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Health

Volume 554: debated on Tuesday 27 November 2012

The Secretary of State was asked—

Health Visitors and Nurses

1. How many (a) health visitors and (b) nurses there were in the NHS in May 2010 and the latest month for which figures are available. (129934)

The number of full-time equivalent qualified nurses and midwives employed in the national health service in England in May 2010 was 310,793, and in August 2012 it was 304,566. The number of full-time equivalent health visitors in May 2010 was 8,092 and in August 2012 it was 8,067, with an additional 226 health visitors employed by organisations not using the electronic staff record.

I thank the Secretary of State for that answer. The recent Care Quality Commission report found that 10% of NHS hospitals did not meet the standard of treating people with respect and dignity, and underpinning that poor care were high vacancy rates and hospitals that have struggled to make sure they have enough qualified staff on duty at all times. That shows us the real impact of losing those thousands of nurses. So does he agree that it is urgent that this Government take action when understaffing in the NHS results in poor care?

I absolutely agree with the hon. Lady that nowhere in the NHS should allow low staff numbers to lead to poor care. What was interesting about the CQC report, which was a wake-up call for the whole NHS, was that institutions under financial pressure, as the whole NHS is, are delivering excellent care in some places and delivering care that is unsatisfactory and not good enough in other places. On her specific question about nurses and nurse numbers, it is important to recognise that across the NHS as a whole the nurse-to-bed ratio has increased. Every NHS bed is getting an extra two hours of care per week compared with the situation two years ago.

Will the Secretary of State give an instruction, irrespective of the numbers, that we go back to traditional nursing methods, as now that we have an almost all-graduate nursing profession we seem to have lost touch with true, caring nursing?

I have some sympathy with what my hon. Friend is saying, although it is important to recognise, as we have this debate about nursing, that the vast majority of nurses in the NHS do an outstanding job and we are very lucky to have them giving their lives to the NHS. Next week, at the chief nursing officer’s conference, we are launching a new vision for nursing, which will put compassion and the patient at the heart of what nurses do. I hope that will address some of her concerns.

Last week, official statistics revealed that 7,134 nursing jobs had been lost under the coalition—almost 1,000 of them in the last month on the Secretary of State’s watch. The very next day, the Care Quality Commission warned that 16% of hospitals in England are not meeting the CQC standard for adequate staffing levels. Is this not prima facie evidence that the NHS and patients are not safe in his hands? Will he urgently intervene to stop the job losses?

The reason why the CQC undertook its shocking investigation into the state of care in our country was that this Government introduced dignity and nutrition inspections, which never happened when the right hon. Gentleman was Secretary of State. He talked about numbers employed in the NHS, so let us look at them. Yes, there has been a 2% decline in the number of nurses, but there has been an increase in the nurse-to-bed ratio. There has been a 4% increase in the number of midwives, a 5% increase in the number of doctors and an increase of more than 50% in the number of health visitors—their number went down when he was in office. How much worse would those numbers have been if we had had the cut in NHS funding that he wanted?

Brain Tumours

Forgive me, Mr Speaker, but as you can hear—you may indeed be pleased to hear this—I am losing my voice. This is a serious matter, as you know, and I pay tribute to all the work you did on behalf of people suffering from brain cancer. The Government are proud to have been behind some important initiatives, such as promoting among general practitioners direct access to MRI scans. From January next year we are introducing a pilot scheme to alert people to the particular symptoms of common cancers, and we are confident that that will improve awareness about brain tumours.

I thank the Minister for her answer, but in the UK about 4,800 adults and 100 children lose their lives to brain tumours each year. Brain tumours kill more children than any other cancer, kill 65% more women than cervical cancer and kill more males under 40 than any other cancer, yet only 0.7% of Government funding goes to brain tumour cancer research. Will the Minister meet my constituent, Romi Patel, and others who have had brain tumours to discuss with them what more the Government can do to save lives?

The short answer is yes, I am more than happy to meet my hon. Friend’s constituent to discuss this matter. The figures she relies on for the amount of money going into brain tumour research are based on 2006 data, but the simple answer is that of course we can do far more. I pay tribute to the great advances made by a number of charities, including Headcase Cancer Trust, in my constituency, and others such as the Joseph Foote Trust. They are all raising considerable amounts of money specifically for research projects such as the one at Portsmouth university. I am more than happy to meet my hon. Friend’s constituent. This is an important topic on which we can do more.

I thank the Minister for her answers, including her very generous and gracious remarks. I wish her a full and speedy recovery.

Does my hon. Friend the Minister agree that Penny Brohn Cancer Care, based near Bristol, which offers a unique combination of physical, emotional and spiritual support designed to help patients live well with the impact of cancer, is an organisation that should be supported? Can she confirm that such organisations are eligible for funds from the cancer drugs fund?

It is important that we consider all aspects of how we can treat cancers. We also need to bear in mind the people who care for those with cancer, as we sometimes forget them. Any organisation—especially in the charitable sector—that offers treatments that help people and their families and carers is to be welcomed.

Mental Health

Mental health is a priority for this Government. That is reflected throughout the first mandate to the NHS Commissioning Board. The quality of all services, including crisis mental health, must improve. It is for the Commissioning Board, working with local commissioners and partners, to commission services in response to need.

I welcome that answer, particularly as regards the strengthening of the NHS constitution. My hon. Friend will accept that a mental health crisis is a very frightening thing to happen to a person and can be life threatening. The charity Mind has shown that there is unacceptable variation across the country in the quality and accessibility of crisis services. Does the Minister agree that just as the Government have rightly shone a light on the variability of physical health services, we need to do the same for mental health services? We need an atlas of variation for mental health services that hon. Members and others can use to challenge local commissioners to improve.

I am grateful to my right hon. Friend for that question. Atlases of variation are an important way of raising standards and we will be discussing their future use with the new commissioning organisations. He is also right to highlight the absolute importance of having parity of esteem between physical and mental health. The Government’s mandate makes it absolutely clear that there must be parity between mental and physical health services.

There are 800,000 people in this country who are living with the effects of Alzheimer’s and dementia. For some of those people, challenging behaviour is a serious issue. Will the Minister ensure that every clinical commissioning group has a lead for dementia in the mental health field so that that can be taken seriously in every community in the country?

That is absolutely a priority for the Government and the right hon. Lady is right to highlight its importance. The NHS Commissioning Board will work with local clinical commissioning groups to ensure that we raise the standards of health and care services, but she is absolutely right to highlight the importance of substantially improving access to dementia services.

Can the Minister clarify how often mental health centres and hospitals are inspected and how often patients are spoken to to help improve the service?

The Care Quality Commission inspects all services. Of course, there is now a registration system for such services. The hon. Gentleman is absolutely right to highlight the importance of ensuring that mental health services are regarded as just as important as physical health services, which has not always been the case.

Does the Minister agree that when people are experiencing a mental health crisis, the initial response that they receive when seeking help is vital? What steps are he and his Department taking to make sure that staff in accident and emergency departments are able to respond appropriately?

I am grateful to the hon. Lady for raising that important point. A fortnight ago I visited Heartlands hospital in Birmingham, where the RAID—rapid assessment, interface and discharge—team provides brilliant access for people arriving in accident and emergency who have a mental health problem, and ensures that they get immediate access to mental health services. That sort of best practice not only improves health and well-being for those individuals, but saves the system money. We need to spread that best practice across the country. I am very grateful to the hon. Lady for raising it.

Consultancy Costs

The amount spent by strategic health authorities, primary care trusts and NHS trusts on consultancy services in the financial years 2010-11 and 2011-12 was £291 million and £278 million respectively—a 39% fall in expenditure, compared to the last year of the previous Administration.

In 2010 the former Secretary of State said he was

“staggered by the scale of the expenditure on management consultants”.

However, in the past year alone foundation trusts have increased their spend on consultancy by 25% and NHS trusts have increased their spend by 13%. Is the new Secretary of State just as staggered?

With respect to the hon. Gentleman, a 39% fall in consultancy expenditure compared to the last year of the previous Administration is something that we are rather proud of. If he wants to know what the Health Secretary is directly responsible for, direct Department of Health expenditure on consultancy in the past year was £3 million. In the last year of the previous Government it was £108 million.

Has my right hon. Friend made any recent assessment of the total efficiency savings achieved in the NHS over the past two years under the Nicholson challenge?

We are making good progress on the Nicholson challenge. This year we expect to save £5.8 billion under that important programme to improve efficiency in the NHS so that we can treat more people.

The Secretary of State cannot have it both ways. Is he aware that in the past year alone Monitor spent more than £9 million on NHS transition costs, with a staggering £5.6 million of that being squandered on management consultants? Is this not a further sign of a Government with their priorities all wrong, wasting precious public money on management consultants to push through a reorganisation that nobody wanted, while they are handing out P45s to our nurses?

If the hon. Gentleman is shocked at consultancy spend in the NHS today, he will be even more shocked to know that it was nearly double when his party was in power.

National Pay Agreements

5. What estimate he has made of the number of foundation trusts considering plans to opt out of NHS national pay agreements. (129938)

The previous Labour Government gave foundation hospitals additional freedoms to set their own pay terms and conditions for staff and, as a result, the information is held locally, not centrally.

I thank the Minister for that non-answer. Will he recognise that with average wages 6.8% lower for full-time workers than they were when this Government took office, people are right to be sceptical about the Government’s record in pay? Why is he sitting back and doing nothing while the national character of our health service is being destroyed through regional pay arrangements?

It is worth reminding the hon. Gentleman that, as I outlined in my first answer, it was the previous Government who gave foundation trusts additional freedoms to set their own pay terms and conditions outside national frameworks. This Government are working closely with NHS employers and the trade unions to make sure that we maintain “Agenda for Change” and national pay frameworks as fit for purpose, and we are very pleased with that. If the hon. Gentleman wants to ask why there is regional pay and freedoms for employers to set regional pay, he should ask those on his own Front Bench, some of whom were Ministers when these freedoms were set.

Does the Minister recognise that the recent progress in national negotiations over greater flexibility is very encouraging and makes the efforts of the south west consortium and others both disruptive and pointless, in context?

We have had encouraging results from national pay negotiations at the recent NHS Staff Council, and unions are to consult their members on those results. There is general agreement that we need to maintain national pay frameworks, provided they are fit for purpose. I hope my hon. Friend will find that the south west pay consortium, which has been somewhat heavy-handed in the way that it has conducted its affairs, also sees the benefit of maintaining national pay frameworks. That is why we would like to see a quick resolution of the matter at a national level.

Cancer Drugs Fund

Since October 2010, more than 23,000 patients in England and more than 1,600 patients in NHS East Midlands have benefited from the additional £650 million funding for cancer drugs that this Government have committed to providing.

I thank my right hon. Friend for that answer, but I have previously raised in the House a constituency case where the NHS East Midlands cancer drugs fund would not pay for drugs that other CDFs would pay for, such as Avastin for second-line treatment of bowel cancer. Sadly, my constituent has since died because she could not get funding for the drugs she needed, having spent all her own money funding the treatment herself. Will my right hon. Friend meet me and my late constituent’s consultant, Dr Bessell, to discuss how we can end this postcode lottery?

Proud as we are of the cancer drugs fund, to hear such stories is extremely distressing, and our first thoughts are with the family of my hon. Friend’s constituent. We will of course look into the issue she raises, which is a cause of great concern. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry), is a neighbouring MP and would be happy to meet her to discuss the matter.

The reality is that the Government are ripping away the foundations of better cancer care. The former Health Secretary made a clear promise from the Dispatch Box to protect cancer network funding, but the NHS South East London and greater midlands cancer networks both say that their budgets and staff have been slashed. The NHS medical director, Sir Bruce Keogh, says that cancer networks are an NHS success story, and Macmillan Cancer Support says it is nonsensical to cut their specialist expertise. Why do the Government not agree?

Cancer networks are here to stay and their budget has been protected. They are extremely important. The hon. Lady uses hyperbolic phrases such as “ripping away the foundations of better cancer care”, so perhaps she would like to talk to the 23,000 people who have benefited from the cancer drugs fund that her Government failed to introduce.

I congratulate my right hon. Friend on the cancer drugs fund and the ring-fencing of the budget for cancer, which delivers important benefits in research, not least by funding new treatments by new companies that would not otherwise be able to sell their product and by generating important evidence on health economics. As a Mo-bro, I am very aware that medicines are better than surgery. Will he give the House some reassurance that the Government plan to renew the cancer drugs fund?

We are committed to finding a way of ensuring that people who have benefited from the cancer drugs fund—23,000 to date—can continue to receive that kind of support. That is something we can do because we protected the NHS budget, unlike the Labour party, which wanted to cut it.

Treatment Rationing

7. What steps he is taking to ensure that primary care trusts do not ration access to NHS treatments and operations. (129941)

12. What steps he is taking to ensure that primary care trusts do not ration access to NHS treatments and operations. (129946)

Rationing on the basis of cost alone is completely unacceptable. That is why the Government are increasing the NHS budget by £12.5 billion over the life of this Parliament and giving front-line health care professionals the power to decide what is in the best interests of patients.

I listened closely to the Minister’s answer. My constituent, Raymond Hickson, has been told that he has a leaking valve in his upper leg, causing varicose veins. His leg will eventually fill with blood, rendering him unable to walk and, therefore, to work, as he is currently employed in a manual job. He has been refused a simple operation on the basis that he now does not fit the PCT criteria, although he has had two similar operations in the past 15 years. What advice would the Minister give Mr Hickson and others like him, who are clearly the victims of treatment being rationed?

It is worth pointing out to the hon. Lady, who raises a legitimate point about that gentleman’s case—[Interruption.] The right hon. Member for Leigh (Andy Burnham) says “Do something”, but this type of rationing of varicose vein surgery occurred when the previous Labour Government were in power—[Interruption.] It did, and rationing of many other types of services was much worse. It is this Government who have introduced the cancer drugs fund to stop the rationing of cancer treatments to patients, which has benefited 23,000 extra patients, and many more elective procedures are taking place across the NHS every single day. On the specific case the hon. Lady raises, obviously if her constituent has a specific concern, there are safeguards in place locally for him to raise it if he thinks the decision is not based on clinical criteria.

Trafford primary care trust offers one cycle of in vitro fertilisation treatment to women up to age 29. The Minister will be aware that the National Institute for Health and Clinical Excellence guidance is for up to three cycles and up to age 39. Last year the all-party group on infertility pointed out that a very large majority of PCTs were not meeting the NICE guidance. Why does he think that is, and what is he going to do about it?

Of all Ministers in the House, the hon. Lady has probably asked the right one about this issue. This is a long-standing problem that goes back many years. There has been great variability in the availability of IVF in different parts of the country, and, at a national level, NICE finds that unacceptable. I will be taking the matter forward, and I assure her that we will make sure that we do all we can to iron out that variability and follow NICE guidelines so that everyone can receive the best IVF treatment.

Does my hon. Friend agree that the best way to ensure that high-quality care continues to be available to all patients, as and when they need it, is to ensure that the health and care systems are brought together into a single joined-up system so that, in the words of Mike Farrar of the NHS Confederation, we operate a care system with a health adjunct rather than a health system with care support?

My right hon. Friend has, over many years, been a very strong advocate—probably the strongest advocate in this House—for integrated care, which this Government are determined to make a reality. He is absolutely right that we need properly joined-up care that we properly deliver when we face up to the big health care challenges of how we better look after people with long-term conditions and older people. The only way to do that is to deliver more care in the community, and that has to be achieved through more joined-up and integrated care.

My constituent, Jennifer Payten of Bognor Regis, needs dental implants because her temperomandibular disorder means that dentures cause pain and severe headaches. For the past 10 years, Ms Payten has been passed from NHS trust to NHS trust in a Kafkaesque nightmare that no one in modern Britain should have to tolerate. I have written to the Secretary of State about this matter. However, will the Minister personally look into Ms Payten’s case to help to unblock the logjam and ensure that my constituent receives the health care that she needs to enable her to return to a normal life?

I thank my hon. Friend for his question. He is right to raise this, because it has been a very long-standing problem. I am sure that he would welcome, with me, the fact that under the current Government over 1.1 million more people are receiving access to NHS dentistry. However, this is a difficult case, and I am happy to meet him to discuss it further and see what I can do to help to unblock the problem.

Ministers have repeatedly promised to ban rationing of treatment by cost in the NHS. If the Minister is presented with evidence that this is still continuing, will he today give the House a categorical assurance that he will act immediately to stop it?

It has been very clear in all the criteria for NHS commissioners set by the previous Government and by this Government that decisions about local health care treatment have to be based on clinical need, and that those decisions are for local commissioners. The difference is that this Government will make sure that doctors, nurses and health care professionals are in charge of budgets and setting health care priorities rather than the managers the previous Government chose to favour, who did not always have experience of front-line care and did not always understand some of the challenges that patients were facing.

I will take that as a yes. The Minister is going to have a busy day, because this afternoon he will have on his desk new evidence that I will send him showing that an estimated 52,000 patients in England are being denied treatment and kept off NHS waiting lists because of new restrictions imposed under his Government on cataracts, varicose veins, carpal tunnel syndrome, and other serious treatments. Ministers boast of lower waiting lists, but that is because they have stopped people getting on to the waiting lists in the first place. Patients in pain and discomfort, unable to work, are being forced to pay for treatment. How many more people will have to suffer before he finally acts?

We have already highlighted in earlier answers the fact that under the previous Government health care rationing was far worse on varicose veins, which one of the right hon. Gentleman’s own Back Benchers mentioned, and elsewhere. This Government are very proud of our record whereby 60,000 fewer patients are waiting more than 18 weeks than under the previous Government and 16,000 fewer patients than in May 2010 are waiting longer than a year. Waiting times are coming down, infection rates in hospitals are coming down, and people are getting better care. This Government ended the worst health care rationing scandal of all—the fact that people with cancer were not getting access to the drugs they needed. Now, 23,000 people are getting access to that care. If he could not do anything about rationing, he should at least recognise that this Government have done something and have made a real difference to people’s lives, particularly patients with cancer, by reducing rationing.

Those of us who live in rural areas such as south Cumbria have faced the rationing of acute services for years—not rationing by price, but rationing by distance. Will the Minister encourage Morecambe Bay, which will undertake its review of the allocation of services in the coming months, to allocate accident and emergency services back to Westmorland general hospital, where they would be closer to the people whose lives they could save?

As my hon. Friend is aware, from next year the NHS Commissioning Board will have responsibility for commissioning local services and for setting the funding formula. I would be happy to raise his issue with the board, because it is true that, historically, the capitation formula has not recognised the fact that there are a lot of older people in rural areas and further distances to travel. The previous Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), took steps towards reviewing the formula and I assure my hon. Friend that the Government will be looking into it further.

Clinical Commissioning Groups

8. Whether he has put in place measures to ensure that clinical commissioning groups do not become for-profit organisations. (129942)

Clinical commissioning groups were established in statute. They are, accordingly, public bodies and cannot become private, for-profit organisations.

I thank the Minister for that answer. As we know, most GPs go into medicine to make people well, but now that her Government have made the NHS subject to competition law there is real fear in Newcastle and across the country that they will find themselves obliged to turn a profit from their patients. Is this not, as Professor Ham of the King’s Fund has said, a further step towards privatisation?

No. I would urge the hon. Lady, if I may, to exercise care when claiming that this is a privatisation of the NHS. It certainly is not. GPs’ surgeries, such as those in her own constituency, have always been private businesses. A GP surgery in the hon. Lady’s own constituency, where, in my view, she has been engaged in considerable scaremongering, was put out to tender under rules introduced by the previous Labour Government. Indeed, it was the previous Government who brought in privatisation to the NHS on a scale that we had never seen before in this country. I am proud that it is this coalition that is making sure that the tariffs are fair and no longer favour the private sector.

One way that the clinical commissioning groups can support the values of the NHS is to back the new social enterprises—forms of business enterprise—that are now delivering NHS services central to our health-care reforms. Is the Minister aware that my local clinical commissioning group wants to shut down a 60-bed rehabilitation unit provided by nurses and owned by a social enterprise called Spiral, without any adequate provision for a replacement? Will she meet me to discuss this worrying development?

Yes, of course I will meet my hon. Friend. I hold a ministerial surgery on Monday evenings and would be grateful if he came along to one, but I would be happy to meet him in any event. These are local decisions that will be made by local commissioners, but they should always commission in the interests and to the benefit of the people whom they serve.

Vulnerable Groups (Access to Health Care)

9. Whether he has recently reviewed how access to health care treatment can be made easier for vulnerable groups; and if he will make a statement. [Interruption.] (129943)

I am so sorry, Mr Speaker, I was getting carried away. It is my hon. Friend the Member for Dover (Charlie Elphicke) who has asked a question, is it not? [Interruption.] It does not help when the right hon. Member for Leigh (Andy Burnham) shouts at me. I am at a profound disadvantage, because I cannot shout back—not that I would ever want to raise my voice, of course. I do not seek sympathy, just parity. Opposition Members should listen with great care. This Government introduced in statute an absolute duty on the NHS to ensure that health inequalities, which, of course, rose under the previous Administration, are at last reduced.

My constituents in Deal are concerned that consultant out-patient services may be withdrawn from their much-loved hospital. Is it not right that GP commissioners should be particularly mindful of services to vulnerable people in rural areas who find it hard to travel?

Indeed it is. That is one of the great joys of the CCGs. As other Ministers have alluded to, we are putting commissioning decisions into the hands of the people who know best—the health professionals. When they exercise their commissioning responsibilities, we urge them to ensure, as I am sure they will, that they deliver the very best services for the people they serve.

On the question of vulnerable groups, does the Minister support the proposal of the hon. Member for Bracknell (Dr Lee) to ration NHS drugs, either by adopting the Danish system in which people have a personal budget for drugs and have to pay to top up, or by removing the right to free prescriptions for long-term conditions such as diabetes? Does she appreciate how much harder that would make life for millions of people in vulnerable groups, or is this the real face of the coalition on the NHS—drug rationing?

At my ministerial surgery last night, which has been somewhat scorned by Opposition Members, I met my hon. Friend the Member for Bracknell (Dr Lee) and discussed his proposals at length. I do not agree with his proposals, but I welcome the debate. There is nothing wrong with a healthy debate. However, on this one, he and I disagree.

Pancreatic Cancer

10. How much the Government have spent on (a) treatment, (b) diagnosis and (c) raising awareness of pancreatic cancer since May 2010. (129944)

We cannot provide the absolute figures on how much we have spent on pancreatic cancer in particular, but some £200 million has been spent on cancers of that type. This month is pancreatic cancer awareness month and I welcome all the hon. Lady’s work towards that.

I recently met some families in my constituency who have been directly affected by pancreatic cancer. One of their main concerns is late diagnosis, which contributes to this cancer having the worst survival rate of the 21 most common cancers in the UK. What assessment has the Department made of the recommendations in the early diagnosis report by Pancreatic Cancer UK, such as improved referral pathways and assessment tools, direct access for GPs to diagnostic tools, and the development of a National Institute for Health and Clinical Excellence quality standard for pancreatic cancer as a means of improving the speed of diagnosis and survival?

I am very grateful for the work of Pancreatic Cancer UK. We have put the proposals from its seminar last June into the guidance that we are issuing. I am meeting Pancreatic Cancer UK, other cancer charities and other people who are involved in cancer work this afternoon. I will be happy to raise the matter with them directly and to meet the hon. Lady and representatives of this very good cancer charity. She is right to expose the fact that this cancer is difficult to diagnose. We will be launching pilots in January and I hope that more people will take advantage of that campaign and come forward if they have any symptoms.

NHS South-West Pay, Terms and Conditions Consortium

11. What contact there has been between his Department and the director of the NHS south-west pay, terms and conditions consortium. (129945)

Since the south-west consortium’s plans were made public in May this year, Department of Health officials have been in contact with NHS employers, NHS trade unions and the south-west consortium better to understand the views of all parties. The Department of Health wants to find a resolution and supports national pay awards.

I thank the Minister for that response and for his acknowledgement earlier that the way in which the south-west consortium has handled the negotiations has been heavy-handed. It is appalling that staff found out about the plans only through the leaks as, it appears, did the Department. Will he go back to the director of the consortium and urge him to put everything on hold in the south-west while national pay discussions are continuing? As the Minister says, this ought to be about national pay, not regional pay.

I fully agree with the hon. Lady and I take her concerns on board. However, because of the additional freedoms introduced by the previous Government, local employers in foundation trusts throughout the NHS have additional freedoms to set their own pay, terms and conditions. Under the rules introduced by the previous Government, it is impossible for us to intervene directly in the matter, except by continuing to encourage trade unions and NHS employers to meet the national agreements. If national terms and conditions are agreed to, I am sure that they will be endorsed at a regional level by the south-west consortium.

I am very pleased that the Minister will be meeting a cross-party delegation of MPs from the south-west next week to discuss this issue. In view of his answer to the hon. Member for Bristol East (Kerry McCarthy), is he confirming that Health Ministers have no powers at all to intervene in the negotiations between employers and their staff?

It is worth putting it on the record that it was the previous Labour Government who introduced foundation trusts in 2003 and set them free from direct accountability to Ministers. That includes the ability to set their own pay, terms and conditions. It was Labour that removed the power of the Secretary of State to direct foundation trusts, and it is Labour, not the Government, that needs to decide whether it supports the legislation that it put in place in government. We endorse national pay frameworks and will do all that we can to preserve them.

Osteoporosis

13. What recent representations he has received on strategies to support patients with osteoporosis. (129947)

The Department of Health has received no recent representations on strategies to support patients with osteoporosis. From April this year, osteoporosis was included in the quality and outcomes framework, giving GP practices financial incentives for diagnosing and treating osteoporosis in their patients.

Does the Minister welcome the new Falls and Fractures Alliance that will hold its first board meeting next month? It has been set up specifically to reduce admissions to hospitals resulting from falls, fall-related injuries or hip fractures in the over 65s.

I very much welcome the establishment of the alliance, and I applaud the work of the National Osteoporosis Society, Age UK, and the all-party group of which I think the hon. Gentleman is a member. We know that if we follow the evidence, we can substantially reduce the number of falls and fractures, thereby increasing health and well-being and reducing the cost to the system.

Health Care Provision (South-East London)

14. What the process is for deciding the future of health care provision in south-east London; and if he will make a statement. (129948)

The trust special administrator at South London Healthcare NHS Trust will be making recommendations to me on the future of the trust’s services. Those recommendations will inevitably impact on the services provided by other trusts in the south-east London health economy.

When the Secretary of State considers outer south-east London health arrangements, and problems that are not at all of his making, will he bear in mind that all five Members of Parliament for Southwark and Lambeth are clear that plans by King’s Health Partners for a super-trust across Lambeth, Southwark and beyond should be put on hold until we know the implications for inner south-east London of any changes that happen further out?

I will certainly bear in mind the right hon. Gentleman’s comments. The decision time scale for the South London Healthcare NHS Trust is very quick as prescribed in the National Health Service Act 2006. I must make a decision on that by 1 February, so the situation will soon become clear.

24. The trust special administrator’s report proposes the closure of the full A and E service at Lewisham hospital —which currently sees 115,000 people a year—and asserts that 30% of that department’s work can be transferred to the community. Will the Secretary of State provide evidence of how that can be done, especially considering a cash-strapped NHS and a local authority that is suffering from deep cuts by his Government? (129958)

I remind the right hon. Lady that the Government have not cut the NHS budget; we have protected the NHS budget. There is an ongoing consultation on the proposal that she mentions. It will finish on 13 December and I hope she will contribute to it. I will receive the recommendations of the trust special administrator at the beginning of January, and I will then make my decision.

The 2010 Conservative manifesto stated:

“We will stop the forced closure of A and E and maternity wards, so that people have better access to local services,”.

They then closed the accident and emergency department at Sidcup, having promised to save it, and they now plan to close the A and E at Lewisham hospital. Is that not a betrayal of people in south-east London and the NHS?

The hon. Gentleman should talk to the shadow Minister on the Opposition Front Bench, the hon. Member for Leicester West (Liz Kendall), who said yesterday that she would not automatically oppose all reconfigurations. The coalition Government have introduced four tests, which were not used by the previous Government. Those tests state that we will not impose closures of A and E and maternity units unless there is local clinical support, and evidence that it will benefit local people and improve patient choice. The tests exist to provide precisely the safeguards about which the hon. Gentleman is concerned.

Mindfulness

15. What recent assessment he has made of the treatment of repeat episode depression by (a) drugs and (b) mindfulness-based intervention. (129949)

The National Institute for Health and Clinical Excellence has evaluated and recommended the use of mindfulness-based therapies as a psychological intervention for the prevention of relapse, within its guideline, “Depression: the treatment and management of depression in adults”. Drug treatment is also useful in the management of enduring depression.

The number of prescriptions issued for anti-depressants has gone from 9 million to 46 million in the past 10 years. NICE has recommended mindfulness as a better treatment than drug therapy for repeat episode depression, but it has not been taken up by the NHS. Will the Minister meet a delegation of MPs and mindfulness experts from across the UK to discuss how mindfulness can play its full role in helping the NHS and people with mental health problems?

I acknowledge the hon. Gentleman’s work on promoting the case for psychological therapies, including mindfulness, and would be happy to meet him and a delegation of experts. The Government have massively increased psychological therapies—nearly 1 million people in the past two years accessed psychological therapies through the improving access to psychological therapies programme. We are totally committed to improving access to psychological therapies to cure the imbalance in access to services for people with mental health problems that has existed for a very long time.

Ambulance Trust Budgets

16. What assessment he has made of the possible effect on patient safety of reductions to ambulance trust budgets. (129950)

The budgets for individual ambulance trusts are set by local health care commissioners. In 2012-13, the budgets are increasing nationally by £2.5 billion. To ensure patient safety, ambulance trusts are required to meet national performance standards in respect of their response times.

Does the Minister share my concern that 100,000 more patients than two years ago wait more than half an hour to be transferred from ambulance to A and E? If so, how on earth can he justify making his top-down reorganisation of the NHS a priority rather than sorting out that appalling situation?

The priorities for local ambulance trusts and the funding allocations are set locally. The hon. Lady will be pleased that between 2010-11 and 2011-12, an additional £9 million was put into the front line of the ambulance service in her area to help address some of the problems she outlines. Under this Government, more money is going to the NHS than before and more money is going into local ambulance services—£2.5 billion nationally. We should contrast that with the approach taken by the right hon. Member for Leigh (Andy Burnham) on the Opposition Front Bench, who said that to increase spending to address those problems would be irresponsible.

The Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), is my constituency neighbour. He will know that, although the East of England Ambulance trust is hitting its targets for the entire region, it is not helping in Suffolk. Will he advise on what more we can do locally to ensure that it serves all rural patients?

The problem has affected both Suffolk and Norfolk—the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), also takes an active interest in it. One problem was that the managers of the local ambulance trust were not listening to front-line staff on how to design and deliver services. In a staff survey, only 4% of front-line staff in the East of England Ambulance Service said they were being properly listened to, which is completely unacceptable. This Government, in contrast to the previous one, want to put front-line professionals in charge of running services, meaning that, in future, more patients will be properly prioritised and ambulance response times will be better met.

Order. These matters could be considered further in an Adjournment debate, which might be a suitable length for the subject.

Topical Questions

I am pleased to report an NHS performing at record levels. There are half a million more out-patient appointments every year since the last election, nearly 1 million more people go through A and E every year, and there are 1.5 million more diagnostic tests every year. To clarify a previous answer, the number of health visitors will go up by more than 50% during the course of this Parliament.

The Erdington walk-in centre is at the heart of our high street. It is much loved, much used and cost-effective, yet it is at risk of closure because of the combination of a £76 million reduction in expenditure by Birmingham primary care trusts and health service reorganisation. Thousands of local people have expressed their concern and elected a users committee. Will the Secretary of State meet the users of the centre and me?

I am happy to look into the issues the hon. Gentleman raises. The purpose of the reforms is to put more money on to the front line and into primary care, where we can save the most lives.

T2. The new mandate for the NHS includes a very welcome objective for it to be a world leader in end-of-life care. Can we have an indicator in the commissioning outcomes framework on deaths in preferred places of care to ensure that new commissioning groups prioritise better end-of-life care, and to ensure that those who want to die peacefully at home have the best opportunity to do so? (129960)

I thank my hon. Friend for that question. The NHS outcomes framework includes an indicator on the quality of end-of-life care as it is experienced by patients and carers, which is based on the VOICES survey of bereaved relatives. The proposals for reform to the NHS constitution include a right for patients and families to be involved fully in discussions, including at the end of life.

T3. What action does the Minister intend to take to reduce the number of unplanned emergency admissions to hospital by sufferers of muscular dystrophy and other neuromuscular conditions? (129961)

I thank the hon. Gentleman for that question and for his concern about this matter. One of the key challenges for the NHS is to ensure that we deliver better care in the community, deliver more preventive care and provide better support to people with long-term conditions, such as muscular dystrophy and diabetes, in their own homes. A key part of the reforms is to make sure that a lot of services are commissioned from the community by the local commissioning groups. We have already seen that that has reduced inappropriate admissions. For example, in my part of the world in Suffolk, they have been reduced by 15% for older people.

T4. Yesterday, I received a letter from the chief executive of Monitor, which asked me and the Asset Transfer Unit to undertake feasibility work to develop a professional business case for the local community to take ownership of Cannock Chase hospital. This would be done through its transfer to a community interest company, which would then take over running the hospital estate, securing the building for the people of Cannock Chase. Will the Secretary of State welcome these proposals, which would be the first of their kind in the UK, and work with us as we develop a plan for the local community to own its hospital? (129963)

I congratulate my hon. Friend on his campaigning and hard work on this issue, which represents an interesting way forward for community hospitals. I wish him every success and I know that hon. Members in all parts of the House will watch carefully what happens in Cannock.

T5. I would like to press the Health Secretary further on the unsustainable providers regime, which has been enacted in the South London Healthcare NHS Trust. Given that the statutory guidance for that regime explicitly states that it is not to be used as a back-door route to service reconfiguration, why are Lewisham A and E and maternity services earmarked for closure? If that is not a service reconfiguration, can he tell me what is? (129964)

What this issue is addressing—it was legislation introduced by the hon. Lady’s Government in 2006—is a clearly unsustainable situation with South London Healthcare. The proposals have to look at making sure that there is sustainability throughout an entire local health economy. I have not made any decisions at all. I will wait for the proposals to come to me at the end of the year, and I will then make my decision in January.

T6. There is mounting evidence that clinical care failure is as much to do with inadequate staff levels as anything else. In view of that, do Ministers agree that it is worth looking at the merits of establishing mandatory registered nurse to patient ratios across secondary and tertiary care wards? (129965)

I thank my hon. Friend for that question. This point has been raised before and although it sounds like a good idea in principle, the problem is that different aspects of care in different wards—for example, an older people’s ward compared with a ward that looks after younger people—will have differences in the intensity of nursing. Therefore, a mandated ratio would be difficult to implement. A ratio may be counter-productive to making sure that we can give more intensive nursing cover where it is needed, and could even encourage a race to the bottom.

T8. A recent Schizophrenia Commission report highlighted catastrophic failings in the care of people with severe mental illness. We know that suicide rates rise during times of economic hardship and that record numbers of people are being detained under the Mental Health Act. The Government have said that mental health should have parity with physical health, so why has funding for mental health services been cut for the first time in a decade? (129968)

Whenever the NHS is under financial pressure, there is the risk that mental health services will get squeezed. As the Health Select Committee identified, that is exactly what happened under the last Labour Government in 2006. I share the hon. Lady’s concern, however, about the report on schizophrenia highlighting how money is used: too many people in in-patient facilities and not enough prevention work. I am committed to working with others to ensure that we use the money more wisely to get better care for those patients.

T7. Since the Prime Minister made his radiotherapy promise to current and future cancer patients last month, cancer centres all over the country have been telling me that it cannot be delivered, because there is not enough investment in new radiotherapy machines and in the recruitment and training of staff to operate them. Will the Secretary of State give the same financial commitment to the annual radiotherapy fund as he is giving to the cancer drug fund, and will he meet me to discuss the matter? (129967)

I thank my hon. Friend for her question, because it touches on a matter of concern to me, notwithstanding the £15 million radiotherapy innovation fund, which, as she said, was announced by the Prime Minister. Indeed, last night, at my ministerial surgery, the hon. Member for Easington (Grahame M. Morris) came along to discuss this very matter, and he raised several important issues, all of which I have this morning taken up with my officials. I am more than happy to meet my hon. Friend to discuss the matter further, however, as I think there is work to be done.

My 20-year-old constituent, Martin Solomon, has blood cancer and is currently receiving expert treatment at the Christie in Manchester. He needs a stem cell transplant, but finding a match is difficult, especially as he has mixed heritage, and his best chance is from an umbilical cord donation. Will the Secretary of State do two things to help Martin? First, will he reinvigorate the campaign within the black and ethnic minority communities to increase stem cell donations, and, secondly, will he establish a cord collection centre in Manchester, so that mothers can donate cord after the birth of a baby and give young people such as Martin an extra chance to find a match?

I thank the right hon. Gentleman for raising an important topic. I send my heartfelt sympathies to his constituent. As he identified, this is a real problem. Yes, is the short answer to his first question. I met officials several weeks ago to discuss exactly this problem, as we need to do more in that area. Of course, this is a national scheme. Whether there is a need for a local scheme in Manchester is a moot point, but his constituent will be able to access the national scheme. I am more than happy to discuss the matter further with him.

Neuroblastoma is a nasty cancer that affects fewer than 100 children a year. Thanks to the previous Labour Minister, Ann Keen, we persuaded the previous Prime Minister that it should be treated on the NHS without the need for a referral. Unfortunately, there seems to be some slippage, with some primary care trusts refusing to pay for the treatment. Will the Secretary of State look into the matter and see if they can be given the correct information, which is that they should be providing this treatment?

I will absolutely look into that issue. We are keen to ensure that people with rare diseases, including rare cancers, are not discriminated against because it is more expensive to do the research and get the drugs necessary to treat them.

The Minister will be aware that the process of making Kalydeco available to people with cystic fibrosis in England is much further advanced than in Scotland, where the G551D gene is two to three times more prevalent—a point highlighted by the Daily Record yesterday in respect of seven-year-old Maisie Black from Burnside in my constituency. Will the Minister clarify that the roll-out in England will not be restricted, so that young children, who have the least accumulated lung damage and therefore most to benefit, do not lose out on the chance of benefiting from this transformational drug?

The specialised commissioning groups will receive advice at their December board meetings and are expected to finalise their advice on the clinical and cost-effectiveness of Kalydeco early in the new year. The aim is to provide consistent national advice on the use of the drug for a sub-group of patients with cystic fibrosis.

Aylesbury constituent Mrs Evans-Woodward is a young woman who has had five heart attacks. One evening her husband drove her to Wycombe’s heart attack unit with a racing pulse, but she was turned away to the minor injuries unit, which again turned her away to the accident and emergency unit in Stoke Mandeville, before suggesting that she sit outside and call an ambulance, which she duly did—all of this with a racing pulse of 180. This is not good enough. It is an appalling prioritisation of bureaucracy over simple human care and compassion. Does it not show that the NHS needs to become much more accountable to patients?

My hon. Friend is absolutely right, and I am very sorry to hear of the case he outlined. Clearly the care that his constituent received was more than substandard. If a patient needs immediate treatment, they should always receive it. This Government are quite rightly ensuring that we embed good care in everything we do. We have beefed up the role of the Care Quality Commission to improve the inspection of care quality throughout the NHS and the care sector. We are also introducing a friends and family test to pick up on examples of bad care, so that the NHS can properly learn from them locally and so that these things do not happen.

We are extremely grateful. Extreme brevity is now required from Back and Front Benchers alike.

On 12 November the Secretary of State gave a categorical assurance to my constituents that there was absolutely no threat to accident and emergency and maternity services at Kettering general hospital. Does he stand by it, will he repeat it today and will he specifically confirm that obstetrics and major injury and trauma services in accident and emergency are no longer at risk at Kettering general hospital?

I thank the hon. Gentleman for his question, and I welcome him to the House and congratulate him on his victory in the recent Corby by-election. I think he has already admitted on the record that there was a lot of scaremongering during the by-election campaign about the NHS locally. One of the main reasons for concerns about the NHS is the indebtedness of many hospitals in the east of England region, because of the record of the previous Government, who signed many of them up to private finance initiative deals. I will restate for the record once again today that, as I understand it, A and E and maternity services at Kettering at the moment are safe, and there is no consultation directly on the table at the moment. He should make sure he gets his facts right before he raises questions in the House.

Last week it was a great pleasure to visit Age UK Peterborough, whose No. 1 priority is dementia care, which coincides with the NHS priorities that my right hon. Friend the Secretary of State outlined earlier this week. Will he put in place procedures to make available capital moneys for the construction of dementia care facilities locally?

I can announce that we have already put in place such funds, because dementia is one of the biggest challenges we face across the entire health and social care system. We need more capital funds, but we also need massively to increase the shockingly low diagnosis rates. At the moment, only 42% of the 800,000 people with dementia are being diagnosed properly and therefore getting the treatment they need.

Is the Secretary of State worried about the high level of qualified managers leaving the NHS—fleeing the NHS—to go to other places or retire early when there are few people in clinical commissioning groups with any management experience at all?

There is always a role for excellent managers in the NHS, but this Government’s priority is front-line clinicians, which is why the number of doctors has increased by 5,000 since we have been in power and why administration costs have been cut, which will save the NHS £1.5 billion every year.

Valued health workers in Wiltshire will appreciate the Minister’s commitment today to national pay negotiations, but they will be frustrated that he does not have the power to force them on foundation trusts. Will he at least make a direct appeal from the Dispatch Box today to the management of those trusts in the south-west consortium to participate fully in national pay negotiations?

I thank my hon. Friend for his question. He is absolutely right. I made it clear earlier that I felt there had been some heavy handedness in the way some of those trusts had behaved—although they are quite understandably exercising freedoms that the previous Government gave them. We want national pay frameworks to remain fit for purpose, which is why we endorse the national pay negotiations that are under way. I would recommend that trusts in the south-west listen to what happens in those negotiations, so that we can ensure that national pay frameworks are fit for purpose in the south-west.

Is the Secretary of State disappointed by the low number of GPs who have come forward to take on accounting officer roles in clinical commissioning groups, and can he say why he thinks that is?

I am actually very encouraged by the enthusiasm of the GPs who are running clinical commissioning groups up and down the country. They are going to transform services and, most of all, they are going to integrate services at a local level. That is something that has long been talked about but not delivered before in the NHS.

I am sorry to disappoint colleagues. As they know, I could happily listen all day to them asking questions and to Ministers answering them—[Interruption.] The Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry) does not seem entirely convinced of the merits of my explanation, but, in any case, time is against us and we must now move on.