where we brought together the commissioning groups, doctors, people from acute hospitals and hundreds of interested constituents to talk about how we would improve local health care. The good news was that doctors and clinicians—

Will the Secretary of State help by telling me how we can communicate out this example so that other MPs can repeat this valuable exercise?

I am very grateful to my hon. Friend for demonstrating how these new developing relationships that CCGs and local authorities are creating with NHS providers and care providers are delivering improvements in care for the constituents we all represent. I urge other hon. Members to follow her example in stimulating exactly those relationships.

The CCG covering my constituency is interested in improving patient care by looking at new methods of contracting and management, but it has been told that it must use a clinical support service set up by the primary care trust, staffed by ex-PCT staff and most likely based in Birmingham, rather than south Warwickshire, at a cost of £4 million a year. Could the Secretary of State—

I apologise, Mr Speaker. Will the Secretary of State confirm that there is no need for the CCG to use such an organisation and that it is free to form its own commissioning structure without incurring redundancy and wind-up costs from the PCT?

Yes, I can confirm that CCGs have the freedom to decide which commissioning activities they will do themselves and which they choose to secure from external organisations, thus enabling them to carry out their functions effectively. They can, if they wish, develop their own organisations and staff or contract with other organisations, and they are not required to contract with the commissioning support services hosted by the NHS Commissioning Board.

In order for the CCGs to be able to carry out and improve their services, they need appropriate funding. Will the Secretary of State therefore tell me why the Halton CCG has had less funding than it was promised originally?

If the hon. Gentleman is talking about the management budget for CCGs, I can tell him that we set out clearly that it would be up to £25 per head across England, and that is indeed the sum that will be made available.

Has the Secretary of State seen the letter to The Times this morning from six diabetes experts? What steps are the local groups taking to do more to prevent diabetes?

Yes, I read that letter this morning. Today, elsewhere in the House, the permanent secretary to my Department and the chief executive of the NHS will give evidence to the Public Accounts Committee on precisely that issue. In the context of doing so, they will demonstrate how we have continued over the past two years to achieve a substantial year-on-year increase in the number of patients with diabetes who are accessing best-practice services.

I welcome the successful development of clinical commissioning groups, but does my right hon. Friend agree that their success in refashioning care throughout the whole of the health and social care system will depend on close relationships not just in the health service but across into social care and the world of social housing, too?

I do believe that and the legislation requires it of clinical commissioning groups and health and wellbeing boards. The relationship being built up between clinical leadership in the NHS and democratic leadership through health and wellbeing boards is an instrumental part of delivering that integrated care.

The year 2011 saw the biggest ever fall in public satisfaction with the national health service. It was also the right hon. Gentleman’s first full year in office. Does he think that those two facts are in any way related?

No, I do not. The right hon. Gentleman might also care to note that the same survey demonstrated a lower level of satisfaction with the NHS in Wales than in England, but let us leave that to one side.

That survey of 1,000 people asked whether they were satisfied with the way in which the NHS was being run. I was not satisfied. We were in the midst of reform, and we are changing how the NHS is run. Government Members were demonstrating to the public that improvement is necessary and possible in the NHS and that we should not be satisfied with the situation. What is more interesting is that a survey of 70,000 people that we published today demonstrates that 92% of the public—an unprecedentedly high level—who received care from the NHS said that it was good, very good or excellent.

How out of touch can he get, Mr Speaker? I would have suggested some work shadowing on the NHS front line to get him back in touch, but I forgot that he cannot go into a hospital without a police escort these days. Let me tell him why satisfaction with A and E is down: he lowered the target and missed it repeatedly, leaving nearly a quarter of a million people waiting longer than four hours. Today we have found out why his waiting list statistics do not match people’s real experience: managers are changing clinical criteria and removing people from lists. If he wants to regain people’s trust, why not start today by ordering an immediate inquiry and ending this unacceptable practice of waiting list recategorisation?

I spend more time in hospitals than the right hon. Gentleman has hot dinners, I suspect—[Interruption.] The weekend before last, I spent two days in hospitals and I did not require any policemen to be there.

Let me make it clear. In A and E, we have 96.6% of patients being seen, treated and discharged within four hours. More to the point, the latest data on A and E show that the average time spent there came down from 57 minutes to 49. On the question of referral to treatment, we inherited more than 209,000 patients across the NHS who were waiting beyond 18 weeks for their treatment. According to the latest data, that figure went down by nearly 50,000. We are delivering for patients better and improving care. I wish the right hon. Gentleman would get on his feet—perhaps he will do it now—thank the NHS and congratulate it on the improving care, rather than trying to find the one thing wrong with it—

Order. I do not want to be unkind, but every month the Secretary of State’s answers are too long. Perhaps he can make this the first month in which he is rather more economical.

NHS Staff Redundancies

Audited 2011-12 figures on NHS exit packages, including redundancies, are not yet available. The data will be available in the summer, once the Department’s annual report and accounts are laid before Parliament.

The latest figures from the Department show that the cost of reorganising the NHS on Teesside is more than £50 million, including £9 million in redundancy payments to hundreds of staff who have lost their jobs. At the same time the Minister is demanding massive cuts of £40 million from the local hospital trust. Will he apologise to the people of Teesside for wasting their money and confirm that none of those made redundant will be re-hired in the new structures?

No, of course I will not. What the hon. Gentleman fails to recognise is that the NHS must continually evolve to meet challenges and that this is the best chance the NHS has to improve and drive up standards. What he fails to mention in his question is that the £1.2 billion to £1.3 billion cost of the reform will lead, between now and the next election, to £4.5 billion of savings, £1.5 billion every year thereafter until 2020, and every single penny of that money will be reinvested in front-line services.

We already know that this Government spent more than £168 million nationally making NHS staff redundant over 2010 and 2011, and more than £3.8 million in Tower Hamlets, where my constituency is based. Can the Minister tell the House how many of those staff were re-hired in the new system?

Yes, there have been redundancies in the NHS, but 15,500 managers and administrators have ceased to work in the NHS, where the savings are reinvested in front-line services. There are also 4,161 extra doctors, 934 more midwives and 151 more health visitors. That is where we are concentrating the money—more front-line staff, fewer administrators.

At a time when almost 4,000 nursing posts have been axed, the Sandwell and West Birmingham Hospitals NHS Trust is using unpaid jobseekers through the Government’s Work programme to perform duties such as collecting drugs and giving food and drinks to patients. Does not the Minister understand that whatever the good intentions of the scheme, most people will see this as staffing on the cheap, and that there can be no substitute for the necessary number of nurses and health care assistants in our NHS?

First, the shadow Minister is incorrect in the number of nurses who he says have left the NHS. The figure is nowhere near 4,000, as he mentioned—[Interruption.] It is 2,693. Secondly, he denigrates a scheme where people have the opportunity, through the jobcentres, to gain familiarity with the workings of the NHS so that they can take a view as to whether they want to invest their future talents in a career in the NHS. I should have thought that that was to be welcomed, rather than snidely denigrated.

Alcohol-related Hospital Admissions

4. What estimate he has made of the cost of alcohol-related admissions to accident and emergency departments in (a) England, (b) the south-east and (c) Reading East constituency in the latest period for which figures are available. (110317)

We estimate that alcohol misuse cost the NHS in England about £3.5 billion in 2009-10. The published estimate for the number of alcohol-related admissions was 1,168,300 in 2010-11. However, that is admissions to hospital. We reckon that the cost of alcohol-related accident and emergency visits was about £696 million in 2009-10.

As my hon. Friend is aware, the Government’s alcohol strategy proposes that more hospital staff have powers to fine troublesome drunks. Will she work with the Home Office to ensure that these fines are not just punitive, but work to recoup a reasonable part of the £700 million cost that she mentioned, so that A and E departments in places such as the Royal Berkshire hospital in my constituency can recoup some of that money?

Indeed, that is why we have a cross-Government strategy. We will be working with the Home Office and many other agencies and Departments to ensure that we deliver the savings. It is not just about the financial cost; it is also about the human cost. Identification, brief interventions and alcohol liaison nurses are all part and parcel of making sure that we reduce the harms of alcohol.

Again, the north-east tops the league of alcohol-related admissions to hospital. Availability, advertising and price all seem to be encouraging more and more people to buy more and more alcohol in supermarkets. When will the Government do something about the pricing and advertising of alcohol? In case the Minister is worried about the politics of this, she should know that she has the support of drinkers in Darlington’s working men’s clubs.

I can assure the hon. Lady that I am not at all worried about the politics of the issue. To ensure a brief answer, I refer her to the Government’s alcohol strategy, which mentions all those factors and draws attention to the substantial progress we expect to see on those figures.

I welcome the Government’s commitment to supporting GP screening for alcohol misuse, but given that less than a third of GPs use an alcohol screening questionnaire, and of those a third use them for an average of only 33 patients a year, how can the reformed national health service incentivise those GPs to ensure that they support early intervention and minimise alcohol harm?

We will introduce an alcohol check within the NHS checks for adults from April 2013. My hon. Friend is right to highlight the substantial impact that identification and brief interventions in the GP’s surgery and elsewhere can have.

Labour Members share the hon. Lady’s concern about the human, economic and public order cost of alcohol abuse. We understand that the question of a minimum price per unit, to which the Secretary of State is a belated convert, has gone out to consultation, but does the Minister recognise the need to align our minimum price with that in Scotland, because otherwise there will be problems with cross-border smuggling?

I can assure the hon. Lady that we will be talking with the devolved Administrations, and indeed all other agencies, and welcome any input on this. It is good to hear her welcome our strategy, and I am sure she will agree that the only way we can reduce alcohol harm is by working across Government.

Thalidomide Grant

The thalidomide grant is a three-year pilot, running from April 2010 until March 2013, to explore how the health needs of thalidomide survivors can best be met in the longer term and how such a scheme might be applied to other small groups of geographically dispersed patients with specialised needs. Officials have discussed the evaluation of the first year of the pilot with members of the Thalidomide Trust and its national advisory council and we await the evaluation of the second year.

The thalidomide grant was introduced by my right hon. Friend the shadow Secretary of State under the previous Labour Government and has been going on for many years. Can the Minister assure me that it will continue until a decision is taken on whether to carry on with the scheme beyond the pilot stage or to do something else?

I can certainly assure the hon. Gentleman that we are in earnest in making sure that we learn the lessons from this evaluation and work actively with the Thalidomide Trust to ensure that we implement the lessons in future schemes.

My constituent Mr Joseph Bannon of Cleveleys, who is a thalidomide patient, has made clear to me the great importance of continuing the scheme. They are a declining group of people with increasing needs and any failure by the state to meet those needs would be absolutely unconscionable. Will the Minister reassure me that there is no prospect of that occurring under this Government?

What I can reassure the hon. Gentleman about is that the Government are carrying on with the evaluation. We are waiting for the evaluation of the second year to see how the scheme is working. The grant is not intended to meet all the additional costs that thalidomiders face. Aside from the grant, there are other sources of public funding and, of course, the funds that the Thalidomide Trust administers on behalf of those survivors of this catastrophe.

Health Outcomes (Cancer)

6. What improvements in health outcomes relating to cancer he anticipates by the end of the decade. (110320)

Our cancer outcomes strategy sets out the ambition to save an additional 5,000 lives every year by 2014-15, which would halve the gap in survival rates between England and the best in Europe. Looking further ahead, our aim is to have survival rates among the best. To realise our goal, we are acting across a broad front: raising public awareness of the symptoms of cancers and supporting GPs; extending screening and the introduction of flexible sigmoidoscopy; improving access to diagnostic tests; expanding radiotherapy; reducing variation in treatment; and improving quality of life for cancer survivors.

Given the importance of early detection, does my hon. Friend share my concern that young women under the age of 25 in Sherwood are currently being refused smear tests?

The important point about the extension of any screening programme is that it is based on evidence. The most recent review of cervical smear and screening campaigns took place in 2009, and on the basis of all the available evidence at the time the Government’s advisory committee on cervical screening concluded that it would do more harm than good to extend screening below that age, but it is a standing item on the committee’s agenda. It looks at any new evidence and will continue to do so.

Pancreatic cancer is greatly feared by many of our constituents. What funds are going to be made available to assist in its research, and how will the Minister measure improvements in that field?

I am afraid that I did not entirely hear the hon. Gentleman’s question, but it was about research, and the Government are certainly committed to substantial investment, working with partners to ensure that we have among the best research in the world so that we have access to treatments at the earliest opportunity.

Does the Minister agree with the recent report by the all-party group on cancer, which found that, if we are to drive improvements and outcomes consistently throughout the NHS, both the one-year and five-year cancer survival rates should be included in the NHS outcomes framework and in the commissioning outcomes framework?

My hon. Friend, who chairs that all-party group, met me recently to make those points, and as a consequence of that meeting and his excellent note of it I undertook to write to him in greater detail. He will understand that some of those issues go to the heart of data collection and to the quality of the data currently available throughout all cancer sites, and that is the reason why we may not be able to do quite what he wants at the pace that he wants.

Why do the tests for bowel cancer and breast cancer have an age cut-off? Just when people are more likely to have either condition, they are not regularly tested. Why is that the case in many parts of our country?

On the day that the Government have confirmed that from October there will be a complete ban on age discrimination within the national health service, except when it can be objectively justified, the answer to the hon. Gentleman’s question is that the evidence used to determine who is eligible for a screening programme is the basis on which recommendations are made to the Government, and they will be extended in future.

Regional Pay

I have not received any such representations. The Government’s evidence to the NHS Pay Review Body shows that market-facing pay has the potential to enable NHS organisations better to achieve their need to recruit and retain staff within the “Agenda for Change” framework for pay. The pay review body will take evidence from all parties and make its recommendations in July.

It can often be harder to work on the NHS front line in more deprived parts of our country, so would the Secretary of State like to join me on a busy Friday night in A and E in Stoke-on-Trent, where he can explain to the staff why their work is worth less than that of someone working in a more affluent part of the country?

I had the privilege and pleasure of visiting the University hospital of North Staffordshire about eight weeks ago. I very much enjoyed being there, meeting the staff, who I thought were doing a terrific job, and talking in particular to a substantial number of nurses. We did talk about that issue, and implicitly the hon. Gentleman is criticising the existing “Agenda for Change” framework, because there are high-cost areas in some parts of the country. The proposals and my evidence to the NHS pay review body do not recommend cutting anybody’s pay; they suggest that within the “Agenda for Change” framework we should extend high-cost areas.

Will the Secretary of State confirm that highly paid senior managers working in the new bodies established by the NHS reorganisation will be exempt from his plans for regional pay variation? Does he think that that is fair?

Yes, I do—in the same way as, for example, we are not including doctors and dentists in the same market-facing proposals. The reason why is that they do not work in what are essentially local labour markets; rather, they work in national labour markets.

The most recent available statistics show that 50% of public sector jobs outside London were vacant for more than eight weeks, compared with 13% in the private sector. How will lower regional pay improve that situation?

I simply reiterate to my hon. Friend the point that I have already made. We are not proposing to cut anybody’s pay; we are proposing to give NHS organisations a greater mechanism through the “Agenda for Change” framework so that they can secure the recruitment and retention of staff. That is precisely the issue. Whatever their needs may be in terms of the recruitment and retention of staff, their pay should be better able to adjust to that.

Given the extent of social deprivation and the fact that £450 billion will be taken out of the pockets of people in Northern Ireland, particularly those on low incomes, will the Secretary of State confirm that there are no plans to introduce regional pay into the national health service in Northern Ireland during this parliamentary term or in future, as this would have a detrimental impact on the economy?

If, as the Secretary of State says, it is not his intention to see pay cut, does he hope that as a result of this measure lower-paid health workers in poor regions will be paid more?

At the risk of repetition, let me say that in any part of the country NHS organisations, like organisations in other fields, should have the ability to set pay levels that reflect to a greater extent local labour market conditions and their need to recruit and retain staff. My hon. Friend will recall that a number of south-west trusts are looking at going down the path of setting their own pay arrangements. It was in fact the previous Administration who in 2004, under the “Agenda for Change” pay framework, gave trusts and foundation trusts precisely the freedoms that they are proposing to use, so I cannot understand how Labour Members can possibly object to those freedoms now.

The Secretary of State may wish to call this market-facing pay, but he has rather let the cat out of the bag with his previous answers. In fact, he has proposed lower pay for NHS staff in poor areas—a move that would create a deeply divided, two-tier NHS and undermine the NHS in the communities that need it most. We know that the Secretary of State does not take advice from medical professionals, but will he perhaps take some from one of his own Back-Bench colleagues, the hon. Member for Hexham (Guy Opperman), who said that

“someone working in the NHS in a deprived part of the North East probably deserves more pay, certainly not less, than a nurse in leafy Surrey”?

Will the Secretary of State commit today, yes or no, to withdraw these disastrous proposals?

If I may say so, I think that the hon. Gentleman wrote his question before he had listened to my earlier answer. I am not proposing to reduce anybody’s pay. It is very simple. The NHS Pay Review Body will have the opportunity to make recommendations. I gave evidence to it on the basis that we should retain a national framework for pay through the “Agenda for Change” framework. However, it is transparently the case that the “Agenda for Change” framework has not thus far enabled NHS organisations, as they say themselves, to adopt a pay structure locally which better reflects the market in which they are employing.

NHS Trusts

We are working directly with all NHS trusts to enable them to achieve foundation trust status—for the great majority, by April 2014. Achieving foundation trust status means that NHS trusts have achieved high and sustainable levels of clinical quality and financial governance.

It is possible that North Yorkshire and York primary care trust will this year declare a deficit based on inherited debt from the merger of PCTs several years ago. I am concerned that the new clinical commissioning groups might have to pick up that deficit. Will my right hon. Friend look at all the options to ensure that clinical commissioning groups can be given the best possible start by having a clear balance sheet?

No primary care trust should plan for a deficit in 2012-13. Primary care trusts carrying legacy debt into 2012-13 must clear it in accordance with the 2012-13 NHS operating framework. As at the end of 2011-12, the primary care trust my hon. Friend mentions had legacy debt that has been managed and absorbed locally by the strategic health authority. As at the end of 2011-12, the PCT is not forecasting any legacy debt.

No-shows and people failing to keep appointments in out-patient departments are costing Brighton and Sussex University Hospitals NHS Trust nearly £6 million a year. Does my right hon. Friend agree that this is extremely selfish, and would he propose sanctions on those who fail to show up for their appointments?

I am grateful to my right hon. Friend. I have no proposals for sanctions, but I commend to him and his trust the many mechanisms that are available, which they may know about, such as sending text messages to mobile phones. I have seen them in practice, and they do stimulate patients to attend their appointments and so reduce what has been an unacceptable level of non-attendance.

Orthopaedic Patients

Substantial progress has been made through innovative approaches and improved risk management, leading to increased survival after fragility fracture, improved trauma care and better governance of hip implants. The latest results to December 2011 show improvements in patient reported outcomes for both hip and knee replacements.

Does my right hon. Friend share my concern about the significant increase in hip and knee revisions over the past five years or so? Does he support Professor Tim Briggs’ proposals to deal with that in his report, “Getting it right first time”, which is supported by all the professional associations and which NHS London is looking to adopt?

An increased number of hip and knee revisions is one of the consequences of an ageing population. I welcome Tim Briggs’ report, “Getting it right first time”. His recommendations are sensible. I am pleased to note that it has the support of the British Orthopaedic Association, as well as clinicians in London. It will help us build on the progress that is being made, to which I referred. The latest figures show that the proportion of hip fracture patients who receive all elements of the best practice tariff has risen from 24% in 2010 to 37% in 2011, and to 55% in 2012. That achievement has attracted international interest and is undoubtedly saving lives.

Public Health Outcomes

This year, we published our public health outcomes framework, which will last from 2013 to 2016. It sets out two high-level outcomes: to increase healthy life expectancy and to reduce differences in life expectancy and healthy life expectancy between communities. This is the first time that a Government have published a public health outcomes framework, and the first time that there has been ring-fenced money for public health.

On 31 July 2010, I smoked my last cigarette. Every day since then has been a struggle and I still consider myself to be a smoker. Will my hon. Friend outline for the House what support the hundreds of people in my constituency and the tens of thousands of people around the country who are in the same boat are getting to improve public health outcomes?

I heartily congratulate my hon. Friend on his considerable success, which he has put on the record. We have a number of initiatives, not least the NHS’s quit helpline. There has been a rise in the number of people phoning it and in the number of people who are attempting to quit. He is an example not only to his constituents, but to many Members around the House.

How do the Government intend to ring-fence the public health money that will be given to local authorities?

Quite literally, by putting it in a ring fence. That money can be spent only on improving public health among the local population. There are 66 supporting indicators in the outcomes framework. The money will be given to local authorities on the basis that they will make progress towards achieving those outcomes.

Clinical Commissioning Groups

11. What his policy is on the national authorisation process for clinical commissioning groups; and if he will make a statement. (110325)

The NHS Commissioning Board is responsible for considering applications from clinical commissioning groups to be established and for determining those applications. The process of authorisation is an important element of ensuring that CCGs are ready to take on their commissioning responsibilities. There are 212 aspiring CCGs that are preparing to apply for authorisation.

West Cheshire clinical commissioning group is making excellent progress towards taking control of all NHS services in April next year. It is one of the first wave to undertake the national authorisation process. When can first-wave groups, such as West Cheshire, expect to hear whether they have been successful?

I congratulate West Cheshire and other CCGs on the progress that they have made by aspiring to CCG authorisation. We expect first-wave applicants to be informed of the outcome of their authorisation applications by November. Once the outcome is known, the focus will be on ensuring a safe and managed transition from primary care trusts to CCGs on 1 April 2013.

Public Health Responsibility Deal

The responsibility deal has brought together 392 partners, a doubling in number since its launch a year ago. Working together, we have removed artificial trans fats in foods, reduced salt content, put calories on high street menus, improved alcohol labelling, set out ambitious future plans for calorie and alcohol reduction, promoted enhanced physical activity and strengthened employers’ support for health in the workplace. Transparent monitoring and evaluation are vital, and our partners’ assessment of the delivery of their pledges will be published on our website. We are making up to £l million available to fund an independent evaluation of the responsibility deal.

The Mayor of London supports a ban on the sale of mega-sized sugary soft drinks at entertainment venues, which will help fight obesity. Will the Government consider such a measure as part of their nationwide responsibility deal?

As I said to the hon. Gentleman, as part of the responsibility deal we are considering an ambitious programme of removing 5 billion calories a day from the diet in England. A range of programmes, such as behaviour change programmes and the reduction of saturated fats and sugars in foods by the industry, will make that happen. All those issues will be considered as part of how we can deliver that ambitious programme.

22. I congratulate the Secretary of State on yet another initiative that has helped to ensure that patients in England have a better standard of health service than their counterparts in Wales. What is his message to Welsh Members of Parliament who call on him to stop various reforms and expect him to impose the second-class standards of health service that we see in Wales thanks to the Welsh Assembly? (110337)

Yes indeed. There are serious public health challenges to be faced up to in Wales, and it would be much better if the Labour Government in Wales, instead of cutting the budget by 6.5% as they are planning to do, increased it in real terms as the coalition Government are doing in England.

Health Inequalities

The legal duties that we have introduced will ensure that health service commissioners have regard to the need to reduce health inequalities. The NHS and the public health outcomes framework will set out ambitions to reduce those inequalities in both health services and the health of the population. That is an ongoing area of work. We already have the indicators in the framework, but we also need the ambition to work on those inequalities.

Central Bedfordshire council has a number of public health challenges such as establishing health and wellbeing boards. Does the Minister agree that those challenges would be much easier to achieve and more effective if agencies such as social services, education services and others worked together? Are the Government doing anything to help facilitate that?

My hon. Friend is absolutely right that education, social services and health services need to be brought together. That is exactly why bringing public health into local government is critical. If we add to that list housing and local business services, we have the mix to turn around many people’s fortunes. Some of the 66 indicators in the framework are school-readiness, social connectivity, air pollution and chlamydia, and they will all require local government to work at every level with all agencies to reduce inequalities.

What steps is the Department of Health taking to address the inequalities in regional health outcomes for pancreatic cancer?

We are doing a number of things, and the most important is devolving responsibility for public health to local areas. It is clear that delivering improvements in diagnosis, outcomes and so on for people with pancreatic cancer relies on different actions in different areas. The important thing is to give local people the power and money to do what they know is right.

I am sure the Minister would agree that Newark hospital is performing outstandingly in stamping out inequalities. However, given the expansion of population in Newark that is expected by the end of the decade, will the Minister allow me and some of my constituents to meet her to discuss the inequalities we anticipate?

I am always delighted to meet any hon. Member or hon. Friend and their constituents, particularly if they face inequality concerns.

Resource Distribution Formula

From 2013-14, the NHS Commissioning Board will allocate resources to clinical commissioning groups. The Health and Social Care Act 2012 contains the first ever legal duties on health inequalities for NHS commissioners and the Secretary of State. This applies to everything the NHS Commissioning Board does, including allocating resources.

Will the Minister give the House a clear assurance that he will not downgrade the importance of economic deprivation in his resource allocation formula?

Yes, I can give that assurance. I know this has been of some concern to the right hon. Gentleman and the north-east, but I can tell him that we are not planning to alter resource allocation to transfer funds from the poorest parts of the country. There is also no mandate to propose a formula based purely on age. As he may or may not know, although age is the primary driver of an individual’s need for health services, the most recent primary care trust formula uses a range of factors to determine fair shares, including the age structure of the population, levels of deprivation and the unavoidable costs in providing services between areas.

The last of those factors is relevant because community health care increasingly allows people to live at home for longer and to go home sooner after hospital admissions. However, that means that sparsity is a factor in the cost of providing health services in rural areas such as Wiltshire. Will the Minister therefore find a way of recognising that within funding allocations?

Yes. I hope I can reassure the hon. Gentleman. As he may be aware, the Advisory Committee on Resource Allocation is currently reviewing the formula by which funding is allocated. We await its recommendations and will look at them carefully before making any announcements.

The reason the funding formula is causing such concern in the north-east is that we have some of the worst public health outcomes in the country, including on obesity, liver disease, vascular disease and so on. Given that there is to be no change to the funding formula, why has the Faculty of Public Health said that the inequalities will get worse because of the reforms the Minister proposes?

No. I do not think the hon. Lady is right in that—[Interruption.] As she will appreciate if her hon. Friends on the Opposition Front Bench would just hush and listen for minute, there will be allocations for public health, but there will also be allocations for acute care in clinical commissioning groups. Those will be done to reflect the needs of areas up and down the country. No one area will be penalised at the expense of another. What is more, they will be done on the basis of independent advice, as I said to the hon. Member for Chippenham (Duncan Hames) in my earlier response.

Breast Screening

15. What progress his Department has made in introducing fully digital breast screening; and if he will make a statement. (110329)

As at 1 May 2012, 74 out of 80 local breast screening services had at least one digital X-ray set, and 53 were fully digital. All services must have at least one digital X-ray set in order to enter the breast screening randomisation project and extend screening to women aged 47 to 73.

I thank the Minister for his reply, but may I press him on making digital happen in my constituency? Where is funding responsibility in the new NHS for investment in new digital equipment and for making the switch? Does it fall 100% with the foundation trust wishing to be commissioned to provide the service, or with the body wanting to commission it, or—dare I say?—is there a third way?

There are three aspects to that question. The first is that we need to ensure that providers can purchase equipment at the lowest possible price. That is why NHS Supply Chain is making arrangements to ensure that digital mammography is available at the lowest possible price to providers through the various initiatives it is taking. The primary responsibility sits with the provider to provide the equipment against which they have been commissioned to provide services. Of course, in the specification it makes for the service, the commissioner will make it clear that digital is required.

Topical Questions

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

The strategic health authority has ruled out the locally preferred option for the transformation of community health services in Milton Keynes. Given the Government’s commitment to localism and their preferred approach to the integration of services, will the Secretary of State look at this matter again?

It is for the primary care trust to appraise the options and decide which is best for local people. The SHA has a role in providing assurance in that process, but I would urge both the PCT and the SHA to ensure that they meet the test that we are looking for, which is that any decision must be in the best clinical interests of patients and must meet the views of clinical commissioners in the future and, indeed, those of the public, not least as expressed through the local authority. I would urge the PCT and the SHA to make progress on that, and, if it would be of any assistance to my hon. Friend, I would be glad if he were able to meet me, the PCT and the local authority to help to resolve the issue.

In their 2010 NHS White Paper, the Government promised legislation on a new legal and financial framework for social care. However, last month’s Queen’s Speech included only a draft Bill, on social care law alone. We cannot tackle the care crisis without tackling the funding crisis, so will the Secretary of State now agree to Labour’s call for legislation on a new system for funding social care in this Parliament? Yes or no?

The hon. Lady will know very well that last year we made it clear that we intended to publish both a White Paper on the reform of social care law and, alongside it, a progress report on the reform of the funding of adult care. We still intend to do both those things, and to do so soon.

T4. The Minister is aware that a form of postcode lottery operates in the provision of IVF treatment at the moment. Does she agree that the Health and Social Care Act 2012 provides an excellent opportunity to end this lottery and allow a more equalised approach to IVF treatment? (110342)

Yes, and may I commend my hon. Friend on the work he has done in this area? In the reformed NHS, infertility treatment services will be commissioned by clinical commissioning groups, with the NHS Commissioning Board providing oversight and support. That will include the provision of resources and tools to enable CCGs to collaborate to commission infertility services. We will continue to expect those commissioning infertility treatment services to be fully aware of the importance of having regard to the National Institute for Health and Clinical Excellence fertility guidelines.

T2. Speaking on 24 April, the Secretary of State indicated that the NHS distribution formula should no longer take account of deprivation. That would have cost Sheffield £73 million a year and benefited Surrey by £400 million. His ministerial colleague, the Minister of State, the right hon. Member for Chelmsford (Mr Burns), seems to have denied that that is the case. Will the Secretary of State therefore confirm that this is the Government’s latest U-turn? (110340)

No, I will do no such thing, because the premise of the hon. Gentleman’s question is completely wrong. I never said any such thing. What I made perfectly clear is that, as has been the case in the past, age will continue to be the principal determinant of health need, and therefore, by extension, that age will be the largest factor in determining the allocation of resources to the NHS. That was true under the last Government; it will continue to be true under this one.

T5. On 21 June, conscientious, hard-working doctors will be putting their patients before the British Medical Association’s ill-judged call for industrial action. Can the Secretary of State confirm to the House, however, how many surgeries, operations and clinics will be needlessly cancelled, and how much all this will cost the NHS? (110343)

I entirely understand my hon. Friend’s concern, and I applaud the way in which she has expressed it. The BMA’s proposed action could result in up to 30,000 operations being cancelled, as many as 58,000 diagnostic tests being postponed, and more than 200,000 out-patient appointments being rescheduled. I do not think that the House will understand why the BMA would risk patient safety in that way, when it knows perfectly well that its action will have no benefit and that we cannot now go beyond the basis for pension reform that has been agreed with the majority of the NHS trade unions, especially in circumstances in which doctors will continue to receive an extremely generous pension worth up to £68,000 a year at the end of their working lives. I think that the right hon. Member for Leigh (Andy Burnham) and I share the view that this is not a justified position for the NHS to take. The pension is intended to be a generous one. Through the negotiations with the BMA and the other trade unions, we arrived at a very generous pension scheme.

T3. Thanks to the staff at St Thomas’ hospital in London, and at Aintree in Liverpool, I have had excellent health care myself in the past three weeks, but, in order to build the morale of staff across the NHS, will the Secretary of State instruct all NHS trusts not to cut anyone’s pay? (110341)

I am glad that the hon. Gentleman has had excellent care; he might like to tell those on his own Front Bench about it, as they are constantly denigrating the NHS. I will simply reiterate what he will have heard me say previously, which is that I have made no proposals to cut anybody’s pay in the NHS.

T6. What progress has been made in discussions with primary care trusts on the transfer of assets to NHS Property Services Ltd? (110344)

The Department is currently reviewing updated lists of properties for proposed transfer. Thereafter, the boards of the sending and receiving organisations will endorse the transfers and give their final approval in the next few weeks to allow the legal transfer process and human resources consultations to commence. The legal transfer of assets to either NHS providers or NHS Property Services Ltd will take place on 31 March 2013.

T7. We have learned today that public satisfaction with the NHS has fallen dramatically. We also know that satisfaction with GP services has fallen for the second consecutive year, and that satisfaction with accident and emergency services is going down by 7% each year. The Prime Minister promised that the NHS would be his priority. Is it not about time that this Government lived up to that promise? (110345)

We have learned no such thing. Indeed, we published on the Department’s website today a survey that asked people who had been looked after by the NHS how well they thought their care had been provided to them. It showed that 92% of the patients said their care had been good, very good or excellent. In my view, that survey of 70,000 patients who had received care from the NHS completely trumps a survey that asked 1,000 people what they might have thought about the NHS in relation to the media activity that took place last year.

T8. The Cheshire and Merseyside treatment centre has been closed for just over a year, since the private sector contract let by the last Government expired. Can the Minister confirm that the centre is now going to be brought back into the NHS as a fully fledged part of the Warrington and Halton hospitals trust, and will he give me an indication of the time scale involved? (110346)

I am grateful to my hon. Friend for giving me the opportunity to explain that the NHS trust and the PCT have made plans for the building to be used by the Warrington and Halton Hospitals NHS Foundation Trust for orthopaedic out-patients and surgery. Those plans should enable clinicians to provide the NHS services needed by local people in much-improved buildings, and I understand that services will be recommenced from those buildings in weeks.

In written responses to questions about clinical commissioning groups, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) incessantly replies—most recently on 18 April—that CCGs do not yet exist, so how can he offer assurances, as he has done today, that any real progress is being made by the CCGs, when they are currently being supported by PCTs? And will he explain his “now you see them, now you don’t” response?

I will tell the hon. Lady how we can talk about the progress made by CCGs—because we actually go and talk to them. I recall visiting the Blue Coat school in Merseyside a few weeks ago and speaking to the leaders of clinical commissioning groups—from Liverpool, Lancashire, Manchester, Warrington, Knowsley and St Helens—and many of them had 100% delegated responsibility for budgets this year. They explained to me the opportunities they were taking to improve the care of their patients by using that responsibility.

T9. Clacton was promised a new renal unit several years ago. While they are waiting, local people have had to travel long distances for treatment. I am due to meet the commissioning authority to discuss the endless delay. If it fails to make progress soon-ish, could I meet the relevant Minister and his officials to work out what we can do to prod the commissioning authority into getting a move on? (110347)

My hon. Friend will be aware—and, I am sure, will understand and support—the devolution of commissioning responsibilities locally. He is right to pursue the matter in the way he proposes. Over a number of years, including under the previous Administration, efforts were made to secure additional access to dialysis. For a long period, we in this country had lesser access to dialysis than in other countries—particularly when people were not only working but likely to be on holiday. I welcome the point my hon. Friend is pursuing and, when he has had his conversation locally, perhaps he would like to tell me the outcome.

The Government blocked Labour’s plans to introduce public health as one of the licensing conditions. I wonder whether, in the spirit of localism, this power should now be given to health and wellbeing boards.

As I am sure the hon. Lady is aware, we have proposed in the alcohol strategy to make sure that public health and other health considerations can be used in making decisions about licensing applications. This is what we have achieved from having a cross-government strategy and approach, moving public health responsibilities back into local government.

May I emphasise to my right hon. Friend the strength of local feeling in Milton Keynes that we should retain our integrated community health service, which has worked incredibly well and provides a good role model for elsewhere in the country?

I am grateful to my hon. Friend. The four tests for service change that we have set out—I think rightly—are not just about the tests that must be met before changes can be introduced; they also involve the same considerations that should drive the design of services. If local commissioners, the local authority and local people are supportive of a particular form of organisation, including community services, I would hope that that would provide the basis on which the design of services would proceed.

Last evening, I attended the launch of UKCK—a group of charities coming together to raise funds to purchase advanced radiotherapy equipment. Will the Minister explain why, despite his previous assurances, regions like the north-east are having to turn to charities to raise funds to buy this potentially life-saving equipment?

If the hon. Gentleman would like to supply me with the details of regions that are having to do that, I will certainly write to him on the matter. What we are doing is making an extra £750 million available to the NHS during this spending period to support the investment in radiotherapy services. I will certainly come back to the hon. Gentleman on his particular point.

In an Adjournment debate last year on the safe and sustainable review, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) confirmed the minimum number of operations at 400 a year, saying that it was based on the level of activity needed to provide good quality care around the clock. Does he share my astonishment that the chairman of the joint committee of PCTs has said that he can give no assurance that that will be included in the final review? Does that not undermine this unhappy process?

My hon. Friend will be aware, as other Members are, that this is an independent review conducted by the joint committee of primary care trusts. On that basis, I will not comment directly on anything said in that context. I simply reiterate what was made clear in last year’s debate that the joint committee will not conduct its review solely on the basis of the options set out in its original consultation.

Regarding the answer given to my hon. Friend the Member for Leicester West (Liz Kendall), the Government did not promise to give us a progress report on funding, but to legislate in this Session to reform social care funding. Social care is now widely seen as being in crisis. When will the Secretary of State commit to acting urgently—because urgency is needed now—to tackle this crisis?

I must correct the hon. Lady. We did not say that we would legislate in the current Session. What we made clear was that we would publish a White Paper—which we will do—and that we would publish a progress report on funding reform. We were also clear—as we still are—about the fact that, as part of the coalition programme, we would act urgently, and we will continue to do so.

The Department of Health is to be asked to sign off the business case for the transfer of services from Lambert Memorial community hospital to the new extra care housing scheme—sometimes called an extra sheltered accommodation scheme—in updated community facilities. Will the Secretary of State give me a personal assurance that there will be no sign-off until the future of Thirsk’s community hospital is guaranteed for its current purposes?

I cannot give my hon. Friend that assurance, not least because such decisions are led locally by local organisations. However, if the tests for service change were not met and the local authority referred the matter to me, I would of course take advice through the independent reconfiguration panel, and consider it in the light of that advice.