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Health

Volume 548: debated on Tuesday 17 July 2012

The Secretary of State was asked—

Clinically Led Commissioning

Clinical leadership in the design of services for patients will deliver better outcomes and improve patient experience of care. In the last year, for example, NHS Dorset clinical commissioning group has worked to improve outcomes in cardiology, dermatology and muscular-skeletal services, and NHS Nene CCG has admitted more than 3,000 patients on to a proactive care scheme, which I have had the privilege of seeing for myself, to identify and reduce the risks of people needing an emergency admission. That is one reason why the number of emergency admissions to hospital in the NHS fell by 1%.

The Secretary of State will be aware of Chester’s location on the border with Wales and of the issues with cross-border health care commissioning. In order to ensure that there will be no financial shortfall for the West Cheshire CCG in relation to the treatment of patients who are registered with general practitioners in Wales but who receive treatment in England, will he confirm that the cross-border commissioning funding protocol between England and Wales will be fully implemented?

I would be grateful if my hon. Friend could convey my best wishes to the Countess of Chester hospital, which I visited just before Christmas, and my appreciation of the work of the West Cheshire CCG. I can confirm that discussions between officials in the Welsh Government, my Department and the NHS Commissioning Board are under way to extend and renew the protocol for cross-border commissioning for 2013-14 and beyond.

If the Secretary of State believes that the reconfiguration of hospitals is clinically rather than finance led, will he ensure that NHS North West London publishes full risk assessments of its decision to close four accident and emergency departments and replace them with urgent care centres?

As the hon. Gentleman will—I hope—be fully aware, the view of Ministers is clear: any reconfiguration of services must be driven not by cost but by a need to improve clinical outcomes for patients; must be in line with the commissioning intentions of the local commissioning group; must be on the basis of strong patient and public engagement; and must protect the choice available to current and prospective patients. To that extent, I hope that all the necessary information to support those four tests is in the public domain.

GP commissioners in Bromley have opened a consultation on the future of services currently provided at the Orpington hospital site. Will the Secretary of State ensure that the administrator recently appointed to South London Healthcare trust takes account of the consultation’s findings when drawing up his proposals for how best to put SLHT on a sustainable clinical and financial footing?

I hope that my hon. Friend is aware that when I appointed the trust special administrator and set a timetable for his work, I specifically added 30 days on an exceptional basis to the timetable for the production of his first report, one of the exceptional reasons being that an accelerated consultation should take place locally on the future of Orpington hospital.

The right hon. Gentleman needs to listen carefully to what I am about to say. Yesterday, he promised action to stop the restricting of cataract operations for financial reasons, if given evidence. How about this example? NHS Sussex has imposed severe restrictions that contradict the Department’s own guidance, “Action on Cataracts”, and this has seen the number of operations in Sussex fall from 5,646 in 2010 to 4,215 in 2011. Does the Secretary of State consider that fair to older people, and will he now take the action his Department has promised?

I have made it clear to the right hon. Gentleman many times, as has the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), that it is not acceptable and we will not allow NHS commissioners to impose blanket bans. I will gladly take note of and investigate that example, but I have to say that the right hon. Gentleman wrote to me with a document that purported to contain a series of examples from across the country, most of which turned out to be fictional. I shall respond in writing about NHS Sussex and put a copy in the Library of the House, but, as I have made clear, we, unlike our predecessors, will not accept any blanket ban on treatment. Any treatment must be clinically determined in the interests of patients.

Well, the right hon. Gentleman is accepting it, and he continues to dispute my evidence, but what does he say to the president of the Royal College of Ophthalmologists, who said yesterday of cataract restrictions:

“They are arbitrary and are a response to financial pressures, not clinical needs”?

The reason for the Government’s denial is that the financial pressures are greater than they care to admit. The figures released by the Treasury yesterday confirmed that he and the Government have now cut the NHS budget for two years running, but they also reveal something else: another real-terms cut planned for 2013-14. Do not their flagship promises on NHS spending now lie in shreds, and will this Prime Minister not be for ever remembered as the man who cut the NHS, not the deficit?

It is staggering, isn’t it? In 2010-11, the NHS budget was set by the right hon. Gentleman, not by us. The final accounts for 2011-12 will not be published until the autumn. I wish he would just get up at the Dispatch Box and admit that over the course of this Parliament the coalition Government will increase the NHS budget in England by 1.8% in real terms, which is £12.5 billion in cash, whereas the Wales Audit Office has said that a Labour Government in Wales will cut the NHS budget over the same period by 10% in real terms.

Social Care

The draft Care and Support Bill contains clauses that support our commitment to introduce a universal deferred payments scheme and a national eligibility threshold. We have set out our intention to base a new funding model on the principles of the Dilnot commission model and we will take a decision in the next spending review.

Last week the Secretary of State dismissed the concerns of Labour MPs about councils being hard pressed to find funds to implement any of the proposals. The Local Government Association stated that there was no money. Will the Minister now commit to legislation in this Parliament to sort out the funding of social care at local level?

It does not need legislation to sort out the amount of money that goes into social services; it does need legislation, however, to put in place a universal deferred payments scheme. We have made it clear that we will fully fund the commitment that we have already announced and we will work with the Local Government Association and others on its detailed design and implementation.

The verdict of the Care and Support Alliance on the delay in introducing legislation to reform social care funding is this:

“Each day of delay condemns greater numbers of older and disabled people to the risk of isolation and neglect,”

trapping people in hospital and pushing many more carers to “breaking point”. Just when will the Government realise the damage done by delaying the decision to do anything about funding social care?

In fact, in October 2010 this Government took an important decision about the funding of social care: to invest an extra £7.2 billion. I wish Opposition Members would stop running local authorities down and support the ones that are doing the right thing and ensuring that they spend the money the Government have provided to them on social care, rather than cutting those services. That is what I am doing; I hope that the hon. Lady will as well. I just wish that she had prefaced her comments by apologising for 13 years of Labour failure on social care.

I welcome my hon. Friend’s statement today and the announcements last week about the future structure and the commitment to introduce legislation later in this Parliament in line with the draft Bill. Will he confirm that it is the Government’s intention to pursue the cross-party talks on funding options for the Dilnot package, and that if solutions can be found, they can be included in the legislation that is introduced?

Notwithstanding some of the perhaps intemperate exchanges we have in this place, my colleagues and I are still determined, if those on the Opposition Front Bench are, to engage in talks on how we reform the funding system. Indeed, the debate we had in the Chamber last night confirmed that both sides of the House wish to support the principles of the Dilnot reforms, so I hope that we can have such talks and that they can be reflected in the Bill.

I welcome the Government’s commitment to support the provision of free and fully integrated end-of-life care. While the palliative care funding pilots are progressing, can lessons be learnt quickly in my borough of Enfield where, sadly, most people are dying in hospital rather than, as is their choice, at home or with the support of local hospices?

My hon. Friend is absolutely right. Just last week we published the world’s first ever survey of bereaved people’s experiences of the end-of-life care received by loved ones. It revealed quite stark variations from one part of the country to another, and will prove a valuable tool in driving up performance of areas that are not doing well by families in end-of-life care. As for the White Paper, we have said clearly that we are committed to doubling funding for the pilots to ensure that we have the data to take decisions about the introduction of free personal care when it comes to end of life.

Opposition Members are genuine in our desire to reach cross-party consensus on the funding of social care. Will the Minister demonstrate his Government’s seriousness by agreeing to include Treasury Ministers directly in the cross-party talks, as Labour has offered to do from the start?

Talks that start with lots of preconditions are not going to be very good talks to start with. The Government always retain the responsibility for making decisions about taxation and spending priorities. We set out our position last week on the Dilnot Commission, and we now have a clear basis for talks, as those on both sides of the House seem to agree on the principles of Dilnot as the basis for reform.

NHS Performance

3. What assessment he has made of the performance of the NHS in 2011-12; and if he will make a statement. (117279)

At the beginning of this month, I laid my first annual report before the House setting out the achievements of the health service in 2011-12. The report showed that the NHS had continued to maintain or improve all the key performance standards while delivering unprecedented efficiency savings and a strong financial out-turn. That is a testament to the achievements of all NHS staff.

I thank my right hon. Friend for that answer. Will he confirm that the numbers of people waiting over 18 weeks, over 26 weeks and over 52 weeks for treatment are now at their lowest-ever levels—lower than when Labour was in office? Will he also confirm that that gives the lie to Labour’s claims that waiting lists are increasing?

Yes; I am grateful to my hon. Friend. When we came into office, something like 209,000 people had waited over 18 weeks. We have reduced that figure to 160,000. The number waiting over a year was nearly 19,000, and we have brought that down to below 5,000. I remind Opposition Members that in Wales the target for the number waiting more than 26 weeks has not been met—the figure stands at 6%, whereas in England it is 2.2%.

In regard to improving cancer outcomes, will the Secretary of State consider using some of the underspend in the cancer drugs fund to allow improved access to advanced radiotherapy?

I am grateful to the hon. Gentleman for that question, because it allows me to confirm that the annual report states that the NHS has met all the cancer waiting time standards, and that we in England have provided for 12,500 patients to have access, through the cancer drugs fund, to cancer drugs that they would not otherwise have been able to have. It is a matter of regret that a similar cancer drugs fund is not available for exceptional treatments in Wales.

What part or percentage of the £5.8 billion efficiency savings can be attributed to the salary freeze alone?

If I may, I will write to my hon. Friend in order to convey the precise figure. From my recollection, I believe that the bulk of the £5.8 billion efficiency savings—£2.8 billion—was in the acute sector. As most of the acute sector’s costs are pay costs, the pay freeze will have contributed a significant part of that.

Will the Secretary of State accept that some of those so-called efficiency savings are totally counter-productive? Despite Ministers’ claims to be saving money on agency staff, is not the truth that hospitals’ attempts to improve their efficiency have backfired, with jobs being cut and agency staff being hired at rates as high as £1,600 a day?

No, I will not accept any such thing. We are aiming to reduce agency staffing costs in the NHS under QIPP—the quality, innovation, productivity and prevention programme—by £300 million, and we have already made a reduction of more than £120 million. Since the election, in complete contrast to the situation beforehand, we have reduced the number of administrative staff in the NHS by 15,000, including a reduction of more than 6,000 managers. We have also increased the number of clinical staff by 4,000 since the election.

Social Care

The White Paper introduces new measures to help us to deliver better quality services and to improve the care that people experience, including through greater transparency, with new provider quality profiles and new care audits. It also clarifies what quality in care and support means, by setting out principles, standards, roles and responsibilities for driving up the quality of care. The White Paper makes it clear that we will rule out crude commissioning by the minute, which turns care workers into clock-watchers, and that we will work with commissioners, care providers and people who use services and carers in order to bring to an end commissioning practices that undermine people’s dignity and choice.

I recently visited Ashton Lodge residential home in Dunstable, and I was delighted to hear from the residents how kind the staff were. Occasionally, however, I get letters from constituents detailing simply unacceptable levels of care for their family in residential homes. How can we involve local communities more so they take a role in ensuring that all residential homes have consistently high standards of care?

I am grateful for that question. Indeed, one of the issues set out in the White Paper is the collaboration by the Department of Health and others with leaders in the care sector to make sure that care homes become much more embedded as part of their local communities and much more genuinely open to their local communities—working with local schools and working with HealthWatch, which will have powers of entry to work with those care homes as well. By turning the spotlight on in a benign way, making sure that all care homes are more open to their public, I think we can significantly improve quality.

In parallel with the social care budget, do the Government see a strong role for GPs to look at prevention—putting in special monitoring as people get older to ensure that we stay younger and fitter for longer?

Indeed we do. We identify in the White Paper the fact that there has been a postcode lottery for many years when it comes to access to primary care in our care home sector. The White Paper sets out how to ensure that we begin to eradicate that postcode lottery. By establishing a national commissioning board to commission primary care, we can ensure greater consistency in the future.

What conversations has the Minister had with his counterpart in Northern Ireland in respect of protecting the high standards of residential and nursing care that already exist for the people in Northern Ireland?

I am grateful to the hon. Lady for her question. Indeed, officials in my Department are in close contact with officials in all the devolved Administrations to make sure that we share best practice across the nations so that we drive up the quality of care for all.

Only last week, the Secretary of State said about care:

“The…number of delayed discharges is broadly the same as it was last year and, I believe, from memory, the year before—I will correct the record if not.”—[Official Report, 11 July 2012; Vol. 548, c. 322.]

Figures published by his own Department show the number of delayed days is up by 18% in the last year and 29% since August 2010. Are Ministers completely out of touch with reality, or would the Minister now like to correct the record?

Of course what the hon. Gentleman omits to mention in seeking to give an impression is this: the implication is that social services are not coping with delayed discharges and are the principal cause of them, but the figures do not bear that proposition out. [Interruption.] Indeed, the extra investment the Government are making in reablement services means that discharges in this area are being assisted and improving—[Interruption.]

Order. The question has been asked, and the Minister is giving his answer. Members may like it or dislike it, but they have a duty to listen to it with courtesy. While I am about it, let me emphasise that there is far too much sedentary noise coming from both Front-Bench teams. I think that the Minister has finished his answer; we are grateful to him.

Insulin Pumps

We are currently undertaking a national audit to give us a clear picture of provision of pump services in England. This will be published shortly. The rapid response survey for 2010-11 suggests that half of all those eligible for a pump in England already have one, or have funding agreed—a significant improvement on the initial survey in 2010.

I thank the Minister for that reply. I am sure he will be aware that Nicola Sturgeon, the Health Minister in the devolved Administration at Edinburgh, announced earlier this year that all the under-18s requiring an insulin pump would get one. My constituent 13-year-old Fiona Clark has been told by Yorkhill hospital in Glasgow that she will have to wait an unspecified time to receive the pump her doctors say she needs. Given that the National Institute for Health and Clinical Excellence estimates the standard benchmark rate for the uptake of insulin pump therapy for type 1 diabetes in England is 12.4%, will the Minister offer his Department’s assistance to help those in Scotland to get above the current paltry 3.1% uptake?

I am extremely grateful to the hon. Gentleman, but as he will appreciate as a Scottish Member of Parliament, this is a devolved responsibility for the Scottish Government. On the specific issue—[Interruption.] If the right hon. Member for Leigh (Andy Burnham) would shut up, it would be helpful. It would probably be useful if the hon. Gentleman raised the specific issue with the Scottish Government, but on the general principle let me say that we are determined, certainly in England, to do all we can through education, the workings of the NHS and the operating framework to ensure that the number of people receiving pumps increases, as it already has in the last two years.

Nursery Milk Scheme

In 2009-10, the number of portions funded was 218 million. In 2010-11 it was 262 million, and in 2011-12 it was 271 million. Of course, children do not necessarily attend nursery five days a week, so the number of portions does not equate to the number of children, so, say, 1 million children attending full- time or 2 million attending 2.5 days a week.

In Hull the nursery milk scheme has never been more needed, at a time when poverty is increasing and food banks are expanding. Will the Minister guarantee that no child who currently receives nursery school milk will lose out after the results of the consultation have been published?

As the hon. Lady will know, we are consulting on a range of options to modernise the operation of the scheme. The cost rose to £53 million in 2010-11, and is due to rise to about £67 million in 2012-13. Given those massive increases, we need to look at the scheme’s operation to ensure that we are getting good value for money.

10. Does the Minister accept that the cost may well have risen because more children are receiving free milk? Because the consultation is being launched during the school holidays, it will be extremely difficult for schools to respond. If this is a genuine consultation which aims to ensure that milk reaches the children who need it, will the Minister consider extending the deadline into September and October? (117287)

The consultation has been running for some time now, and I should have thought that local authorities in particular would have had plenty of time in which to respond. Given that 8,962 settings are paying more than 90p for a pint, which is an outrageous amount, it is extremely important for us to hear from everyone. If the hon. Lady feels that there has been any problem with responses to the consultation and would like to drop me a line, I shall be happy to respond.

Health Inequalities

The Health and Social Care Act 2012 established the first legal duties to reduce health inequalities for national health service commissioners and for the Secretary of State. Both the NHS and public health outcomes frameworks will have a strong focus on reducing inequalities in access to health services, and on inequalities in the health outcomes of the population as a whole.

My right hon. Friend will be aware of the inequalities in diagnoses of dementia around the country. What steps has he taken to reduce that variation in diagnosis rates?

As I think my hon. Friend will know from recently published data, some of the pilot work involving general practices demonstrated that it was possible to increase substantially the number of patients diagnosed with dementia. I believe that during the pilot period there was an increase of two thirds, more than 60%, in the number diagnosed. As part of the Prime Minister’s dementia challenge, we are using quality incentives in the NHS to identify and refer patients who are admitted to hospital with potential dementia in order to improve their diagnosis and treatment. We hope that that and other measures will identify more of those whose dementia is at an early stage, and will also assist their treatment.

One of the key elements in the tackling of inequality is funding. The funds allocated to the clinical commissioning groups was set out in the operating framework, which related to GPs’ patient lists. It has now been changed to take account of data from the Office for National Statistics. Will the Secretary of State assure me that deprived areas will not lose out on the funds allocated to CCGs—not the per-head funds, but the funds allocated to CCGs as a result of the change?

As I am sure the hon. Gentleman knows, we will publish the allocations for 2013-14 later this year. However, we are ensuring, I think rightly, that the allocations to clinical commissioning groups for NHS services reflect the population, because they have a responsibility for the whole population. Some parts of the country, particularly London, have substantial unregistered populations, which often include the groups who are most at risk.

Does my right hon. Friend agree that one of his important initiatives that could reduce health inequalities is the development of personal care budgets, which give real power and choices to patients, and also have the potential to reduce hospital admissions and costs?

Yes, since the election we have pushed forward with offering access to a personal care budget to those who are in receipt of care and support. At the time of the last election, about 168,000 people were exercising that right. The figure now is over 432,000, and we are extending the scheme so that, for example, people in receipt of continuing health care through the NHS will not lose the opportunity for personal care when the NHS takes over that responsibility; instead, that will continue as a personal budget under the NHS.

Does the Secretary of State think any of the steps he set out in his original answer will lead to a repeat of the shock rise in the number of cancelled operations in the local hospitals serving my constituents, the figures for which were recently set out in a written answer to me by his Minister of State, the right hon. Member for Chelmsford (Mr Burns)?

The number of cancelled operations rises at certain times during the winter, and it did so during last winter. We are clear about the necessity of ensuring that patients do not have cancelled operations if we can avoid that, and, in particular, that those whose operations are cancelled have access to treatment rapidly thereafter. The key is to make sure, as we have done, that patients have timely access to treatment under the referral to treatment times guidelines, and as the hon. Gentleman will be aware, the average waiting time for treatment in the NHS has fallen since the election, as has the number of people waiting a long time for treatment. That is the strongest measure for ensuring all patients get timely to access to care.

Wythenshawe Hospital A and E

8. How many patients attended the accident and emergency department at Wythenshawe hospital in the last 12 months for which figures are available. (117285)

The Department does not collect data on accident and emergency attendances at hospital level. These data are only available at trust level. In the 12 months up to 8 July 2012, there were 108,393 accident and emergency attendances at University Hospital of South Manchester NHS Foundation Trust.

I am grateful to the Minister for that reply, and I am sure he will want to join me in thanking the staff at Wythenshawe A and E department, particularly given that that colossal number of 108,000 attendances has taken place in a unit originally designed for 70,000 patients. However, if the A and E department at Trafford general hospital is closed, as is currently proposed, that would lead to a still greater increase in the number of patients at Wythenshawe A and E. Given that, is it not essential that the £11.5 million that will be required for extra facilities at Wythenshawe should be made available?

I hope the right hon. Gentleman is not disappointed, but I cannot add anything to the answer I gave in the debate we had last week when he asked that specific question. I can assure him, however, that local commissioners have assessed the impact of the proposed changes at the Trafford and other hospitals, including Wythenshawe. The plans are still at an early stage and are yet to go to public consultation, and I have been informed that local commissioners will continue to review the impact of these changes on the other hospitals, including Wythenshawe. I urge the right hon. Gentleman, other Members whose constituencies are in the area and their constituents to contribute fully to the consultation process.

The Minister knows that the proposal is, first, to reduce services at the Trafford to urgent care provision and then, within not less than two to three years, to a minor injuries unit. What processes will be put in place to ensure that the most stringent criteria are applied in respect of investment in Wythenshawe and the other hospitals, as well as in Trafford community services and improved services to patients, before any such further move is contemplated?

As the hon. Lady will be aware from the debate we had last week, these proposals are subject to the consultation process and to consideration of the results. Commissioners fully recognise the need to minimise the impact the changes will have on neighbouring A and E departments and other services. The Trafford and South Manchester clinical commissioning groups are working on developing further integrated care services, and on developing community care services as an alternative to hospital care, as well as on ensuring that the final decisions meet the needs of the local health economy by providing first-class quality care for the people of that area.

Of course, it is not just Wythenshawe A and E that is facing difficulties. All Members throughout the House are grateful for the work our medical professionals do in extremely trying circumstances, but the truth is that the Government’s chaotic reorganisation has resulted in longer waits in accident and emergency. The Minister of State said last night that A and E departments were meeting the target, but figures published by his Department last week show that the Government have failed to meet the 95% target across major type 1 A and E units. If he cannot get his own figures right, he cannot expect to command the trust of patients or medical professionals. Will he now take this opportunity to show some respect for this House, for the public and for patients in general, and correct the record?

Order. May I just explain that the Minister did not widen the parameters of the exchange and therefore they should not be widened, so he is perfectly within his rights, if he wishes, to focus his reply on Wythenshawe. I hope he is not going to be too disappointed. We’ll give it a go.

I am most grateful.

Of course, the hon. Gentleman is playing with the figures. As he knows from previous discussions, he is talking about the SITREP—situation report—figures, which do not form the basis of the figures the Government use. [Interruption.] If he will keep quiet for a minute and listen, I will reiterate the point I made last night. Regarding A and E waits of under four hours and the percentile of 95, we are at 96%, which means we are within and above the level set down by the Government’s figures.

Health Allocation Formula

The independent Advisory Committee on Resource Allocation is reviewing the allocation of resources for the NHS through clinical commissioning groups, and for local authorities in relation to their future public health responsibilities. ACRA’s interim recommendations on the preferred distribution of public health resources were published on 14 June. The NHS formula will be published in due course. The draft mandate for the NHS Commissioning Board makes it clear that it should provide resources to secure equal access for equal need.

I thank the Secretary of State for that answer. It is becoming increasingly clear that ageing is a key driver of health care costs, yet the ACRA formula currently does not properly take that into account, to the detriment of towns such as Warrington. Can he confirm that under the new formula, ageing will be more prominent?

Yes. As my hon. Friend will know, under the existing formula, age was the single biggest factor, but what is important is that the formula accurately reflects the factors that will give rise to need for health care, so that the allocation of resources can respond directly to that need. Ensuring separately that there is an allocation to local authorities for public health, which will be measured in relation to mortality below the age of 75 in particular, will enable those resources separately to be focused on, for example, areas of greatest deprivation which give rise to the poorest health outcomes.

I am interested to hear the Secretary of State say that he understands there is a link between deprivation and health inequality, in light of the new funding arrangements that seem to indicate that councils in the north-east will receive £17 per head less for public health, whereas councils in wealthier parts of the country will receive £8 per head more.

The hon. Lady knows perfectly well that I have said many times that deprivation can give rise to inequalities in health outcomes. In particular, we are improving substantially the framework for reducing those health inequalities, because we are giving local authorities specific, dedicated resources. Let me make it clear to her that under the public health allocation formula that I outlined just a few weeks ago, no part of the country will see any reduction in its public health resources from the baseline established.

Residential Care (Funding)

12. What assessment he has made of the effect on residential care providers of reductions in local authorities’ budgets. (117290)

Local authorities choose how best to use their funding; however, the levels of residential care provision are not determined solely by local council social care budgets. The supply of care home places is governed principally by demand from both public commissioners, such as local councils and the NHS, and private purchasers of services.

Nine out of 10 residential home providers say that low council fees are creating a two-tier system, as new investment is directed at wealthier areas where there are more people who can self-fund, and 82% of those providers say that self-funders are being charged more to cross-subsidise local authority-funded residents. This clearly is not fair, so what is the Minister going to do to rectify the situation?

We know from the most recent survey published by Laing and Buisson that there has been a 1.4% increase in the fees paid this year, compared with no increase last year. We also know that there is a surplus of places, which accounts for about 10% of the total number of bed places available in care homes up and down the country. So there is actually space, and it is entirely appropriate for local authorities to negotiate appropriate prices to provide good-quality care from one locality to another.

Following the census announcement yesterday that there are elderly hot spots, including North Yorkshire, will this is be a good opportunity for the Minister and the Government to review health and social care funding to reflect a growing elderly population in sparsely populated, isolated rural areas such as North Yorkshire?

My hon. Friend is absolutely right to highlight those issues and the emerging findings from the survey. It is important to say that data will be a key consideration in how the next spending review is shaped, along with the priorities that the Government will give to different demographic pressures as a result.

Children's Heart Services

I have received representations about the review of children’s heart services via letters, parliamentary questions and e-mails from hon. Members, via letters and e-mails from organisations and the public, and via meetings. My right hon. Friend the Secretary of State has received two overview scrutiny committee referrals, one from the Yorkshire and Humber joint health and overview scrutiny committee and one from the royal borough of Kensington and Chelsea.

Is the Secretary of State confident that the committee has properly balanced the clinical decisions with the practical transport issues faced by families of children with heart problems?

The assurance I can give the hon. Gentleman is that we certainly believe so, but these are matters for the joint committee of primary care trusts, which carried out this review. As he will appreciate, it is totally independent from the Department of Health, and rightly so.

My right hon. Friend will be aware of the concerns in Yorkshire about the review. Can he confirm to us, for the sake of absolute clarity, with whom this decision will lie finally?

I am very grateful to my hon. Friend; this is the hors d’oeuvre before the main meal later today. Ultimately, if any overview and scrutiny committees of relevant local authorities do not agree with the final decisions, they have a right to write to my right hon. Friend the Secretary of State asking him to refer the matter, with their concerns, to the Independent Reconfiguration Panel. If it is asked to look into the matter, it will then come to a conclusion, of which it will inform my right hon. Friend and he will then take a decision.

The Scottish Government have decided that although the Yorkhill unit is currently unsafe, it can be made safe in the context of three surgeons doing 300 operations, whereas the “Safe and Sustainable” review, which is increasingly discredited, is demanding 400 to 500 operations. Why is it one rule for children in Scotland and another for children in Yorkshire?

I have to tell the hon. Gentleman that the decisions that the Scottish Government and the Scottish Health Department might take with regard to Glasgow is a matter for them. The fact is that we recognise what is commonly accepted among the international community: that the safest way of providing that surgery is by carrying out about 400 operations a year.

NHS (Whistleblowers)

14. What steps his Department is taking to ensure that confidentiality agreements do not discourage NHS whistleblowers from coming forward. (117293)

The Department wrote to the NHS trusts most recently in January 2012 reminding them that compromise agreements should not prevent information from being disclosed in the public interest. It also said that they should satisfy themselves that their organisational policies are in line with previously issued guidance.

I am grateful to my hon. Friend for that answer. She will be aware of the case of my constituent Mr Gary Walker, the former chief executive of United Lincolnshire Hospitals NHS Trust, who has been prevented by a confidentiality agreement from raising his concerns about the effect on patient safety of the previous Government’s targets. I want to hear Mr Walker’s concerns and my constituents are entitled to hear them. I hope that my right hon. Friend the Secretary of State will look into this matter and give a categorical assurance that the concerns that Mr Walker has told us about will come into the public domain.

I thank my hon. and learned Friend for his supplementary question. I cannot comment on the individual details of the case, but I appreciate his concern that NHS staff could be prevented from speaking out by confidentiality agreements. Confidentiality and compromise agreements are allowed in contracts, but the Public Interest Disclosure Act 1998 provides that any clause in that contract or compromise agreement between employer and employee is void in so far as it acts to stop the employee making a protected disclosure.

Given the proliferation of new bodies being created to deliver NHS services, including a number of private sector organisations, can the Minister be confident that the NHS constitution protects whistleblowers working for private companies but delivering NHS public services?

I assure the hon. Lady that all must have regard to the NHS constitution. In fact, we issued guidance to NHS organisations that all contracts of employment should cover whistleblowing rights. In September 2010, we amended terms and conditions of service and guidance to the NHS on supporting and taking action on concerns raised by staff. The changes made to the NHS constitution make very clear the rights and responsibilities of NHS staff and their employers in respect of whistleblowing. As I have pointed out, all those providing services on behalf of the NHS must have due regard to the NHS constitution.

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.

I thank the Secretary of State for that answer. Two of my local dentists have been closed as a result of an Office of Fair Trading investigation. Although that is totally understandable and nothing to do with the NHS, will the Secretary of State confirm to my constituents that they will have access to NHS-funded dentists? There happen to be more NHS-funded dentists in this country now than there were under the previous Government.

I think I can give my hon. Friend that reassurance. We are committed to increasing access to NHS dentistry, and over 1.1 million more patients have been seen by an NHS dentist since May 2010 than before the election. Nationally, there are more dentists. In 2010-11, there were 22,799 compared with 22,003 in the preceding year, before the election. NHS Kent and Medway has confirmed that it will have six dentists in place from 1 September 2012 who will temporarily provide the treatment that she is looking for, and it has started tendering processes to commission permanent NHS dental services in her area.

T2. The Minister will be aware of the 500% increase in the use of antidepressants over the past 20 years. I welcome the announcement of the hundreds of millions that will be spent on talking therapies over the next few years, but will the Minister tell us specifically what funding has been allocated for mindfulness, which is the best known treatment for repeat episode depression? (117303)

I am grateful to the hon. Gentleman for that question. He has been a doughty campaigner and pursuer of this issue and I can tell him that a number of improving access to psychological therapies—IAPT—services are developing and using mindfulness-based approaches. Indeed, as the hon. Gentleman said, NICE recommends them for the treatment of recurrent depression. A number of randomised controlled trials are going on to see how it might be applied to other long-term health conditions. There is baseline allocated funding but there is no specific earmarked funding for this particular project other than in the context of the IAPT programme, in which we have invested £400 million.

T6. Yesterday’s figures showed a 17% increase in the population of Milton Keynes over the past 10 years, the highest outside London or Manchester, and an unexpected increase of some 4,000 over the estimate in the past 12 months. May I seek the Secretary of State’s reassurance that that will be reflected in future health care budgets for the city? (117307)

As my hon. Friend will, I hope, have understood from previous exchanges, the focus on the delivery of care to the resident population in an area covered by a clinical commissioning group will mean that we try, as far as possible, to align resources with the needs of a whole population rather than with just the practice-registered population.

T3. The Government often talk about reducing the number of managers in the health service to defend the front line, but following my recent meeting with my local representative from the Royal College of Nursing, can the Secretary of State confirm that under the Government’s definition a ward sister at band 7, who has a hugely important front-line role, is actually considered a manager? (117304)

If a member of staff is professionally qualified, they will be counted against the number of managers part of the overall work force census. It remains true, as we have said, that since the election we have reduced the number of managers in the NHS by more than 6,000 and increased the number of clinical staff by more than 4,000.

T7. Last year’s National Audit Office report highlighted inconsistencies in the care of patients with neurological conditions such as Parkinson’s, which neurology networks could address. When will the Government publish their review, announced last September, of clinical networks in the national health service, and will it offer any hope for Parkinson’s patients? (117308)

I am grateful to my hon. Friend for asking that question. The NHS Commissioning Board is currently conducting a review of the effectiveness of clinical networks, and the scope for expanding them. It includes examining the case for neurological clinical networks, and a report should be published very soon.

T4. In yesterday’s debate, when talking about the south-west consortium, the Minister of State, the right hon. Member for Chelmsford (Mr Burns) emphasised the need for negotiations and agreement with staff. Does the Secretary of State not think it was shocking that staff found out only through a series of freedom of information requests that the consortium existed, and can he tell me when the Department of Health first found out about the consortium? (117305)

I will gladly write to the hon. Lady about when we were first aware of the consortium. I think it was several weeks ago; indeed, the document referred to prominently in the press on Sunday had been on websites for some weeks, so there is nothing new about that. We knew about it. I reiterate the point that I and my right hon. Friend made yesterday: even though under a Labour Government, in the 2006 legislation, powers were given to trusts to take their own decisions on the employment of staff, they must do so in negotiation with the staff side. We would expect that. From my point of view, the South West Pay Consortium is rightly looking to maximise flexibility, but I have made it clear to the pay review body that we believe that the flexibility it needs can be delivered through negotiations and “Agenda for Change”. It will not and should not require the reduction of pay for staff.

T9. The clinician-led “Better Services Better Value” review has condemned the accident and emergency unit, and the maternity and children’s wards at St Helier hospital, because it expects out-of-hospital services to be expanded instead. Will the Secretary of State meet me to discuss local concerns that the £5 million allocated to provide the out-of-hospital services will be totally inadequate to the task? (117310)

I am grateful to the right hon. Gentleman for that question. As he knows, any proposals for service changes will be subject to the Secretary of State’s four tests and a full three-month public consultation across south-west London, which I am sure the right hon. Gentleman and his constituents will take part in. My right hon. Friend the Secretary of State will be more than happy to meet him to discuss the matter further.

T8. In the north-east region, there is one neuromuscular care adviser providing dedicated specialist care and support for more than 3,000 people with muscular dystrophy and associated conditions. Will the Minister give assurances that care advisers will continue to be funded and commissioned at specialist NHS Commissioning Board level so that they can carry on supporting community teams across the country? (117309)

I give the hon. Lady that assurance. Specialised commissioning will be carried out through the NHS Commissioning Board.

T10. I commend the Government for their plans to improve the care and support system, especially for an ageing population. How will the changes make a real difference to carers, particularly those supporting people with Alzheimer’s and dementia? Is there more we can do to support them? (117311)

I am grateful to the hon. Lady for her question. She is right: we have to do as much as we possibly can to recognise and support family carers. In the White Paper, we have set out a number of steps, not least investment of £400 million to fund more breaks for carers. We are working with the Royal College of General Practitioners to make sure that they are more aware of carers and can identify more carers. We are doing work to make sure we have earlier, quicker diagnosis in more areas of dementia so that people get the support they need. Most important of all, we are making sure that hospitals, as part of the services they provide for people with dementia, actually deliver on NICE guidance on supporting family members. Finally, the Government are legislating, for the first time ever, on support for the needs of carers.

What assessment has the Secretary of State made of the views of clinicians, and scientists from academia, industry and the third sector, on the impact of change on the development of stratified medicines?

I have the benefit of a review undertaken by Sir John Bell and his colleagues, which I accepted wholeheartedly. In particular, I immediately agreed with the recommendations, and we are implementing and funding recommendations for the establishment of centres across the NHS for genetic testing to support stratified medicine for cancer patients.

Further to the Secretary of State’s welcome response to the hon. Member for Bristol East (Kerry McCarthy), and his comments yesterday on the issue of the south-west consortium in relation to pay reductions, will he apply the same attitude to pay and conditions, particularly backward or downward regradings and other detrimental changes to terms and conditions?

As my hon. Friend knows, trusts and NHS employers are responsible for the terms and conditions of their staff, and for ensuring, as “Agenda for Change” intends to, that staff who effectively have the same knowledge and competences have the same pay banding, wherever they happen to be across the country. That is the objective of “Agenda for Change”. As I said yesterday, and will continue to say, “Agenda for Change” can be improved—we made that clear to the pay review body—but we think it is possible, if the staff side works with us, to enhance “Agenda for Change” and increase its flexibilities, so that NHS employers can recruit, retain and motivate their staff, with local flexibility, in a national pay framework.

Given that every year, 1.2 million admissions to accident and emergency units are alcohol-fuelled, when will the Government help the NHS and legislate for a minimum alcohol unit price?

I am sure that the hon. Gentleman is very familiar with the alcohol strategy and has read it in detail. It is one of the things that we need to do. Brief interventions, specialised treatment, the NHS alcohol check and, of course, changes to licensing will all make a difference. As I say, the alcohol strategy, a cross-Government document, is out. We will respond further in due course.

Last week, the Royal Cornwall Hospitals NHS Trust cleared an important milestone towards becoming a foundation trust. An historical debt remains, largely as a result of punitive accounting measures under Gordon Brown. Will my right hon. Friend the Secretary of State do everything that he can to ensure that when the Royal Cornwall becomes a foundation trust, it is debt-free?

I think the hon. Lady was referring to the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown). For future reference, we do not refer to Members of the House by name.

My hon. Friend will, I am sure, know that an application for foundation trust status from the Royal Cornwall Hospitals NHS Trust is currently being considered by my Department. The trust is being assessed on whether it meets the quality, service, performance, business strategy, finance and governance standards required if a trust is to be an FT. Once the trust has demonstrated that it has met those standards in all other regards, the Department will ensure that any outstanding liquidity issues are resolved in time for the trust to be authorised as an FT. The process of assessing FT applications will ensure that any remaining debt carried by the trust when it becomes a foundation trust is affordable within the trust’s forward plans.

The chair of the South London Healthcare NHS Trust has written to the Secretary of State to correct inaccurate information given out by the Department of Health regarding the trust’s performance. [Interruption.] Instead of barracking me, would the Secretary of State—[Interruption.] Instead of shouting at me now, it is a shame that the Secretary of State did not meet the local MPs when he had the opportunity. Will he distance himself from the false information put out by unattributable sources in his Department, which will undermine the performance of the hospital and shows little respect for the health service workers who are working to improve services?

If I can calm the situation down. [Interruption.] If the hon. Gentleman will just hush I will give him the answer.

Order. There is, frankly, too much noise on both sides of the House. It does not suit the Minister now for the hon. Member for Eltham (Clive Efford) to shout from a sedentary position, and I absolutely understand, similarly, that it does not suit Opposition Members when the right hon. Gentleman and his colleagues chunter from a sedentary position. Let us have a truce, and the right hon. Gentleman can be a statesman—we look forward to it.

As ever. I do not share the hon. Gentleman’s analysis of the interpretation of what has happened with regard to the trust’s performance. There has been an historic problem with its performance, but I pay tribute to the staff, who have made tremendous efforts to improve performance, and have achieved some improvement. The trouble is that it is not sustainable not to put the trust on a sustainable financial footing. The hon. Gentleman said that he would like a meeting with me or my right hon. Friend the Secretary of State. [Interruption.] As he will know, if he keeps quiet for a minute, I have written to him offering a meeting with my right hon. Friend, on 24 July; I hope that the hon. Gentleman can attend.

Cases of blood poisoning from E. coli have increased by nearly 400% in the past 20 years, and E. coli resistance to antibiotics is almost certainly linked to record levels of antibiotic usage on factory farms. By over-using antibiotics we risk ruining for future generations one of the great discoveries of our species. Will the Department put pressure on the Department for Environment, Food and Rural Affairs finally to take that issue seriously?

I understand the issues. Indeed, I was interested to see analysis some years ago of the extent of antibiotic resistance in hospitals in the Netherlands. Resistance was clearly much more prevalent in parts of Friesland where there was much greater antibiotic usage in farming. I therefore completely understand, and my colleagues in DEFRA understand this too. Just as we are looking for the responsible and appropriate prescribing of antibiotics in the health service, my colleagues feel strongly about the proper use of antibiotics in farming.

When the national advisory council of the Thalidomide Trust recently met Government representatives, no funding undertakings were available on the replacement of the health support grant for sufferers. When can we expect a meaningful commitment in that regard, and is the Department liaising with its devolved counterparts?

Yes, we are liaising with the devolved Administrations. Yes, we had a productive meeting with the trust and the council, which confirmed that they will shortly submit to us the second-year evaluation of the pilot programme. I undertook to look at that carefully and enter into further discussions with a view to reaching a conclusion and making further announcements this autumn.

Ministers may recall the concern of patients and carers in the New Forest area about the decision to close a third of acute adult mental health beds in Hampshire. Are Ministers aware of a similar trend in other parts of the country, and if they are, as they should be, what do they think about it?

My hon. Friend has raised that issue in different forms on many occasions, and feels strongly about it. The decision to reconfigure services in his constituency was made locally, and the Hampshire overview and scrutiny committee decided not to write to my right hon. Friend the Secretary of State asking him to refer it to the Independent Reconfiguration Panel, because it presumably believes that it is the right way forward to continue to provide first-class quality care for patients.

Does the Secretary of State agree that commissioners in Cumbria must bear their share of responsibility for the deep-seated problems in the Morecambe Bay health trust, which have taken far too long to address. Will he join me in urging those commissioners to protect services such as Barrow’s maternity unit in their forthcoming review?

As we have seen in a number of instances over the years in the NHS, all those responsible should always be aware that, although the responsibility for quality may be, in the first instance, for the board of a trust, it is also the responsibility of those who commission the services. As the hon. Gentleman will be aware, one of the key considerations for the future in the development of services is for the NHS to respond to the commissioning intentions of local commissioners. Clearly, the matter that he raised will be determined locally as regards what commissioners require in terms of services from Morecambe Bay trust.

Order. I am grateful to Ministers and all colleagues, but as usual, demand has exceeded supply. I am sorry to disappoint some colleagues but we must now move on.