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Topical Questions

Volume 548: debated on Tuesday 17 July 2012

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.