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Health

Volume 559: debated on Tuesday 26 February 2013

The Secretary of State was asked—

Comparative Performance Data

1. What assessment he has made of the benefits of comparative performance data in raising standards in the NHS. (144336)

Comparative performance data are essential to raise standards in the NHS. I have therefore commissioned a review from the Nuffield Trust to consider whether aggregate ratings of provider performance should be used in health and social care, and if so, how best this should be done.

My right hon. Friend will be aware that NHS North West London has made considerable use of comparative performance data to justify closing four A and E departments in one concentrated part of its area. Charing Cross, Ealing, Hammersmith and Central Middlesex are the four A and E departments closest to my constituents, who will be wondering how their closure will raise standards of health care provision locally. Does my right hon. Friend appreciate that there will be strong support among my constituents for any calls to review the decision and the use of comparative performance data?

I first congratulate my hon. Friend on campaigning extremely hard on behalf of the views and concerns of her constituents throughout the process of the decision that was finally made by NHS North West London last Tuesday. Comparative performance data have a very important role to play, particularly with regard to excess mortality of people who use A and E on weekends. I am, however, aware of my hon. Friend’s concerns and will consider them carefully if, as is likely, the decision is reviewed by Ealing council.

I thank the Secretary of State for his previous answer. Comparative data are essential in compiling an evidence base on which to plan effective health interventions. Will he use the radiotherapy data sets that his Department publishes as a basis to inform planned investments in advanced radiotherapy systems, particularly in regions like mine which lack such equipment?

I know that the hon. Gentleman asks a lot of questions about radiotherapy. We use a strict evidence base before we make any investments. We also want to embrace innovation, but our absolute priority is to save as many lives as possible from cancer. He will know that we are in the lower half of the European league tables when it comes to cancer survival rates, and that is something that we are determined to put right.

On collecting performance data, has the Secretary of State seen the NHS Confederation publication “Information overload: tackling bureaucracy in the NHS”, which points to a great deal of duplication in information? What is his reaction to it?

There is far too much bureaucracy in the NHS, which is why I have asked the chief executive of the NHS Confederation to report to me on how we could reduce the bureaucratic burden on hospitals by a third. If there is a lesson from the Francis report on the tragedy at Mid Staffs, it is that we need to free up the time of people on the front line to care, which is what they went into the NHS to do.

The hon. Member for Ealing Central and Acton (Angie Bray) asked a key question. Under the secondary legislation being introduced by the Secretary of State under section 75 of the Health and Social Care Act 2012, local commissioning groups will be forced to allow private providers into the NHS. These private providers will be exempt from the Freedom of Information Act, which will make it harder for patients to compare data between providers. It cannot benefit NHS patients for core clinical services to be given to private providers that do not have to conform to the same standards of transparency as those in the NHS. Will the Secretary of State see reason, ensure a level playing field for the NHS and withdraw the section 75 regulations without delay?

Who exactly are the section-75 bogeymen that the hon. Gentleman hates: Whizz-Kidz who are supplying services to disabled children in Tower Hamlets, or Mind, which is supplying psychological therapy to people in Middlesbrough? The reality is that those regulations are completely consistent with the procurement guidelines that his Government sent to primary care trusts. He needs to stop trying to pretend that we are doing something different from what his Government were doing when in fact we are doing exactly the same.

Local Authority Public Health Responsibilities

2. What support his Department has given to local authorities in respect of their new public health responsibilities. (144337)

The Department has continued to work with all its partners to ensure that there is a swift and effective transition of public health responsibilities to where they should be—back with local authorities. We have made available £15 million to ensure that the transition is successful and complies with all the requirements that we have laid down.

I thank the Minister for that answer. I invited the Silver Star charity to my constituency on Friday, where it offered free diabetes tests to all residents. Will local authorities be encouraged to work with such charities to improve public health?

The Silver Star bus is making many journeys because as well as going to my hon. Friend’s constituency, it is coming to mine on Saturday. It is an outstanding charity that provides diagnosis at a local level. I pay tribute in particular to the right hon. Member for Leicester East (Keith Vaz) because the charity goes to communities that are often hard to reach, such as the Asian community, where we need to do good work to reduce the level of diabetes, both type 1 and type 2. I look forward to local authorities working with outstanding charities such as Silver Star.

Why is the public health grant for next year £58 per person in Barnsley and £53 per person in Rotherham, but £130 per person in Westminster and in Kensington and Chelsea, especially given that deprivation is less and life expectancy at least seven years longer in those wealthy, Tory London boroughs?

I do not accept that for one moment. I am exceptionally proud of this Government’s commitment to public health which, in the difficult times that we have inherited, has ensured that local authorities are in some cases receiving an increase of some 10% in spending on public health. That is a record that I am proud of and that the Labour Government could not have matched.

My hon. Friend will be aware that the local authorities and the Food Standards Agency have a public health responsibility to ensure that food entering schools and hospitals is appropriately labelled and is safe and healthy to eat. Does she have absolute confidence in the procedures that have been followed in that regard or might she be prepared to review them?

I am grateful for that question. I pay tribute to all my hon. Friend’s work on this matter, especially as Chair of the Environment, Food and Rural Affairs Committee. This has been a difficult time for all concerned. We need to ensure that all food is what it says on the label. Important work needs to be done to ensure that that is the case and to restore confidence to all consumers. We are very mindful of that in the Department.

I thank the Minister for her very kind comments. I know that the charity Silver Star is looking forward to visiting her constituency on Saturday and testing her for diabetes. I am sure that we will find her in perfect health. I remind her that, according to the national health service, it will take five years before all diabetics have access to the full nine checks. Will she consider issuing guidelines to local health and wellbeing boards to ensure that they raise awareness of diabetes?

I am concerned, as we all are, about diabetes and about the recent report. We have accepted all but one of its recommendations and a lot more work needs to be done. I pay tribute to Silver Star and to the work of Diabetes UK, for example in Boots. I was happy to go to the launch of a new system whereby people can go to clinics at Boots and get the sort of checks that Silver Star is doing. We recognise that there is a lot more work to be done and are making every effort to ensure that there is a huge improvement in the diagnosis and outcomes of everybody who is affected by diabetes.

A and E and Maternity Provision (South-east London)

3. What recent assessment he has made of the future demand for accident and emergency and maternity services at (a) Guy’s and St Thomas’ NHS Foundation Trust and (b) King’s College Hospital NHS Foundation Trust. (144338)

I have accepted the trust special administrator’s broad recommendations on the future of A and E and maternity services in south-east London. Appendix E of the administrator’s final report outlines the forecast A and E activity and births in south-east London, and the methodology used to determine that information. That includes activity at Guy’s and St Thomas’ NHS Foundation Trust and King’s College Hospital NHS Foundation Trust.

I am grateful for the Secretary of State’s answer. Following his statement and decision, does he recognise that there are still two significant concerns? The first is that any downgrade of A and E and maternity services in Lewisham will put pressure on the other trusts which they cannot cope with. The second is that there is not yet support among all GPs and clinicians, including in Lewisham, for the current plan. Will he assure me that he will seek their support before anything is implemented, and that he will give us the assurances that we need?

I recognise the concerns that the right hon. Gentleman outlines. As he knows, we have allocated £37 million to help the other four A and E departments that will take the 25% of cases that will no longer go to Lewisham to deal with that extra capacity. He is right to say that the way in which the plan is implemented will be critical. We need to do it properly and extremely carefully to ensure that we meet the concerns that he talks about.

When the Secretary of State announced his decision to downgrade Lewisham’s A and E services and transfer the patients to St Thomas’ and King’s, he said that Sir Bruce Keogh, the medical director of the NHS, had reviewed those proposals and that:

“He believes that…these proposals…could save up to 100 lives every year”. —[Official Report, 31 January 2013; Vol. 557, c. 1075.]

Having read Sir Bruce Keogh’s review, I can tell the House that he makes no mention whatsoever of saving 100 lives each year. Will the Secretary of State now apologise for misleading the House?

Order. Just before the Secretary of State replies, I ought to say to the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) that she is perhaps suggesting that the Secretary of State may have inadvertently, rather than deliberately, misled the House. Could she just confirm that? A nod of the head would suffice.

That is the right hon. Lady’s suggestion, and it is for the Secretary of State to respond as he thinks fit.

Thank you, Mr Speaker.

Sir Bruce Keogh accepts the calculations that were made in the proposals put forward by the trust special administrator that the plans would be likely to save about 100 lives a year, because they would allow the hospitals in south-east London to move towards the London quality standard, which would mean reducing excess mortality at weekends. Sir Bruce Keogh accepted that, and I accepted his view of it.

Order. Many London hospitals and the representatives thereof have an interest in the question. Newark is some distance away, but I feel sure that the hon. Gentleman’s supplementary question will be not about Newark but purely about these London hospitals. On that basis, I am delighted to hear from him.

I am disappointed, but never mind. We will hear from the hon. Gentleman ere long on another matter, I feel sure.

Demand for A and E services at Guy’s and St Thomas’ and at King’s will go through the roof if Lewisham’s full A and E closes. The Secretary of State may claim that he is keeping a smaller A and E at Lewisham, but that is nothing more than dangerous spin. No blue-light ambulances will call at Lewisham under his plans, and even the College of Emergency Medicine says that they do not meet its definition of an emergency department. How on earth can the Secretary of State be so confident that other hospitals in south-east London will be able to cope once he has taken the axe to Lewisham?

I recognise that the hon. Lady has been campaigning hard for her constituents, but she massively overstates her case. The reality of the proposals is that 25% of the people who go to Lewisham A and E will no longer go there—the most complex cases among her constituents, who will get better treatment as a result. Those 25% will be spread among four other A and E departments, and we are allocating £37 million to help them upgrade their capacity. That is a sensible proposal that will save the lives of her constituents.

Local Members of Parliament are right to raise concerns about future capacity at Guy’s and St Thomas’ and at King’s. The recent King’s Fund report showed that between October and December 2012, many A and E departments in England faced their worst winter in almost a decade. Standards of care are deteriorating, with too many people waiting too long to be seen and many being left on trolleys in corridors or waiting in ambulances stuck outside A and E. Does the Secretary of State now accept that the NHS is struggling to cope with the toxic mix of cuts and reorganisation, and that patients in south-east London and elsewhere are paying the price for this Government’s mismanagement of the NHS?

Really, from a party that closed or downgraded 12 A and E departments when in office, I would expect a slightly more mature attitude to an extremely difficult and complex problem. We will not take any lessons in meeting A and E targets from that lot. The reality is that we met our A and E targets last year, but in Wales, where Labour cut the NHS budget by 8%, they have not met their A and E targets since 2009.

Sexual Health Policy

4. What the reason is for the time taken to produce the Government’s sexual health policy document; and when he now expects it to be published. (144339)

Will the sexual health policy document contain a strategic plan, effectively resourced by Government, to address and reduce HIV stigma, especially among health care professionals, the police, media, teachers and social services? Perhaps a good starting point could be to draw on the lessons and the success of the Government’s anti-stigma work on mental health.

I certainly support the sentiment behind the hon. Gentleman’s question, and make it clear that I wanted to ensure that the document included the need for everybody to eradicate prejudice in all sexual health work. I was very keen to put that in the document, and I am sure he will join me in welcoming its publication, which will, we hope, be next month.

The under-18 pregnancy rate has fallen by 25% in the past 10 years. Will the Minister confirm that the strategy document will make it clear that it is important to protect specialist, dedicated sexual health services for young people, such as the Brook service at the Talkshop in Trafford in my constituency?

Does my hon. Friend recognise the excellent progress that has been made in vaccination against the human papillomavirus to prevent cervical cancer in young girls? Will she find the time to meet me to discuss the benefits of vaccinating boys against that virus?

Yes, it is always a great pleasure to meet my hon. Friend, and he raises an important issue. I have met a number of other colleagues to talk about their concerns about screening—or rather the lack of screening—for young women under the age of 25 in relation to cervical cancer. That is a concern and we look forward to working on that. I am very happy to meet my hon. Friend.

The Government have been woefully complacent about producing their sexual health strategy. The Minister constantly says that responsibility for decisions lies locally, but will she admit that the Government’s reorganisation has created huge confusion, splitting the commissioning of sexual health services between GPs, councils and the national board, and that the Government’s lack of interest has delayed the sexual health strategy by 21 months? Will she explain the reasons for the delay, and when the strategy finally comes out, will she commit to it addressing seriously the rationing of access to contraceptive services for women aged over 25?

Is it not remarkable to have criticism of a reorganisation from someone who supported a Government who had nine reorganisations in nine years? The sexual health strategy document is very important, which is why we are working hard to ensure that it is absolutely right. I re-wrote a large section to ensure that it will deliver—[Interruption.] I do not know why the hon. Member for Hackney North and Stoke Newington (Ms Abbott), from a sedentary position, says “Ah.” It is an important document and we want to get it right, and I am sure she will welcome it when it is published. However, let me make it clear: any delay in the document is not preventing rightful commissioning at a local level. I saw that yesterday when I went to Bedford and met the Brook organisation and the Terrence Higgins Trust, which have long been engaged, certainly in that county, in a tendering process from the local authority to continue to deliver excellent services.

Whittington Hospital

5. What recent discussions he has had with the Whittington hospital on the proposed disposal of its assets and reductions in medical and non-medical staff. (144340)

This is a matter for the local NHS, in particular the Whittington Hospital NHS Trust. Neither the Secretary of State nor the ministerial team have met with the trust recently on this subject.

That is a disappointing reply from the Minister. Is he aware that the Whittington is a successful, popular, local district general hospital, yet, as part of its application to become a foundation trust, it is proposing to: sell off a quarter of its land; make 500 of its staff, including many nurses, redundant; and reduce the number of beds to 177, roughly half the current figure? This is, apparently, to provide a better service to the community, a point totally lost on the thousands of local people who are angry at the reduction in their hospital services. They see it as a prelude to its ultimate closure as a district general hospital with an A and E department. Will the Minister take an interest and perhaps intervene to protect a very good local hospital from this not very sensible plan?

The hon. Gentleman is right to highlight the fact that the trust has handled this issue badly at a local level, but, as he will know, decisions about local health care reside with local trusts. The point is this: if we look at the plans, the trust is talking about selling off land that is mostly not used for clinical purposes and reinvesting that money in front-line patient care: investing £10 million in improving the maternity department, which has already benefited from £750,000 from the Government only this year; £2.9 million in the same-day treatment centre to support A and E and treat patients faster; and £1.9 million for a new undergraduate education centre and library. Those assets are being sold off to directly influence and improve patient care, which has to be a good thing.

Is the Minister aware of how angry and concerned Londoners are about the threats to their health service—not just about the £17 million property sales at the Whittington and the drop in bed numbers, but about the threat to four A and Es in north-west London and, of course, the A and E in Lewisham? Ministers have accused campaigners of overstating the case. Is that not a complacent attitude? Surely doctors and residents on the ground know the value of these services better than Ministers in Whitehall. Is he aware that Londoners came out in unprecedented numbers to fight for Lewisham hospital and will continue to fight for the best possible NHS services in our region?

The hon. Lady is absolutely right to highlight the fact that service changes have to be clinically led, meet the tests we have outlined and engage with communities effectively, but the point is that the previous Government also redesigned and changed services, very often for the benefit of patients. When the redesign of services is clinically led and services are better delivered for patients, that has to be a good thing so let us look at these proposals. If they are clinically led, let us see whether they deliver improved care for patients, and if they do, it is the right thing to do.

Alcohol Consumption (Pregnancy)

6. What assessment his Department has made of harm caused to babies by alcohol consumed during pregnancy; and if he will make a statement. (144341)

Foetal alcohol syndrome is a severe, lifelong condition caused by heavy alcohol consumption during pregnancy, and foetal alcohol spectrum disorder is usually less severe. There is a consensus, however, that FASD is more widespread.

I thank the hon. Lady for her answer and for her recent letter to me on this subject. She will be aware of the Medical Research Council’s research suggesting that 7,000 babies are born every year suffering from serious genetic and permanent damage. Just as worrying, however, is that even moderate consumption can have an impact on IQ. In America, all drinks containers must have the following written on them:

“According to the surgeon general, women should not drink alcohol beverages during pregnancy because of the risk of birth defects.”

When will the Government insist that all drinks containers in Britain carry the same slogan?

The hon. Gentleman makes a very good point. Our advice is clear and the chief medical officer continues to give this advice: women who are pregnant or trying to become pregnant should not drink alcohol. If they feel that they must drink it, they should drink one or two units once or twice a week, at the very most. Our advice is clear, but he makes a good point, and I am happy to discuss it with him further.

Recent NHS figures show that £2.7 billion was spent on alcohol-related illnesses. Will the Minister consider a campaign across the whole of the United Kingdom, including the Northern Ireland Assembly and Northern Ireland as a region, to combat the issue of drinking during pregnancy?

That is a very good point. The overconsumption of alcohol, whether by a pregnant woman or not, greatly concerns the Government, and that is one reason we want to introduce a minimum unit price of 45p. It was a good point well made, and I am always happy to meet the hon. Gentleman to discuss the matter further.

Dementia

The National Institute for Health Research supports a wide range of research, including a number of studies of pre-senile dementias, more commonly known as early-onset dementias. This includes 85 studies recruiting patients with dementia and a further 17 in the set-up phase.

I declare an interest.

Dementia in the ageing population is beginning to be better understood and recognised—I appreciate the Government’s efforts on this—but there are also the frontotemporal dementias, such as Pick’s, corticobasal degeneration, Lewy body, progressive supranuclear palsy, Parkinson’s and stroke-related dementias, which are early onset. There is less understanding and awareness of these dementias. I welcome the Government’s commitment to research in this area, but we also need to extend understanding among nurses, general practitioners and care providers. Will the Government ensure that this wider understanding is available and extended?

I thank the hon. Lady for her interest in early-onset dementia. She is absolutely right: there is a widespread lack of understanding of dementia in general, and of early-onset dementia in particular. In addition to the research that I mentioned in my earlier answer, we are also looking at a major programme to engage GPs. Sadly, some GPs still think that it is not worth diagnosing someone with dementia, and there is a lack of understanding that we absolutely have to put right.

Government and charitable spending on dementia research is 12 times lower than spending on cancer research, with £590 million a year being spent on cancer research and only £50 million being invested in dementia research. What steps can we all, including the Government, take to increase the amount of investment in dementia research?

My hon. Friend makes an important point, and he will be pleased to learn that the Government are more than doubling the amount of money that we put into dementia research. We need to catalyse the private sector companies because although they know that the size of their potential market of people with dementia is huge, they have been frustrated in their attempts to find the breakthrough medicine that we urgently need. We need to use the research to excite their interest and keep them focused on this truly tragic disease.

8. What steps his Department plans to take to improve dementia diagnosis rates and to reduce regional variations in such diagnoses. (144343)

There are unacceptable variations in the level of dementia diagnosis across the country, and we are committed to driving significant improvements. We have asked local areas, through the NHS mandate, to make measurable progress in improving dementia diagnosis over the next two years.

In North Yorkshire and York, only 43% of those suffering from dementia receive a diagnosis. Given the ageing population in the county, that means that about 7,000 people with dementia remain undiagnosed. Does my right hon. Friend agree that the clinical commissioning groups have a large role to play in the delivery of dementia services, and will he tell us what support those groups will get?

My hon. Friend is absolutely right. It is a tragedy for those 7,000 people and their families that they are not getting a diagnosis. With a diagnosis, medicines and drugs could have a big impact and stave off the condition for between one in three and one in four people, and support services could also be put in place for carers. We need a massive transformation, and we need to make it much easier for people to get a diagnosis. We need much better understanding among GPs, as I mentioned earlier, and among hospitals as well, given that 25% of all in-patients have dementia.

Mortality Indicators

9. What recent discussions he has had with officials in his Department on the forthcoming NHS investigation into mortality indicators. (144345)

Ministers have discussed the terms of reference for the review of hospitals that have been highlighted as outliers for the last two consecutive years using nationally published mortality indicators. The terms of reference were published by Professor Sir Bruce Keogh on Friday 15 February.

Just over a year ago, I asked the previous Secretary of State a question about gagging orders and the specific case of Mr Gary Walker, the former chief executive of United Lincolnshire Hospitals NHS Trust. In the light of the recent news that our local health trust is now being investigated amid concerns over patient safety, what assurances can the Minister give the House that such Stalinist gagging orders, which have cost the taxpayer £15 million in the past few years, will be outlawed as soon as possible, to ensure that, under this Government, it will not take 81 requests to ensure that patient safety is paramount?

My hon. Friend is absolutely right to highlight the fact that all staff in the NHS should feel able to speak up and raise concerns about patient safety, so that the organisations for which they work can take up their concerns and investigate them. He will be aware that the people who raise such concerns are protected under the Public Interest Disclosure Act 1998.

Last week I visited Salford Royal hospital, which has the lowest death and weekend mortality rates in the north-west, and the seventh lowest in the country. It is interesting to note that Salford also has higher ratios of nurses per in-patient bed, and that individual wards in the hospital publish data on their rates of MRSA, ulcers and falls. Does the Minister accept that good practice at hospitals such as Salford Royal should be investigated alongside the poor practice and high mortality rates in other hospitals?

The hon. Lady is absolutely right. That is exactly what the review is about. It is going into the 14 hospitals in which concern has arisen over mortality data, looking at the practices there and commissioning a peer review of them from leading clinicians and patient groups. That will help to raise standards of practice where required.

In supporting the points that have just been made by my hon. Friend the Member for Lincoln (Karl MᶜCartney), may I tell the Minister that, as he might expect, there is considerable anxiety among my Lincolnshire constituents over the fact that the United Lincolnshire Hospitals NHS Trust has a higher than average mortality rate? Will he tell us when the promised review of the situation will begin, and who will be conducting it?

To reassure my right hon. Friend, the review is being carried out and led by Sir Bruce Keogh, the NHS medical director. We are already well under way in implementing the review. It should be in place by the very early summer to inform Members of this House and to make improvements to patient care at the local trust level.

People in Dudley were concerned to discover that higher than average mortality rates have led to Russells Hall hospital in my constituency being investigated. I have written to Sir Bruce Keogh to ask whether he or a member of his team will meet me to discuss the inquiry, so that we can find out exactly what has been going on and local people can provide information to it. How does the Minister think that things at the hospital will be improved when nurse numbers in the NHS are being reduced, waiting lists at the hospital have gone up by 177% and the NHS in Dudley has had to spend £20 million on a costly and bureaucratic reorganisation instead of on improving front-line care?

I had thought that the hon. Gentleman had risen on a consensual note, raising his constituents’ concerns—and he was right to do that. The review is about making sure that any failings in care in local trusts are picked up and improved. The fact of the matter is that waiting times are down under this Government in comparison with the previous Government and many more additional clinical staff are working in the NHS—about 2,000 more than under the previous Government. At the same time, we have cut 18,000 administrative and management posts, and the money from that is being reinvested in front-line patient care.

If the hon. Member for Crawley (Henry Smith) wishes to come in on this question, he may, but he is not obliged to do so.

Private Finance Initiative Hospitals

10. What assessment his Department has made of the effect of hospitals built under the private finance initiative on the work of neighbouring hospitals. (144346)

This Government recognise that no hospital operates in isolation. We are providing seven NHS trusts that are facing difficulties as a result of PFI agreements with access to a £1.5 billion support fund to pay for extra costs accrued as a result of those damaging PFI schemes.

I apologise for my voice—perhaps I shall soon be interacting more directly with the NHS.

The Warrington and Halton hospital has independent trust status. It is busy and getting busier. The previous Government built a huge PFI hospital about 10 miles away at Whiston, which does not have the patient volumes to sustain the demands of the botched PFI deal. It is heavily loss-making. Will the Minister provide assurance that there will be no forced merger and that my constituents will not pay for a bad decision made a decade ago?

I thank my hon. Friend for his question. He is right to highlight the very damaging PFI scheme signed by the previous Government for the St Helens and Knowsley NHS Trust. The percentage of annual turnover going on PFI payments at the moment is 14.2%. That is unsustainable, which is why this Government are trying to sort out the mess created by the previous Government’s signing up to too many PFI agreements.

The Minister will be aware that support for excess PFI costs was an important element in the report of the trust special administrator in south-east London, to which the Secretary of State referred in an earlier exchange. That recommendation was widely welcomed. However, as I highlighted in questions a month ago, the Government have not accepted the financial recommendations of the trust special administrator for the capital costs and the transitional costs inherent in his recommendations. If the Government wish to proceed with these changes, will the Government agree to meet those costs as well?

The right hon. Gentleman is in dangerous territory talking about PFI schemes to which the previous Government signed up. No hospital operates in isolation. The South London Healthcare NHS Trust was paying out 13.9% of its turnover on the PFI. That was unsustainable. It has caused huge difficulties in the local health care economy and affected patient care, which was a very bad thing to do. The right hon. Gentleman needs to recognise that this Government are providing £1.5 billion-worth of support to many trusts that have struggled under these PFI agreements—

Order. I am grateful to the Minister, but we have many questions to get through and the answers are sometimes just too long.

GP and Specialist Health Services

12. What steps his Department is taking to increase the availability to patients of GPs and specialist health services. (144348)

The Department of Health is currently working with key partners to support the increase of training numbers in general practice. From 1 April, the NHS Commissioning Board will be responsible for commissioning primary care medical services and specialised services. It will have a duty to commission those services in ways that improve quality and promote integrated care. Clinical commissioning groups will be responsible for commissioning most other services.

The Minister is aware of the need to increase health care provision in Witham town. Can he reassure me that the appalling financial legacy of Mid Essex primary care trust will not hold back proposals to provide much-needed health care in the town?

I applaud my hon. Friend for repeatedly raising her constituents’ concerns about this subject. We have made it absolutely clear that primary care trusts must work closely with clinical commissioning groups to ensure that they meet the challenges of the current financial year. As for the future, the joint strategic needs assessment and the health and wellbeing boards will provide real accountability locally, and I think that my hon. Friend will be able to feed into that to ensure that her constituents are given the health services that they need.

The Limbless Association wrote to Members of Parliament this month expressing concerns about proposals for the commissioning of extremely specialist prosthetic services, which would reduce patient choice and oblige the patient to follow the money rather than vice versa, and would damage some highly skilled professionals in the field. When did the Minister last meet representatives of the Limbless Association, and will he agree to meet them with me?

I should be happy to meet the hon. Lady and members of the association to discuss those concerns further.

There is currently much talk about the importance of integrated services. Can my hon. Friend assure us that when commissioning primary care, the NHS Commissioning Board will emphasise the importance of integrating it with the other community health services supplied by the NHS, and that social care will be included in that fully integrated service?

I am happy to give my right hon. Friend an absolute assurance to that effect. The Department and I are working closely and collaboratively with both the Commissioning Board and the Local Government Association to ensure that we deliver integrated care, which is much the best way of keeping patients out of hospital and maintaining their condition.

There are plans to increase the number of training places for GPs, with the aim of providing more than 3,000 extra places by 2015. That will fully meet the needs to which the hon. Lady has referred.

Premature Mortality

13. What steps he has taken to support research on the most common causes of premature mortality. (144349)

We are still far too low in the European league tables for premature mortality, particularly in respect of cancer, liver disease and respiratory diseases. I have therefore made improving our performance a key priority.

Can the Minister say a little more about what is being done to prevent early mortality as a result of heart disease?

We are investing £34 million in cardiovascular research. Much excellent work is being done at, in particular, the Oxford Biomedical Research Centre, which will help us to make great strides.

19. It is widely accepted that late diagnosis of cancer makes for premature mortality. Will the Government recommend the inclusion of proxy measures such as staging and accident and emergency admissions in the outcomes indicator set, as a way of complementing the one and five-year survival measures? That would give us a more complete picture of how CCGs are performing in encouraging earlier diagnosis. (144355)

I congratulate my hon. Friend on his campaigning. No sooner do we agree to the inclusion of one indicator in relation to early cancer diagnosis than he finds another that should also be included.

I will certainly consider the issue that my hon. Friend has raised, but I think that there is a broader question about the role of GPs. They should see themselves as being in the front line when it comes to early diagnosis of not just people who walk through the doors of their surgeries, but people in their communities who are at high risk. That is a much more fundamental change that we need to think about.

Adult Mental Health Services

14. What was the change in the level of spending in real terms on adult mental health services in 2011-12. (144350)

It is the responsibility of local commissioners to ensure that resources are used effectively to meet the needs of their local populations. According to the national survey of investment in adult mental health services for 2011-12, cash investment rose between 2010-11, but real-terms investment fell by 1%.

I will meet Sheffield Mind on Friday, and one of the issues we will be talking about is the impact of that fall in spending on crisis care. Mind’s research shows that crisis care teams are often under-resourced and overstretched, with four in 10 trusts having staffing levels below the Department’s own guidelines of 14 staff to 25 service users. Does the Minister think that is acceptable, and if not, what is he going to do about it?

The Government inherited an institutional bias against mental health in the NHS. [Interruption.] It is absolutely true; when the 18-week target was introduced, nothing was available for those suffering with mental health problems. Mental health patients did not benefit from choice that was introduced elsewhere in the NHS. I completely agree with the hon. Gentleman about the importance of crisis services, and the first NHS mandate has required the Commissioning Board to do work on the availability of mental health services and to ensure that we can introduce access standards so that mental health service users and patients benefit from the same rights as those with physical health problems.

First, may I thank you for your earlier guidance, Mr Speaker?

May I thank the Department for its approach to the ravages to which Newark health care has been subjected, principally by the last Government, and thank the Minister for his forthcoming visit to Newark and assure him that mental health care services, which have been diminished in Newark, will certainly be top of the agenda?

The Minister who will visit Newark is, in fact, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), but I am grateful to my hon. Friend the Member for Newark (Patrick Mercer) for raising this issue and for highlighting the importance of mental health care. The mandate makes it very clear that the Commissioning Board and the NHS must make measurable progress towards achieving parity of esteem by 2015.

Technology (Savings)

15. What recent estimate he has made of the potential savings to the NHS of making better use of technology. (144351)

PricewaterhouseCoopers estimates that the NHS could save £4.4 billion every year through proper investment in IT, which is one of the reasons I set the NHS the challenge of becoming fully paperless by 2018.

I am grateful to the Secretary of State for his answer, but can he assure me that investment in new technology will release resources for patient care, rather than follow the pattern over the past 15 years, when investment in new technology has detracted from the available resources?

My hon. Friend makes an important point. In encouraging such investment, we are thinking about the nurse who recently reported that in order to admit someone to trauma she had to fill out a 22-page admission form and another 10 forms after that. The whole point of this move is to free up the time of professionals on the front line so that they can spend more time with patients.

The Secretary of State will be aware that the general practice extraction service contract has recently been awarded to French IT firm Atos Healthcare. Given the concerns expressed by the Public Accounts Committee and the National Audit Office about the way in which Atos has performed in respect of other contracts let by the Government, what has the Secretary of State got in mind to ensure that there are safeguards for patient data under the general practice extraction service contract?

With respect to all IT contracts, all I will say is that we have learned a great deal from the mistakes made by the previous Government.

Topical Questions

The last month has seen the Government take two radical steps that will fundamentally improve the quality of health care in this country. First, in our response to the Francis report on the appalling tragedy at Mid Staffs, we announced the setting up of a chief inspectorate of hospitals based at the Care Quality Commission. That will introduce compassionate care, patient feedback and expert peer review into a system that has been too long dominated by targets and box-ticking. Secondly, in response to the Dilnot report, the Government announced a long-term solution to the funding of social care, which will both help thousands of low-income pensioners avoid having to sell their homes and make us one of the first countries in the world where it is as normal to save for social care costs as it is to save for a pension.

This week I will meet my constituents Neal and Rita Denvir, whose son, Fionn, made a miraculous recovery from meningitis. Many are not so fortunate, however, so will the Secretary of State pledge his support to the Meningitis UK “Beat it now” campaign, and include the newly licensed vaccine for meningitis B in the NHS childhood immunisation programme, so that no family has to live with the terror of that terrifying disease?

As the father of two young children, I completely share the hon. Lady’s passion for this issue and I am happy to give my support to Meningitis UK. The decision on whether to include a meningitis jab in the immunisation campaign is made by an independent expert panel, and I will always follow its advice.

T2. We used to believe that tuberculosis was beaten in this country, but the number of instances of it is increasing, and there were more than 9,000 new cases last year. Does that not suggest, particularly when the incidence of drug-resistant TB is a concern, that a comprehensive public health strategy is needed to tackle the disease? What steps is the Department taking to lead that strategy? (144362)

I am grateful for that question, because my right hon. Friend has identified the fact that TB is a growing problem. We are exploring the effectiveness of an approach across health sectors for a national strategy on TB, while ensuring that we recognise the local variances. We need to improve in that area.

I am sure that, like me, the Secretary of State has spent recent weeks absorbing the Francis report and its recommendations; there are lessons for everyone at every level, particularly on staffing. New analysis to be published later today will show that the NHS is set to lose 12,000 nurses over the course of this Parliament, raising doubts about its ability to respond to Robert Francis’s recommendations on staffing. Will the Government say today whether they accept those recommendations and the principle of a minimum staff-to-patient ratio?

If the right hon. Gentleman had read the Francis report carefully he would have, first, observed that the appalling tragedies covered in that report happened between 2005 and 2009, when nursing numbers were going up. So to say that this is an issue about nursing numbers is to miss the point completely. This is not an issue where there is a quick fix; it is an issue about the NHS having become dominated for far too long by a culture of targets at any cost. Unpicking that culture is the biggest challenge we face if we are to return a culture of compassionate care to the NHS.

I have read both Francis reports, and I think it is essential that everybody learns the lessons—that is what I said—including Labour Members. It is also important that we do not repeat the mistakes, and the first Francis report said that the problems were caused because the trust cut staff to dangerously low levels. The most worrying thing from the analysis that will be published today is that four in 10 of the jobs being lost come directly from services linked to the care of older people. Does the Secretary of State therefore agree that there is a danger that the NHS is already failing to learn the lessons of the recent past? Will he join me in sending a message to the NHS that care of older people should be a priority for improvement, not an easy target for cuts?

If we are to learn the lessons of the Francis report and admit to our mistakes, perhaps the right hon. Gentleman will reflect on the fact that, because we decided to protect the NHS budget, there are 8,000 more clinical staff in the NHS today, yet he still wants to cut the NHS budget from its current levels, as he confirmed only last December.

T3. In today’s edition of the Daily Express, the Prime Minister promises to prevent immigrants freeloading on our NHS. Words are one thing, but can the Secretary of State spell out exactly what actions will be taken to deliver on the Prime Minister’s pledge? (144363)

I am happy to confirm to my hon. Friend that we intend to take some profound steps in this area, because we have a national health service, not an international health service. We have to ask whether it is appropriate for us to be giving free health care to short-term visitors, to students, to people on temporary visas. We will be saying more about that issue shortly.

T6. On 13 March 2012, the former Secretary of State said of the Health and Social Care Bill:“There is absolutely nothing in the Bill that promotes or permits the transfer of NHS activities to the private sector.”—[Official Report, 13 March 2012; Vol. 542, c. 169.]However, the new NHS competition regulations break those promises by creating a requirement for almost all commissioning to be carried out through competitive markets, forcing privatisation through the back door, regardless of local will. Will the Secretary of State agree to make the regulations subject to a full debate and vote of both Houses? (144366)

If the hon. Gentleman had listened to my previous answer, he would have heard that the regulations are consistent with the procurement guidelines that his own Government sent out to PCTs. It is not our job to be a champion for the private sector or the NHS sector; we want to be there to do the best job for patients. That is the purpose of the regulations.

T4. Two years ago, the Prime Minister welcomed the installation of CyberKnife, the latest in cancer radio surgery equipment at the world-leading Royal Marsden cancer centre, as an example of how the NHS has progressed. Since then, the Royal Marsden has invited successive Health Ministers to visit the cancer centre but no one has accepted the invitation, and I am aware that Ministers have been to see other cancer treatment systems. Will the Secretary of State follow the Prime Minister’s lead and visit the Royal Marsden to see for himself the great progress that has been made there? (144364)

I understand that the Secretary of State has been to the Royal Marsden, but I am more than happy to accept the invitation and look forward to going along and seeing it for myself.

T10. What steps is the Secretary of State taking to prevent the fragmenting of the national health service through a massive reorganisation that is costing £3 billion, diverting much-needed resources from the front line? (144370)

The truth is that the Government inherited a completely fragmented NHS; we had managed institutionally to separate health care from social care, mental health from physical health and primary care from secondary care. At the heart of the legislation we have already passed and the proposed social care legislation, which we hope to introduce very soon, is the principle of integrated care. I am determined that that should be central in every area of the country so that we deliver proper care and avoid crises, keeping people out of hospital.

T5. The South Devon and Torbay clinical commissioning group is building on the integrated health and social care system for which many have praised the area. Will the Minister help complete the integration by assisting with the inclusion of mental health care services within the regime? (144365)

I thank my hon. Friend for that question and applaud the brilliant work that has been done in Torbay. There has been a reduction in hospital admissions because they care for people better. As I said in my last answer, it is essential that we integrate mental health in the system as well as physical health so that we give people proper care.

On performance data, what plans does the Minister have to expand the friends and family test so that it provides the reasons for patients’ views and real-time feedback on their experience of services?

I thank the hon. Gentleman for his question. The friends and family test will give real-time feedback about patient services, but we need to ensure that the data from the test are used effectively by local trusts and scrutinised by the Care Quality Commission and other organisations so that they can go in if there are problems to ensure that they stand up for the rights of patients.

T7. Kevin Davies, a constituent from Cowbridge, visited my surgery yesterday. He is a prostate cancer patient and robotic surgery was deemed to be the most appropriate form of care. Unfortunately, robotic surgery for prostate cancer is not available in Wales and he was forced to travel to Bristol and pay £15,000 for the treatment. Will my hon. Friend agree to work with the Welsh NHS either to come up with a formal agreement whereby facilities are available to Welsh NHS patients or to press it to invest in its own facilities? (144367)

My hon. Friend makes a good point: in England, the NHS is benefiting from not suffering a cut in funding such as that imposed by the Labour Administration in Wales.

The Prime Minister promised a fight to save district general hospitals, yet the Secretary of State’s recent decision on Lewisham suggests something completely different. Will the Secretary of State therefore give the House an assurance that the north Cheshire hospitals trust will not be forced into a merger or to downgrade its services because of financial problems elsewhere?

I know that the hon. Lady had tabled a question on this matter. The point is that a foundation trust has autonomy and cannot be coerced or forced into a merger. It is for the board of that trust to make decisions for the benefit of patients.

T8. Patients in Suffolk are very worried about the performance of the ambulance service. In the past two months, less than 60% of ambulances have hit the target for reaching emergency cases. The strategic health authority and others, including all the MPs in the region, are not happy about that. Will the Government intervene, too? (144368)

With two Ministers in the Department from the east of England, I can assure my hon. Friend that all of us are aware of the concerns that she and other Members have about their ambulance trust and, if I may say so as an east midlands MP, about the East Midlands ambulance trust. I know that Earl Howe, who has responsibility overall, has offered a meeting with Members from the east of England, and I am sure that that meeting will produce the sort of benefits that everyone hopes for.

Last week’s decision to close four north-west London A and Es, including Charing Cross and Hammersmith in my constituency, will shortly be on the Secretary of State’s desk, as he predicts. It was referred by Labour Ealing council because Tory Hammersmith and Fulham council supports the closures. Will the Secretary of State refer the matter for independent review? This is the biggest hospital closure programme in the history of the NHS. It will see a world-class hospital downgraded to 3% of its size.

I am aware how concerned people are throughout north-west London about the proposals. If the matter is referred to me by Ealing council, I will indeed ask the independent reconfiguration panel for its independent view on the proposals.

T9. The cancer drugs fund has been a huge success and has helped up to 25,000 patients, but the negotiations between the Government and the pharmaceutical companies on its replacement—value-based pricing—is causing real uncertainty for cancer patients and clinicians alike. For example, will new medicines be available to new patients under the new system and what guidance is being given to local cancer drugs funds as they wind down? Can we please have clarity urgently? (144369)

I think the hon. Gentleman was seeking an Adjournment debate and is disguising his request as a question, for which we are grateful.

I thank my hon. Friend for that question. I am happy to discuss it further with him. Value-based pricing will be primarily for new drugs, but obviously I understand his concern. It is the concern of the Government to ensure good access to cancer drugs for patients in the future.

Recent comprehensive research by the international study of asthma and allergies in childhood found strong evidence of a link between fast food and asthma, but when I asked the Minister which public health responsibility deal partners he had discussed that with, he said that evaluating science was not within their remit. Does he agree that if the fast food companies have the kudos of being classed as public health responsibility deal partners, they ought to look into such research and actually take some responsibility?

Those are good points well made, if I may say so. I am more than happy to discuss that further with the hon. Lady, because I take the firm view that everyone involved in making, manufacturing, supplying and selling food has a responsibility to make sure that all of us have longer, healthier, happier lives. I am all for ratcheting up the responsibility deal.

May I alert my right hon. and hon. Friends to the recently published road map for complementary and alternative medicine in Europe, which cost the European Commission £1.5 million? Will they look at it carefully to see where services can be extended in our own national health service?

I assure my hon. Friend that we will look carefully at anything that he wants to put forward, but any treatment on the NHS needs, of course, to be evidence-based.

Every year 18,000 epileptic fits are triggered by video games and screen-based activity. Can the ministerial team tell us what research is being done on that and what discussions they have had with the industry to make video games safer and improve the labelling?

I would be happy to look into that further. I recognise the significant concern that the hon. Lady raises. Often the diagnosis of epilepsy is not good enough and there needs to be much better co-ordinated care. The issue that she raises is important and I am happy to look into it further.

In spite of my right hon. Friend’s earlier comments, I am afraid that the regulation that implements section 75 of the Health and Social Care Act 2012 does not maintain the assurances previously given and risks creating an NHS that is driven more by private pocket than concern for patient care. Will the Secretary of State please withdraw that regulation and take it back to the drawing board?

We are looking at this extremely seriously. Clear assurances were given in the other place during the passage of the legislation, and it is important that they are complied with in the regulations.