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Oral Answers to Questions

Volume 569: debated on Tuesday 22 October 2013


The Secretary of State was asked—

Tobacco Products (Standardised Packaging)

1. If he will bring forward legislative proposals to introduce standardised packaging of tobacco products. (900583)

As the hon. Gentleman knows, the Government have decided to wait before making a decision on standardised packaging, but the policy remains under active consideration. As he can imagine, I have spent much of the past two weeks, as I get to know my brief, looking at that carefully.

I welcome the Minister to her new role. Stirling university’s systematic review of plain packaging concluded that it made cigarettes less attractive and health warnings more effective. Will she give me a straight answer: has she read the report, and if not, why not?

The straight answer is that I have not read the whole report, but I have read the summary, and it reaches some interesting conclusions. It is one of a number of interesting new pieces of information and evidence coming forward to support decision making in this policy area, and from work going on in countries right around the world as well as Australia.

Three hundred thousand young people a year start smoking, and the tobacco industry’s last vestige of advertising is packaging. Will my hon. Friend, in her new role, look at the proposal very seriously so that we can stop young people starting this terrible habit?

Stopping children and young people smoking is a priority for us all; all Members care deeply about the health of their constituents. I can certainly assure my hon. Friend that we are looking at that very seriously and assessing all the new information available, not just from this country but from around the world.

The vast weight of not only expert opinion but of public opinion says that standardised packaging cuts the risk of people taking up smoking. When will the Government act on that and ignore what is coming from the vested interests—the lobbyists and the big tobacco companies—as an excuse for doing nothing?

I can only repeat what I have said: I am a new Minister and I am looking at this very carefully. There are interesting new pieces of information coming through all the time to assist us in making public policy in this area. It is under very active consideration.

I welcome the Minister to her new role. Will she, when considering the evidence, look at the fact that the tobacco industry, in its marketing and packaging strategies, is aiming at certain markets, particularly children and young people, whom they want to start smoking? Given her desire to ensure that children do not take up the practice, surely she should act on the evidence by ending the existing packaging arrangements and having standardised packaging so that we can deal with this problem.

At the risk of repeating myself, all I can say to my right hon. Friend is that I am looking at that very carefully. He is right that we all want to stop children and young people smoking. There is a mass of evidence out there, and we are gaining new evidence and information all the time to help us make decisions. I will continue to look at it as one of the absolute priorities within my brief.

I welcome the hon. Lady to her new post. We knew that her predecessor supported standardised cigarette packaging: Labour will table amendments to the Children and Families Bill in the other place and in this place to make that a reality. I have listened to contributions from Members on the Government Benches supporting the policy. Will the Minister tell us today whether she supports standardised packaging?

We are very aware of the discussions that have been going on in the other place and the amendments that have come forward, in which we have taken considerable interest. At this stage, we want to look at all the available evidence, because new information is coming through, before coming to a view. I take this opportunity to welcome the hon. Lady to her new post.

Maternity Services (Gloucestershire)

2. What assessment he has made of the adequacy of provision of maternity services in Gloucestershire. (900584)

On 12 November last year, I announced the allocation of a £25 million capital fund to the NHS to improve maternity services across the country, and that has supported improvements in 110 maternity care settings. I am pleased to say that, of that figure, Gloucestershire Hospitals NHS Foundation Trust was awarded £150,000 to refurbish the Stroud maternity unit.

I thank the Minister for that encouraging answer. We now have 1,400 new midwives since 2010. Coupled with the very welcome recent investment in Stroud maternity unit, does he agree that this represents a real choice for expectant mothers and an excellent maternity service in general?

My hon. Friend is absolutely right to highlight the fact that when we came into Government there was a historical shortage of investment in maternity and midwifery care. We now have almost 1,400 more midwives in the work force, training commissions are being maintained at a record high, and we are continuing to invest in on-the-ground capital projects to support the birthing environment for women.

European Working Time Directive

3. What assessment his Department has made of the effect of the European working time directive on patient care and the professional development of doctors. (900585)

We are aware that concerns exist about the impact of EU legislation on some areas of training and service delivery within the NHS, specifically the impact of the EWTD on patient experience and continuity of care, and the detrimental effect on the quality of training for doctors.

Harrogate hospital, which serves much of my constituency, suffers very badly from recruitment and retention issues as a result of the working time directive. Does the Minister agree that it, and other areas of social and employment law, should be front and centre of our renegotiation strategy prior to the referendum in 2017?

My hon. Friend is absolutely right to highlight some of the concerns that have been raised by the Royal College of Surgeons and other groups about the impact of the European working time directive in medicine. That is why we have tasked the royal college with investigating and doing some work on exactly what the impact is on surgical trainees and elsewhere in the health sector. We look forward to its reporting back, and I hope that that will be very informative for future discussions on other work force regulations.

NHS Trusts (Financial Deficits)

4. What estimate he has made of the number of NHS Trusts forecasting a financial deficit at the end of 2013-14. (900586)

The Trust Development Authority and Monitor, for foundation trusts, indicate that there will be a financial surplus across the health care provider sector in 2013-14.

With so many NHS trusts in deficit and many missing their A and E targets, when will the Minister stop blaming everybody else and get a grip on the A and E crisis?

I am disappointed that the hon. Gentleman used a pre-prepared question and did not listen to my answer. Throughout the health care provider sector, over 80% of trusts and foundation trusts are in financial surplus, and the overall end-of-year forecast is pointing to a surplus of £109 million across the sector. To support hospitals through what can be very difficult winter periods, with flu and other seasonal problems, we have put in place measures including a £500 million fund for winter pressures. That will take the pressure off A and E—unlike in Wales, where the Welsh Administration are cutting the budget for the NHS. In Wales the NHS has failed to meet A and E waiting targets since 2009.

While I welcome the fact that the provider sector as a whole is in surplus, will my hon. Friend confirm that some trusts are indeed anticipating that they will be running deficits? Will he also confirm that the National Audit Office has estimated that up to 30% of acute hospital admissions would be avoidable if we had properly integrated services, and that that would allow us to deliver not only better financial management but, much more importantly, better quality care for patients?

My right hon. Friend is absolutely right to highlight the fact that a very small minority—20%—of trusts across the health care provider sector, including trusts and foundation trusts, are anticipating a deficit. Many of those trusts have a direct legacy of debt from the private finance initiative arrangements that the previous Government put in place. That is one of the direct legacies of the poor PFI deals that were arranged. He is absolutely right to highlight the importance of integrated and joined-up health care. That is exactly what the £500 million we are providing for winter pressures is designed to do by focusing on better preventive care to keep people out of hospital.

Trust balance sheets are bound to be affected by the resources allocated to the commissioning groups. On 12 June last year, I asked the then Minister for

“a clear assurance that he will not downgrade the importance of economic deprivation in his resource allocation formula”.

He told the House:

“Yes, I can give that assurance.”—[Official Report, 12 June 2012; Vol. 546, c. 167.]

Why is the Minister’s Department now consulting on doing precisely what the then Minister said he would not do and taking £230 million out of the budget for the north-east and Cumbria?

The right hon. Gentleman has perhaps misunderstood the information imparted on that occasion. It is very clear that the allocation formula is now independently set and NHS England has primary responsibility for it. There is legitimate concern. There is a 10% deprivation weighting for some of the poorest communities in-built into that formula. It is also important that we recognise that demographics and an ageing population are putting pressure on a lot of CCG budgets, but these are matters for NHS England.

As Morecambe Bay trust seeks to recover from its financial crisis, one of the options put forward by clinicians is for a new, acute hub hospital to be created south of Kendal to improve safety, access and financial efficiencies. It is bound to involve a capital cost to start off with. If the new hub hospital is the option chosen by clinicians, will my hon. Friend give it his backing politically and financially?

My hon. Friend will be aware that this is a matter for local commissioners to decide and it is not for Whitehall to impose solutions on them. There are issues and efficiencies that Morecambe Bay trust can drive by better managing its estate and reducing temporary staffing costs. The hospital and trust will, of course, want to look into those issues in improving their financial outlook and the quality of care they can provide for patients.

Whatever the Minister claims, the reality is that the Secretary of State has lost grip of NHS finances just as he has lost grip of the crisis in A and E. Earlier this month, we learned that half of all NHS hospital trusts are now predicting deficits—up from one in 12 last year. As a self-proclaimed champion of openness, will the Minister now commit to publishing those deficit figures monthly and guarantee that all NHS acute trusts will balance their books by the end of the year? It is a simple question—yes or no.

The hon. Lady is being economical with the figures. I indicated earlier that 70% of trusts and 89% of foundation trusts are predicted either to break even or end the year with a financial surplus. That is hardly a difficult position. Those trusts that have deficits are often a direct legacy of the PFI deals negotiated by the previous Government and the right hon. Member for Leigh (Andy Burnham) when he was Secretary of State. The sector as a whole is predicting £109 million of surplus. That is hardly a deficit. I know that the Labour party is not very good with figures and cannot add up, which is why this country is in such an economic mess, but the figures speak for themselves: £109 million of surplus is predicted for trusts and foundation trusts.

Hospital Trusts (Special Measures)

5. What recent progress he has made on improving the performance of hospital trusts placed in special measures. (900587)

8. What recent progress he has made on improving the performance of hospital trusts placed in special measures. (900590)

9. What recent progress he has made on improving the performance of hospital trusts placed in special measures. (900591)

Significant progress has been made at all 11 trusts placed in special measures in July, including changing the chair or chief executive officer and recruiting more nurses in every single one them and partnering each of them with a high-performing hospital so that they can make rapid progress in turning things around.

I thank the Secretary of State for his reply. He will be aware of my constituents’ concerns about services at Diana, Princess of Wales hospital in Grimsby. There are doubts about the future of the stroke unit and high mortality rates, and there are also problems with the East Midlands ambulance service. Will the Secretary of State give an assurance that he is satisfied that progress is being made at the hospital?

I think good progress is being made and I commend my hon. Friend for his campaigning on the issue. The trust concerned has introduced better privacy for patients, hired 154 nurses since the Keogh report and introduced electronic vital signs reporting at the bedside—all because we are being transparent and open about problems in the NHS and not sweeping them under the carpet.

Burton hospital, which serves part of my constituency, was one of the 11 hospitals placed in special measures following the Keogh report. Will my right hon. Friend assure my constituents that the improvements needed in those hospitals will be carried out in a culture of openness and transparency rather than one of opaqueness and cover-up, which so unfortunately typified the way in which the previous Government ran the NHS?

I know that my hon. Friend takes a very close interest in what happens at his hospital and I think that progress is being made in turning it around. What will be of concern to my hon. Friend is that, as far back as 2005-6, Burton’s mortality rate was 30% higher than the national average—it was even higher than that at Mid Staffs—and yet the problem was not sorted out. We are sorting it out.

As the Secretary of State is aware, North Cumbria trust is in special measures. We have on our doorstep a potential solution to our problems, namely Northumbria trust. Will the Secretary of State give me an assurance that everything possible will be done to get North Cumbria out of special measures at the earliest opportunity and, much more importantly, that every support will be given to Northumbria in is acquisition of North Cumbria?

I can give my hon. Friend both assurances because Northumbria has been doing a huge amount to help North Cumbria turn itself around, including installing its patient experience systems to ensure that patients are treated with the dignity and respect that they deserve. The problems have been around since 2007 and he can tell his constituents that we are finally turning them around.

As my right hon. Friend will be aware, Basildon university hospital in my constituency is one of the 11 hospitals that were placed in special measures following the failure of the previous Government to act on the information that they had. Will he tell the House what support the new management team, in whom I have great confidence, are receiving and when my constituents can expect to see sustained, long-term improvements?

I reassure my hon. Friend that the trust has hired 257 more nurses since the problems emerged this year, has better A and E processes, and has been partnered with the Royal Free in London to help it make even more progress. He will be as shocked as I am that when the Care Quality Commission identified problems at that hospital the last Government sat on the report for six months. That cannot be acceptable.

How can NHS patients and staff have any confidence in decisions about their local services when they are taken by the Competition Commission on the overriding grounds of what is best for a competitive market and not what is best for patients? Will he learn from the failure of the merger between the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and the Poole Hospital NHS Foundation Trust, and take merger off the table as an option for Rotherham hospital?

May I reassure the right hon. Gentleman that the competition authorities make their decisions based on what is in the best interests of patients and do not hold competition as an overriding ideology? He is right that we need to work closely with those authorities to ensure that they have the expertise to take decisions in the right way and with trusts to ensure that they have the expertise to ensure that they do not stumble when they go through those processes.

How can the public have confidence in their health service when police officers are taking patients who are sick and injured to A and E because ambulances are backed up outside A and E and take longer than an hour to arrive?

I will tell the hon. Lady why the public can have confidence in their health service: compared with three years ago, on broadly the same budget, the NHS is doing 800,000 more operations year in, year out; MRSA rates have halved; and the number of people who wait for a year or longer for operations has gone down from 18,000 to fewer than 400.

Will the Secretary of State explain why we have had a summer crisis in A and E? We are all used to the emergency services being overwhelmed in winter. Given the crisis that we have had, what will he do to assist the NHS in averting a winter crisis this year, rather than just blaming everybody else?

The figures for September, the last month of the summer, were 95.8% in England and 90.6% in Wales. It was not coalition-controlled England that had a summer A and E crisis, but Labour-controlled Wales.

The Secretary of State for Health is clearly not adequately monitoring performance. If he was, he would be aware that serious problems remain across the accident and emergency departments of the trusts that were placed in special measures by Professor Sir Bruce Keogh. On his watch, the A and E performance at eight of the 11 trusts has got worse since Keogh reported, including at my hospital in Tameside. The A and E performance has got substantially worse at East Lancashire Hospitals NHS Trust, where the number of patients waiting for more than four hours has doubled since Keogh reported, and at Medway NHS Trust, where the figure has quadrupled. When will he stop all the grandstanding, cut the spin and get a grip on his A and E crisis?

I hope that the hon. Gentleman will be pleased that something is happening under this Government that did not happen under the Labour Government: we are putting those hospitals into special measures and sorting out the problems, including the long-term problems with A and E such as the GP contract—a disaster that was imposed on this country by the Labour Government.

Acute Hospital Wards (Nurse-patient Ratio)

6. What the current (a) highest, (b) lowest and (c) mean average registered nurse-to-patient ratio is on acute hospital wards. (900588)

As my hon. Friend is aware, we do not hold information on registered nurse-to-patient ratios on acute hospital wards. Local hospitals must have the freedom to decide the skill mix of their work force and the number of staff they employ to deliver high-quality, safe patient care.

I am grateful to my hon. Friend. The Government should be monitoring the situation, but he will be aware of the concern, which I have consistently highlighted, about inadequate registered nurse ratios in acute hospital wards, and of the Health Committee’s report into the Francis inquiry, which made recommendations in that regard. In inspecting hospitals, what objective measure should the Care Quality Commission use when looking at safe staffing levels on acute hospital wards?

The CQC is working with the National Institute for Health and Care Excellence and NHS England to devise tools to do exactly that. As my hon. Friend will be aware, the number of front-line staff required, whether nurses or doctors, to look after a patient who is in a cardiac intensive care unit will differ from the number required in a rehabilitation setting. The tools that the chief inspector of hospitals will be able to apply are being developed.

Why do the Government continue to set their face against the essential recommendation of the Francis inquiry on minimum staffing levels?

The simple reason, as the right hon. Gentleman will be aware from his time at the Department of Health, is that ticking boxes on minimum staffing levels does not equate to good care. It can sometimes lead to a drive to the bottom, rather than to addressing the needs of the patients whom the front-line staff are looking after. The Berwick review has borne that out clearly. It is important to consider the patients and the skills mix on the ward, and to ensure that we get things right on the day for the individual needs of the patients.

Will my hon. Friend ask the chief inspector to ensure that by the bed of every in-patient there is the name of the nurse and the doctor responsible, so that nobody gets lost in hospitals again?

I am very sympathetic to the point made by my hon. Friend. The chief inspector has indicated that he will look at how individual wards are run on a granular level to ensure there is the right skills mix to look after patients on any particular day, with proper accountability for patient care.

The chief inspector of hospitals says he will monitor levels of unanswered call bells, but not the ward staffing levels that cause the bells to be unanswered. Is that not ridiculous? Is it not time that Ministers changed their minds on this important issue, as Robert Francis has now done?

As the hon. Lady will be aware, on the basis of the Francis report the Berwick review considered that issue in detail and highlighted the fact that safe staffing levels are not about ticking a box for minimum staffing, but about developing tools that recognise the individual needs of patients on the ward. The previous Government went down the route of tick-boxes in health care. I worked on the front line during that time and that route did not deliver high-quality care. We need the right tools to support front-line staff so that they make the right decisions in looking after patients. It is not about tick-boxes; it is about good care.

Fast-food Industry (Public Health Responsibility Deal)

7. What recent assessment he has made of the effect of the public health responsibility deal on the products and marketing practices of the fast-food industry. (900589)

We appreciate the contribution that the fast-food sector is making to the responsibility deal. More than 5,000 fast-food restaurants have labelled calories clearly, which means that more than 70% of high street fast food and takeaway meals are labelled. There is always more to do and we are keen to take this forward. Progress has been made through voluntary responsibility deals with industry.

I welcome the Minister to her new post. I do not suppose she has yet had time to look at the authoritative international study of asthma and allergies in childhood, which shows a clear link between the consumption of fast food and asthma and allergies. The Government, however, have refused to discuss that with the public health responsibility partners. When will the Government start to take public health seriously and hold companies to account?

The idea that the Government do not take responsibility for public health seriously is ridiculous. Public health will never be improved just from Whitehall. The work has to be done together, among local government—which is keen and has been given the tools and resources—central Government, business and industry. Such long-term partnership working to improve the public’s health can only be done together. I will look at the hon. Lady’s specific point, but I reject the idea that the Government are not taking this issue seriously—far from it.

Will the Minister confirm that as far as fast food is concerned, personal responsibility will not be replaced by Government-imposed nanny state regulation?

It is good as a Minister to hear the phrase “nanny state” get its first airing. We believe in the informed consumer, and that is the idea behind so many restaurants labelling calorie content on their food. Most of us want to be healthy and most of us know when we want to diet and lose weight. By working with business, we can enable the consumer to make an informed decision about their health.

I declare my interest and welcome the Minister to her new portfolio. I wish to support the nanny state to this extent: it is fine for companies to sign up to the responsibility deal, but they have to deliver. As her first act as Minister with responsibility for diabetes, will she ban sugar from all Department of Health canteens, and stop selling in our hospitals fizzy drinks that contribute to diabetes?

As the right hon. Gentleman might know, my first outing as public health Minister was to attend a diabetes think-tank, which I hope indicates how seriously I take the issue. I do not think what he asks for is within my powers, but obviously I will take a close interest in the Department of Health canteen. The right hon. Gentleman is right. We have never said that other measures will not necessarily be taken, but the responsibility deal has taken us a long way when many predicted it would not, and we are keen to inject new energy into it.

When I was in the classroom as a school teacher, people used to come to school having had Micro Chips for breakfast. I do not wish to see a nanny state imposed on anybody, but we must do a lot more education. I urge the Minister’s Department to work cross-departmentally with the Department for Education to ensure that we get proper health and food education in our schools. Those using fast food at the moment are often those who can least afford it.

I am glad my hon. Friend has raised the issue of working with schools and education, and I have already had initial discussions with my opposite number at the Department for Education. We think we have an exciting agenda to take forward, and I hear what my hon. Friend says.

In 2011-12, childhood obesity rose by 37% across the United Kingdom. Will the Minister take into account the child marketing strategy of the fast-food industry when considering how best to address the issue?

I am interested in looking at what the hon. Gentleman says, and I will be happy to talk to him about that.


10. What steps his Department is taking to promote a culture of openness and transparency across the NHS. (900592)

We need to change the culture of the NHS so that where there are problems with care or safety, people feel able to speak out. The Government have banned gagging clauses, they are introducing a statutory duty of candour, and they have for the first time published surgery outcomes for 10 specialties by consultant.

I commend the Secretary of State for his transparency agenda, which has uncovered previously untold horrors. What more can he do to ensure that in future no Minister can ever cover up failure in the NHS?

I know this is difficult territory for the Labour party, but the most important thing is for regulators to feel that they can speak out about poor care without fear or favour. I am afraid that did not happen under the previous Government, so let me just—

Order. I told the Secretary of State privately before, and I say it publicly now, that if he intends to devote part of his answer to talking about what happened under the previous Government, he can abandon that plan now and resume his seat. I suggest he resumes his seat.

As part of this openness and transparency, will the Government improve their relations with the police and prison services, so that we can have a clearer idea of why people with mental illnesses are spending time in police cells or being sent to prison?

I am pleased to tell the right hon. Gentleman that we are working closely with the police to try to ensure that some of the people held in police cells are given much faster access to mental health services. That includes a street triage pilot, which has had early and promising results.

I was informed this morning that the chair of the NHS property board has resigned. That follows the revelation last week, through parliamentary questions I asked, that the board has been raiding its capital allocation to subsidise its own revenue funding. In the interests of transparency, will the Secretary of State undertake to review and publish the recruitment and employment procedure of executive and non-executive members of the board—including civil servant Peter Coates who created the board, which oversees £3 billion-worth of assets—and conduct careful audit and scrutiny of the board’s accounts and minutes?

Obviously, the suggestions my hon. Friend makes are extremely serious. If she lets me have a copy of all the things she is directly concerned about, I will look into it with the greatest priority.

With regard to openness and transparency, the Secretary of State’s failure to extend the Freedom of Information Act to private providers delivering NHS services is fostering a culture of secrecy. As he forces clinical commissioning groups to tender more services to the private sector, and if he truly believes in openness and the independence of health regulators, will he follow the clear advice from Monitor and extend FOI legislation to private providers, or is he content to allow them to continue to withhold information from patients?

When it comes to transparency about care, there should be an absolute level playing field between private providers and NHS providers. To answer the hon. Gentleman’s question on regulators, what this Government are going to do, Mr Speaker, is ensure that the Care Quality Commission has statutory independence so that no Government can ever try to interfere with the processes of reporting poor care.

Calderdale Royal Hospital (Accident and Emergency Ward)

11. Whether he plans to close all or part of Calderdale Royal hospital’s accident and emergency ward. (900593)

I am advised by the NHS that there are no plans for the closure or downgrading of the accident and emergency department at Calderdale Royal hospital. Obviously, as the hon. Lady knows, the reconfiguration of local health services is a matter for the local NHS commissioners. As I understand it, they and the local authorities are currently reviewing health and social care services, including emergency care, across the wider Huddersfield and Calderdale area.

I thank the Minister for her reply, but we need stronger reassurances in Halifax that the accident and emergency unit at Calderdale Royal is safe, particularly given the threatened closures of walk-in centres. Will she give that commitment now?

As I have said, those are matters for the local NHS commissioners. As I understand it, they have begun a review. The hon. Lady will want to be deeply engaged with it on behalf of her constituents. Everything that might be proposed will be subject to a full public consultation.

Order. I am always pleased to hear the hon. Gentleman, but I simply point out to him that Calderdale is rather a long way from Morecambe and Lunesdale. Calderdale is the subject of the question; therefore, it is essentially closed. I hope that that is helpful to him and the House.

Barnet, Enfield and Haringey Clinical Strategy

13. What progress has been made on implementation of the Barnet, Enfield and Haringey clinical strategy. (900595)

The local NHS continues implementing the Barnet, Enfield and Haringey clinical strategy, which was approved by the Secretary of State in September 2011 following a review by the independent reconfiguration panel. Enfield council has recently issued an application for judicial review of local clinical commissioning group plans. Unfortunately, I am therefore limited in what I can say in that regard.

Department of Health Ministers know well of my continued opposition to the decision. However, does the Minister understand that it is crucial that the investment in primary care first promised by the Secretary of State in 2008 is in place before the reconfiguration takes place? Will the Minister confirm that patients will have access to a doctor on the Chase Farm site 24/7?

First, I acknowledge my hon. Friend’s campaigning on behalf of his constituents—he has worked very hard. I understand that, as part of the case for change and for reconfiguring health services at Chase Farm hospital, a doctor will be available to see patients at Chase Farm 24 hours a day, seven days a week. However, given that my right hon. Friend the Secretary of State for Health has been named as a defendant by Enfield council in the judicial review, it would not be appropriate for me to comment further at this time.

Does the Minister recognise that the question is not if the changes take place, but when? Does he recognise that all my local doctors say that it is in the best health interests to get on with the changes, not least given that the £200 million invested in the new North Middlesex hospital in Enfield was dependent on them?

I recognise my hon. Friend’s work in this regard. Decisions should be based on clinical judgment and the views of local doctors are important. He draws attention to a fantastic new facility. I pay tribute to everyone who has worked to achieve it. It will serve the local community well.

Doctors (Accountability)

While always paying regard to the superb job done by most doctors, we should allow no hiding place for doctors who endanger patients’ lives by irresponsible or careless behaviour, which is why we have asked the Law Commission to come up with proposals to speed up General Medical Council investigations. We are also considering a new criminal offence of wilful neglect, as recommended by Professor Don Berwick.

The cancer diagnosis of my constituent, Mrs Julia Wild, was delayed by nine months because of a mistake by the initial doctor at her first assessment. For four years, she has been fighting for an apology, for transparency and for the doctor to acknowledge what went wrong with her case. What can Mrs Wild, and other patients in the NHS who have had similar experiences, do to ensure that their complaints are taken seriously, that these life-changing mistakes are acknowledged and that the individuals responsible are held to account?

My hon. Friend speaks extremely well and I fully understand her concern about Mrs Julia Wild and the care she received. I cannot second-guess the clinical judgment of the GMC, but I agree that Mrs Wild is owed an apology. If the local NHS will not give it, I will give it now. We should have spotted the advanced lobular cancer and I apologise to her that we did not.

On Friday I visited Cruddas Park surgery in my constituency to see the fantastic work that doctors and staff are doing in the face of huge levels of unmet need, health inequalities and rising mental health issues. If we hold doctors to account for their mistakes, is it not right that they should be able to hold Ministers to account for taking millions of pounds out of their funding and then telling my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown) that it was nothing to do with him?

Doctors should be able to hold Ministers to account, as should the public. That is why they will be pleased to know that we protected the NHS budget, and did not follow the advice of the right hon. Member for Leigh (Andy Burnham), who wanted it cut from its current levels.

While we are always of course keen to hold doctors to account for their mistakes, I trust that we will be equally keen to reward them for examples of really good practice, such as those my right hon. Friend will see on Thursday when he makes his very welcome visit to the East Surrey hospital. I commend to him the work of Dr Ben Mearns and his emergency and acute team, who demonstrate good practice and also make it transparent to the rest of the national health service.

I am greatly looking forward to visiting my hon. Friend’s hospital on Thursday and going out on the front line. I agree that we need to celebrate success. This has been a difficult year for the NHS as we have learned to be much more transparent about problems when they exist, but one of the advantages of having a chief inspector is that his team will be able to identify and recognise outstanding practice, so that everyone will understand that, as well as some of the problems that get more attention, brilliant things are happening throughout our NHS.

Is the Secretary of State comfortable with a surgeon such as Ian Paterson flitting between the NHS and the private sector, making the same blunders in both but being subject to different levels of accountability and his victims having access to different levels of redress?

As I said in response to an earlier question, the responsibility to be transparent about care should apply equally in the public and the private sector. Obviously, in the public sector we have more levers, because we are purchasing care and we can impose more conditions than it is possible to do in the private sector. The most important thing is to have a culture in which such problems come to light quickly when they happen, so that they are dealt with and not repeated.

Cancer Survival Rates (Data)

15. For what reasons the publication of data on one-year and five-year survival rates for all cancers within the Clinical Commissioning Group Outcomes Indicator Set has been deferred until March 2014. (900597)

I am aware of delays in the availability of source data at a local level. For that reason, it is not possible to publish data on one-year and five-year survival rates for all cancers before March 2014. I know that my hon. Friend is frustrated by this and that he has done a lot of work on this issue as the chair of the all-party group, but I am sure he will agree that it is better to have accurate information to make these vital clinical judgments.

The Minister will be aware that the all-party group on cancer has campaigned long and hard for the monitoring of the one-year and five-year survival rates as a driver for earlier diagnosis—cancer’s magic key. What assurances can she give that the March 2014 deadline will be met and that appropriate action will be taken against those CCGs that underperform?

We have spoken to NHS England, which has advised me that it is not aware of any reason to think that the March 2014 will not be met. As my hon. Friend knows, however, the day-to-day management of CCGs is a matter for NHS England, and I am sure he would not approve of Ministers trying to micro-manage CCGs from Whitehall. His strength of feeling is clear, and I am happy to have an ongoing dialogue with him and the all-party group on this matter.

Having heard the Minister’s answer on survival rates and the importance of early diagnosis, may I ask her whether cancer patients in need of life-saving treatment recommended by their clinicians who have waited for more than two weeks because of the commissioners’ delay in agreeing funding have the legal right to insist on being treated once they have gone past the two-week deadline? If so, how would they do that?

If my hon. Friend will allow me, we will perhaps need a separate conversation. I am happy to meet her afterwards to discuss the matter she has raised.

Patient-led NHS

The big shift we need to make is to turn the NHS into a patient-led organisation. Two measures that will help that are: independent inspections by a new chief inspector that put the patient experience at their heart; and asking every NHS in-patient if they would recommend their treatment to a friend or member of their family.

I am encouraged by that answer. Long ago, the medical establishment was held to account by what were essentially patient-led co-operatives, and today more and more voices are asking for more patient engagement. Will the Secretary of State consider a paper brought forward by Civitas and Anton Howes calling for the incremental implementation of patient-led commissioning to close this gap?

No one campaigns harder than my hon. Friend on the issue of putting patients first in his constituency and throughout the NHS. CCGs have a legal obligation to involve patients in decisions about services and about them personally. The ideas in the paper he mentions are interesting, and I respect them, but given that we have brand-new commissioners and inspectors going out this year, I think we should see how the current reforms work first.

Topical Questions

Today we published a report demonstrating that the NHS could recover as much as £500 million from better systems to monitor and track those who should be paying for the NHS treatment and introducing new charges to certain categories of people currently exempt. This is a significant sum of money that could fund 4,000 doctors, and far from being xenophobic, as some in the Opposition have alleged, the Government believe it is right that overseas visitors who do not pay for the NHS through the tax system should make a fair contribution through charges.

Poole hospital, which is much loved locally and has excellent care ratings, has a financial problem relating to tariffs that must be addressed. The £5 million spent on putting a failed case for a merger between Bournemouth and Poole hospitals to the Competition Commission raises questions about processes and openness with the public. I hope the Secretary of State can make some comments today, but will he meet me and other local MPs to discuss all these issues in greater detail?

I am happy to do so. I want to make it clear to my hon. Friend that I am keen to ensure we have a structure inside the NHS that makes it easy for high-performing hospitals that want to work more closely together and share services to do so, if it is in the interests of patients. We need to do more work in this area.

The Secretary of State has been in post for a year, and in that time we have got used to his style: everything is always someone else’s fault, be it lazy GPs, uncaring nurses or the last Government. And today we see more diversion tactics—now immigration is to blame. But there is an inconvenient truth that gets clearer day by day and which he cannot spin away: A and E is getting worse and worse and worse on his watch. We have had ambulance queues, a treatment tent in a car park and now police cars doubling as ambulances, with a patient dying on the backseat. The NHS stands on the brink of a dangerous winter. Will he today set out in detail what he personally is doing to avert a crisis?

I welcome the right hon. Gentleman back to his place. It is a great pleasure to see him there, even if it is not entirely what the Labour leader wanted.

If the right hon. Gentleman is shocked that I breached the A and E target for one quarter last year, he will want to make a full apology for the fact that he breached it for two quarters when he was Health Secretary.

This complacent spin is no good to the NHS. If he wants to compare records, let us do that. Under me, 98 per cent. of people were seen within four hours; under him, over 1 million people in the last year waited more than four hours in A and E—not only a winter crisis, but the first summer A and E crisis in living memory. Today it gets worse. New figures this morning show a further 450 nursing jobs have been cut, taking the total close to 6,000 under this Government. But what were they doing last night? They were voting in the Lords against safe staffing levels. Will he now listen to the experts, stop the job cuts and take immediate action to ensure that all A and Es have enough staff to provide safe care this winter?

We will listen to no one on the Opposition Benches when it comes to safe care for patients in the NHS. They presided over a system where whistleblowers were bullied, patients were ignored and regulators felt leaned on if they tried to speak out about poor care. That is a record to be ashamed of.

T5. There is evidence that a nutritional meal can be a real aid to the recovery of patients, yet the Campaign for Better Hospital Food found that 82,000 hospital meals are thrown in the bin every single day. Will the Minister update the House on the steps being taken to ensure that patients receive a hot balanced meal, served at an appropriate time? (900612)

My hon. Friend is absolutely right to highlight the importance of all patients receiving high-quality nutrition, and a lot of work has gone into promoting time for hospital patients to be fed and into protecting mealtimes, as well as into reducing hospital waste. Hospital food waste is now below 7 per cent nationally.

T2. We have a crisis in community nursing in Hull, with district nurses being stretched to breaking point. Does the Minister not agree that withdrawing funding from this service is economically short-sighted given that the foundation trust’s deputy chief executive says:“If the crisis continues, the nurses will not be able to care for patients in the community and it could result in them being readmitted to hospital”? (900609)

The hon. Gentleman is right to highlight the fact that local commissioners have a duty to ensure adequate community health care provision. I hope that that is an issue that he will take up with them. If he would like help in that fight, I am happy for him to come and meet me, and to bring in the local commissioners to talk this through, as it is important that we have enough community nurses to provide good care in communities and local commissioners need to listen to that.

T6. Can my hon. Friend update the House on what he is doing to support the earliest relationships of new families through early years intervention? Specifically, will he support the cross-party “1,001 Critical Days” manifesto? (900613)

I pay tribute to the work that my hon. Friend has done on the early years, and there are many good things in that manifesto. That is why we are investing in an additional 4,200 health visitors by 2015 and why we are supporting the most vulnerable families by increasing to 16,000 the number of families that will be supported by family nurses by 2015. A lot of investment is going into early years, which pays back to the Exchequer and gives much better care to families, too.

T3. Wirral council has said that anybody who wants to be involved in providing social care must show their commitment to the ethical care charter. Will the Minister congratulate leading councillors Phil Davies and Chris Jones on taking this initiative, which includes a move away from zero hours contracts? Will he say specifically what conversations he has had with the Local Government Minister and with Treasury Ministers about making sure that each and every local authority has sufficient funds to fulfil their legal obligations in care services? (900610)

I pay tribute absolutely to that local initiative, which is exactly the sort of direction we are going in. I have made the point several times that we cannot get great care on the back of exploiting workers. The idea that people should not be paid while they are travelling from one house to another is, in my view, unacceptable. When employers and care providers breach the minimum wage legislation, we should be absolutely clear that that is completely unacceptable. To ensure great care, the Government are introducing in 2015-16 the £3.8 billion integrated transformation fund, which will pool resources between the NHS and social care to ensure that we shift the focus to preventing ill-health and deterioration, and I think that that can make a real difference.

T7. I and my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) have long campaigned for the maximum hospital facilities at Frenchay hospital, including a community hospital with an outpatients clinic—as was agreed as part of the Bristol health services plan in both 2005 and 2010. Now it seems that NHS managers are attempting to revisit these plans, something to which I am opposed, as is my hon. Friend the Member for Filton and Bradley Stoke, who has recently written to the Secretary of State to ask for a meeting to look into the situation. Will the Secretary of State agree to meet us both and investigate the situation? (900614)

I am always happy to meet colleagues for discussions, particularly when they are championing important health care facilities in their local area. I can confirm that the Secretary of State has received a formal referral from South Gloucestershire council in relation to these proposals, and has referred them to the Independent Reconfiguration Panel. He will of course consider the panel’s recommendations before making a final decision, and I am sure that my hon. Friend would agree that it would be inappropriate to pre-empt those deliberations.

T4. My constituent Jemma Hill is 25 and suffers from chronic hip pain, for which a specialist has recommended hip arthroscopy surgery. However, she has now been told that her local clinical commissioning group does not fund such treatment. Does it not make a mockery of GP-led commissioning when a CCG will not fund the treatment recommended by a specialist to whom the GP referred my constituent in the first place? (900611)

I am very happy to look into that matter, because it sounds like a very deserving case. I will look into the details carefully if the hon. Gentleman gives me the relevant information.

T8. Does the Secretary of State agree that we need to learn from the mistakes of the Safe and Sustainable review of children’s heart surgery services and improve the forthcoming review in two ways? First, we should make the process a lot more transparent. Secondly, areas such as neo-natal, paediatric and adult intensive care unit services and transport and retrieval services should fall within the scope of the new review. (900615)

I agree that we must learn the lessons. NHS England is responsible for conducting the new review into congenital heart disease services, and it is committed to conducting a review that is robust, transparent and inclusive, in the interests of delivering high-quality, sustainable services for all patients.

T9. When the minimum wage increased recently, a working carer on 15 hours a week contacted me because she found herself to be 85p over the threshold for carers allowance, meaning that she would lose £259 a month. What work is the Minister doing with other Departments to ensure that carers are not penalised for caring and working? (900616)

First, we should applaud the work of the many carers around the country who are doing absolutely invaluable work. It is obviously important to ensure that the policies of one Department do not have an adverse impact on the work of another, and I will be happy to look into the case that the hon. Lady has raised.

T10. Dr Elizabeth Stanger, a highly respected Salisbury GP, recently questioned me about the sustainability of providing multiple treatments for complex medical problems for several generations of the same family of foreign nationals. I welcome today’s announcement, and ask the Minister to reassure me that the mechanism to recover the funds will ensure that the money goes back to the clinical commissioning group so that it can provide a benefit locally. (900617)

I absolutely can reassure my hon. Friend about that. The point about the new, improved system for recovering charges is that we want the money to go back to the people providing the services so that they will be able to resource them better. This is not the diversionary tactic that some have accused us this morning of introducing; £500 million could have a huge impact on the NHS front line and allow his GPs to do a much better job.

This evening, the joint health overview and scrutiny committee for Trafford and Manchester will meet to consider whether the preconditions for the reconfiguration of services in Trafford, including those set down by the Secretary of State, have been met. I understand that the NHS area team has already confirmed that it believes the conditions have been fulfilled, but will the Secretary of State tell me what would happen if, as seems possible, the scrutiny committee were to take a different view tonight and decide that not all the conditions had been met?

We will obviously respect the legal processes, but if the scrutiny committee were to take such a view tonight, we would certainly look very closely at its concerns and ensure that we had satisfied ourselves on them before proceeding.

A written answer from the former Minister, my hon. Friend the Member for Broxtowe (Anna Soubry), to my recent parliamentary question has on this subject revealed that people living in the south-west of England are three times as likely to contract Lyme disease as those in the rest of the country, yet I have a constituent doing what he calls drug runs to the rest of Europe to access the medicines necessary to tackle his symptoms. Will the Minister meet me to discuss how we can ensure the continuing availability of treatments for Lyme disease on the NHS?

I learned a great deal about Lyme disease in the course of answering my first parliamentary questions, so I would be very happy to meet my hon. Friend to have that discussion.

Given that at least a quarter of a million children aged 11 to 15 take up smoking across the country each year, does the Minister accept that if we wait for two to three years for evidence to emerge from Australia about the impact of standardised cigarette packaging, hundreds of thousands of children will have started to smoke in the meantime?

On the Government Benches, we are interested in all measures that might stop children smoking. I do not recognise at all the time scales that the hon. Gentleman mentions. We are looking now at what is emerging in Australia and around the world so that we have more information on which to base an informed decision.

When the Secretary of State meets the chairman of NHS England to discuss future priorities for NHS spending, will he ensure a fair deal for rural areas by ensuring that they reflect rurality, sparsity and the number of elderly patients and that we keep the minimum income guarantee for rural GP practices?

I can reassure my hon. Friend, as I am meeting some Yorkshire GPs later this week who have concerns about that very issue. The most important thing about the difficult issue of the funding formula is that it should be fair. That is why under the new legislation we have given the decision to an independent body so that it is taken at arm’s length from Ministers and so that it strikes the right balance between the issues of rurality, age and social deprivation.

The NHS, with its massive purchasing power, can make a real difference to local areas through jobs and through supply chains. Some hospital trusts are enthusiastically implementing the Public Services (Social Value) Act 2012, including Barts and King’s. Will the Minister ensure that his new procurement strategy recognises the importance of social value?

The right hon. Lady makes a good point. We want improvements to the procurement process not just to save money, so that hospitals have more money to spend on the front line, but to support small and medium-sized businesses appropriately, such as by simplifying the qualifying questionnaire process, which is often too complex for small businesses to become involved in and therefore rules them out of the market. There are a lot of good things and I am happy to meet her to discuss the matter further if she would like.

The Secretary of State knows Worthing hospital well; he has rolled his sleeves up there. When I went there a few weeks ago, I was told that the average age of patients in the hospital, stripping out maternity, is 85, yet we have qualified for no winter pressures money and we have a diminishing number of community hospital beds. Will he look into this anomaly, as he well knows the specific pressures we have on the south coast?

I understand my hon. Friend’s concerns and I know that there is a large elderly population in Worthing. I thought it was an excellent hospital with a fantastic atmosphere when I went and did part of a shift there. The winter pressures money went to the third of A and E departments that are struggling the most, so it is probably a compliment to his hospital that it did not receive it. We felt that with limited funds we had to concentrate resources where they were going to have the most impact. I hope that he understands why we had to make that difficult decision.

This week, the report of the trust special administrator in respect of Stafford hospital is being presented to Monitor. Given that the preferred option is that the University Hospital of North Staffordshire should in some way take over, will the Secretary of State urgently meet all Members of Parliament for the north Staffordshire area to ensure that health care in north Staffordshire, where we already have a deficit of £31 million with an extra £18 million set to come over, will not be destabilised?

We are acutely aware of those concerns. In any reconfiguration, and particularly in this one, we want to ensure that there is no instability in the local health economy. We have given the trust special administrator a little longer to come up with a plan for Stafford hospital to try to secure local agreement, so I have not had a recommendation yet and I am going to wait and see what he says.

Order. I am grateful to the Secretary of State and colleagues, but as usual demand has exceeded supply and we must now move on.