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Oral Answers to Questions

Volume 571: debated on Tuesday 26 November 2013


The Secretary of State was asked—

Support for Carers

1. What steps he is taking to improve signposting to support and information for carers by health bodies and local authorities. (901258)

The Care Bill will require local authorities to ensure that information and advice is available to their local populations, including carers, and to co-operate with health bodies in fulfilling this function. The Bill will extend carers’ rights to an assessment of their needs so that carers receive appropriate support and signposting to local services.

I welcome those measures in the Care Bill to support carers, but for them to benefit from that support, they first need to be identified. It is estimated that only one in 20 carers of people with cancer, for example, receives a carer’s assessment. How does the Minister propose to get local authorities to work with the NHS and other health bodies to identify carers and ensure that their needs do not go unnoticed?

The Care Bill will introduce a right to an assessment for all carers, which I think is an incredibly important advance for them. We are also giving money—£1.5 million—to the Royal College of General Practitioners and other bodies, including nursing bodies, to raise awareness of the vital role of carers in working with GPs to improve the care of those who need it.

I think the Minister is missing the point, though, in that carers of people with cancer do not have contact with local authorities. Macmillan Cancer Support found that half of those carers are not getting any support at all and do not know where to go for it. They do have contact, however, with GPs and hospital doctors, so what is the Minister going to do to make sure that GPs and hospital doctors identify carers and make sure that they get that support and advice?

First, I pay tribute to the work of Macmillan. It does brilliant work, and this is a really important campaign because it will raise awareness. I do not think I am missing the point, because raising awareness among front-line professionals is critical, and local authorities will also have a duty through the Care Bill to co-operate with the health service and, of course, to integrate or join up care, all of which is in the interests of carers.

Carers—and, I hope, the Minister—local authorities and GPs will be distressed by this week’s report of care companies being investigated by Her Majesty’s Revenue and Customs, almost half of which were found not to be paying the minimum wage. How does tackling that problem at the heart of our care system fit into the Minister’s plans to help support carers?

I completely share the hon. Lady’s concern about care companies that do not pay the minimum wage. All care companies should meet their obligations in law to pay the minimum wage. HMRC has done a lot of work, focusing on the care sector, and I have been absolutely clear that there is an obligation for those care companies to meet their requirements under the national minimum wage legislation. We cannot get good care on the back of exploiting low-paid workers.

Compassionate Care (NHS)

Last week, we published a full response to the Mid-Staffs public inquiry and set out our ambition to transform the quality of compassionate care in the NHS. We have already put in place a robust new inspection regime and measures to make it easier for doctors and nurses to speak out when they are concerned about standards of care or safety.

Compassionate care goes right through from surgeons to GPs. Will my right hon. Friend comment on evidence that epileptic women of child-bearing age are not being shown the compassion necessary during pregnancy from their GPs or neurologists and are not having the risks of taking their epilepsy medication outlined to them? To date, such medication has caused more than 20,000 birth defects.

I thank my hon. Friend for highlighting this important issue. The Medicines and Healthcare products Regulatory Agency regularly reviews the evidence relating to anti-epileptic drug use, particularly sodium valproate products, and we check what information is available to doctors so that it can be passed on to patients. I am concerned about the issue my hon. Friend raises, so I have asked NHS England’s national director of patient safety, Dr Mike Durkin, to look into it carefully and get back to me.

New York has raised the age for buying tobacco products to 21. As a public health care policy, has the Department considered that matter?

As the hon. Gentleman will know, we are constantly reviewing all policies that could reduce tobacco use among young people. Smoking is the No. 1 killer, so dealing with it would be the best way of reducing this country’s premature mortality rates, which are far too high.

23. Does the Secretary of State agree that transparency is critical in improving hospital standards and that, following the Government’s latest measures in response to the Francis report, the health cover-ups by the previous Government will never be allowed to happen again? (901280)

The Labour party does not like to hear this, but the reality is that micro-managing the NHS through top-down targets failed to deal with the problems of compassionate care. My hon. Friend is absolutely right that the best way to deal with this is through total transparency, so that when we are sure there is a problem, the public find out about it quickly and it is dealt with quickly.

Compassionate care must be central to the NHS. The Health Minister in Northern Ireland has launched “Quality 2020”, a strategy that is intended to improve care in Northern Ireland. What discussions has the Secretary of State had with the Northern Ireland Assembly and the Health Minister about this issue?

We are in close touch with all the devolved Administrations about the changes that we are making in the NHS in England, and, interestingly, we are experiencing different levels of engagement. We have had very good discussions with the Northern Ireland Health Minister about some of the changes, but those in Wales are still refusing to commission a Keogh report on excess deaths, which I think shows that Labour in Wales has not learnt the lessons of transparency.

Accident and Emergency Health Specialists

I have asked Health Education England to consider how we can improve the structure and skill mix of the emergency medicine work force to deal with long-standing shortages in staff at both consultant and trainee levels. Along with the Emergency Medicine Taskforce, we are considering a number of options, such as increasing the non-doctor work force and the number of emergency nurse practitioners.

Just what is going on in medical education in this country? We train doctors, but some never work as doctors, and others move abroad. Calderdale and Huddersfield NHS Foundation Trust has advertised and advertised again, but it cannot recruit accident and emergency staff. It certainly cannot recruit any who have been trained in this country, or who have been trained in paediatrics. What is going wrong with medical education here?

The hon. Gentleman has raised some important issues. We do face big challenges. We have increased the number of doctors in the NHS by 6,600 over the last three years, but it is still very difficult to attract as many people as we need to disciplines such as A and E.

I know that Calderdale and Huddersfield NHS Foundation Trust is especially concerned about A and E staffing. I had a very good meeting with representatives of the College of Emergency Medicine last week to discuss A and E consultants’ terms and conditions and, in particular, their antisocial working hours. We are giving the matter close consideration, but I agree with the hon. Gentleman that we need to do better in this regard.

While it is important to recruit and retain more A and E specialists, part of the problem is that a third of the patients who are dealt with in A and E departments could receive better treatment closer to their homes. What can the Secretary of State do to encourage that?

My hon. Friend is absolutely right. One of the biggest mistakes made in health care over the past decade was the introduction of the disastrous changes in the GP contract in 2004, which broke the personal link between GPs and their patients. Hard-pressed A and E departments, including the one at Kettering hospital, say that one of the things that will make the biggest difference to them is the provision of a named GP for the over-75s, so that they know that someone is responsible for those people when they are not in hospital.

Is it not the chaotic and overstretched nature of many A and E departments that makes A and E an unattractive discipline for people to work in? Ever since the closure of the A and E department at Wycombe general hospital in my constituency, Wexham Park hospital has been unable to cope. What will the Secretary of State do about that?

We have gained more than 600 additional A and E doctors over the last three years, so the numbers are rising. However, the best thing that we can do for A and E staff is to give them a sense that we are addressing the long-term challenges that they face. The issues of integration with social care and delayed discharges are being addressed through the health and social care integration transformation fund, but we must also ensure that there are better primary care alternatives. The named GP for the over-75s will make a big difference in that regard.

My local hospital, Russells Hall, is experiencing considerable difficulty in recruiting A and E consultants. Would not a good alternative approach be to train more paramedics to serve on ambulances and provide more effective and robust triage at emergency centres, so that patients can be redirected when necessary?

As ever, my hon. Friend speaks very wisely about this subject. In his review of A and E services, which was published a couple of weeks ago, Professor Keogh said that paramedics could deal with 50% of 999 calls on the spot, without taking people to hospital. I think that there is a big role for ambulance services that are prepared to upskill. It is also important for us to ensure that they have the necessary information. One of the main changes that we intend to make next year will ensure that they have access to the GP records of the people whom they pick up, so that they can give those people the care that they need in their own homes.

The president of the College of Emergency Medicine has said that the Government’s reorganisation has made A and E recruitment worse; the chief executive of the NHS Confederation has said that A and E pressures have been compounded by three years of structural reforms; yesterday, we learnt that the number of nurses choosing to leave their profession had jumped by more than one quarter under this Government; and the Health Secretary himself admits he is worried by the fall in nurse numbers on this Prime Minister’s watch. I hope he listens carefully so that he can answer precisely: will he today give the House a guarantee that every A and E in the country will have enough nurses this winter?

Will the hon. Gentleman think about what he has said? He said he was against a reorganisation that got rid of 8,000 managers and put 6,600 doctors on to the front line. That is why we are doing nearly a million more operations every year and why waiting times for longer waits are shorter than they were under Labour. We are recruiting more doctors because we are putting money into the front line.

It takes seven years to train a doctor, but, for whatever reason, the new GP contract is looking to end seniority pay in six years. Is my right hon. Friend not concerned that that will lead to a mass retirement of doctors at the end of that six-year period in 2020?

We have to make the GP profession attractive to younger GPs as well. The money we save from getting rid of seniority pay will go back into practices, but it should not be given to people just for length of service; it should be related to quality of service too, which will make the GP profession much more attractive.

Ambulance Handover Times

5. What recent assessment he has made of ambulance handover times at accident and emergency departments. (901262)

Patient handover is a key part of delivering good emergency care. Systems are in place to ensure efficient handover, but we recognise that it sometimes takes longer than the recommended 15 minutes, particularly during peaks of demand. We are taking the issue of handover delay seriously, which is why we have introduced financial sanctions for unacceptable delay.

Southport and Ormskirk hospital in my constituency has one of the longest handover times in the north-west, with ambulances queuing outside the hospital and patients lying on stretchers for hours. How does that offer the patient-centred care and dignity that the Government keep promising but failing to deliver? What can the Minister do to make it better for my constituents?

That sort of experience is not acceptable and has to be addressed, and I am sure the hon. Lady will welcome the encouraging news that the sanctions in the national contracts that clinical commissioning groups enter into with hospitals have resulted in a 38% reduction in delays, comparing the first two weeks of last November with the first two weeks of this November, which is the first period during which we measure winter pressures on handovers. That sign of a significant increase is to be welcomed.

As an east of England MP, the Minister will be aware of the problems with the East of England ambulance service and handover times at Broomfield hospital. While I warmly welcome the initiative, through the contract, to bring pressure to bear to reduce handover times to 15 minutes, will he join me in paying tribute to the new management of the ambulance service for what it is doing, through its assessments and monitoring, to deal with this problem?

I have had a similar experience at the Norfolk and Norwich hospital. It is clear that the number of delays in the east of England has reduced substantially, and I pay tribute to everyone involved. Getting urgent care right requires collaboration between ambulance trusts, acute care and GPs and social care workers on the ground. Significant improvements have been made in the east of England, as well as across the rest of the country.

The Minister surely knows that deteriorating ambulance handover times are just one of a growing number of signs highlighting what is going wrong with A and E on this Government’s watch. Now we see the Secretary of State and his Ministers in full panic mode after denying for months that there was a problem. The question is: why was the Health Secretary the last person in the entire NHS to realise that there was an A and E crisis?

It seems as if Labour is always desperately in search of a crisis, even if there is none to be found. If the hon. Gentleman had listened to the answer that I gave to the hon. Member for West Lancashire (Rosie Cooper), he would have heard me say that there had been a 38% improvement in waiting times for ambulance handovers between last November and this November. I am sure that he will welcome that.

I congratulate the Minister and the Government on the work that is being done to integrate social and NHS care. Does my hon. Friend agree that, for the many elderly patients moving between hospital care and community social care, integrated patient records across the two areas will significantly improve elderly care? Will he meet me and campaigners following Health questions to discuss my ten-minute rule Bill?

My hon. Friend deserves credit for that one. Of course I would be happy to have a chat with him. He makes a point about integrated care records. We should be focusing on ensuring that we do much more to keep frail and elderly people out of hospital in the first place. The system that we have inherited is dysfunctional, and the shift towards integrated care is exactly what needs to be done.

Out-of-hospital Care (Elderly People)

6. What progress his Department has made on improving out-of-hospital care for frail elderly people. (901263)

13. What progress his Department has made on improving out-of-hospital care for frail elderly people. (901270)

17. What progress his Department has made on improving out-of-hospital care for frail elderly people. (901274)

Improving the quality of out-of-hospital care is the biggest strategic long-term change that we need to make in the NHS. It will help to make the NHS sustainable. Reforming the GP contract is the first step, but we also need to make major progress on integrating the health and social care systems.

I welcome the Government’s announcement of named GPs for older people. What does the Secretary of State envisage that will mean for my older constituents?

My hon. Friend is not the only person to welcome that change. After months of telling the House that this was nothing to do with the A and E problems, the shadow Health Secretary said on the “Today” programme that he welcomed the change and that it would make a difference to A and E. So I welcome the return of the prodigal son with great pride and pleasure. For my hon. Friend’s constituents, this will mean that there will be someone in the NHS who is responsible for ensuring that they get the care package that they need. That is incredibly important, because when people are discharged from hospitals, the hospitals worry about whose care they will be under. This change will provide that crucial link and make a real difference.

Does my right hon. Friend agree that the 2004 GP contract did enormous damage to the relationship between GPs and their patients, and that the recent changes agreed with GPs should ensure much more proactive care of our most vulnerable constituents and ease pressure on A and E departments?

I agree with my hon. Friend, and I am pleased that the shadow Health Secretary also agrees with him in welcoming the reversal of that disastrous contract. The personal relationship between doctor and patient is at the heart of what the NHS stands for, and at the heart of that is a responsibility to ensure that people get the care they need. That is what we need to get back, and I think that the change will make a big difference to my hon. Friend’s constituents.

Enfield CCG is working closely with Enfield council to try to deliver integrated health and social care, particularly for the elderly and the frail. Noting our higher-than-average elderly age demographic in the borough, will the Secretary of State take steps to ensure that those efforts are supported with extra funding?

My hon. Friend knows that the funding arrangements are decided independently of the Government, by NHS England, which will make its decision at a board meeting before Christmas. He is absolutely right to suggest that the funding formula should reflect not only social deprivation but the age profile of constituents, because the oldest people are of course the heaviest users of the NHS.

The Health Secretary claims that he wants the NHS to be the best in the world at looking after the elderly. Nice rhetoric, but the reality is that we now have the highest-ever number of elderly people trapped in hospitals because they cannot get the health and social care they need at home. We now have the equivalent of five hospitals full of elderly people who do not want to be there, and that is costing the taxpayer £20 million a month. Is not the truth that care of the elderly is getting worse, not better, on his watch?

The truth is that the previous Government had 13 years to integrate the health and social care systems, but they failed. We are doing that, and we are also providing named GPs to the most vulnerable people, so that, hopefully, they do not have to go to hospital in the first place. That is doing a lot more for older people than the hon. Lady’s Government ever did.

Does my right hon. Friend agree that successive Governments over 30 years have talked about the importance of joining up the different bits of the health care system and joining that up with social care? Is not the difference between this Government and their predecessors that, through health and wellbeing boards, the integrated care fund, named GPs and the pioneers programme that he has announced, this Government are actually doing it, rather than just talking about it?

I have to pay tribute to my right hon. Friend, because he has been talking about the integration of health and social care for a lot longer than I have, and he is absolutely right. I would add to his list one other really important thing we are doing: we are making sure that whatever part of the system someone is in, doctors can access their GP medical record—with their permission—because that information is vital in showing their allergies, medical history and previous admissions. Breaking down the barriers that prevent that from happening is one of the things that has not been picked up but is in the GP contract.

NHS (Winter Pressures)

7. What steps his Department has taken to ease the short and long-term impact of winter pressures on NHS services. (901264)

In the short term, a record £400 million has been assigned to help the NHS cope with winter pressures this winter, with £250 million announced in August—much earlier than before. For the long term, we will provide better out-of-hospital care for the frail elderly, by restoring the link between GPs and older patients, and looking to integrate the health and social care systems.

Will my right hon. Friend join me in praising the outstanding work of Age UK and, in particular, Age UK Cheshire, which serves my constituency? It is raising older people’s awareness of seasonal impacts on health and offering support to prevent unnecessary pressures on the health service.

I am delighted to do that. As these are the last Health questions before Christmas, all of us would want to pay tribute to the voluntary organisations that do an extraordinary job of making sure that vulnerable older people do not get lonely over the Christmas period. It is heroic what they do—when we are with our families, they are looking after other people—and we should salute them all.

22. One way to ease the pressure on the NHS is by not handing the £2.2 billion underspend back to the Treasury. Will the Secretary of State consider using it for the NHS? (901279)

I wish the hon. Lady had been as diligent in asking that question of Labour Ministers, who also handed back underspends to the Treasury when they were in power.

Along with county colleagues, I wrote to the Secretary of State on this subject, because Buckinghamshire Healthcare NHS Trust is relatively underfunded compared with the rest of the country and it is in special measures following the Keogh review. Further to the answer that he gave to the earlier question, when can we expect the NHS England funding settlement to reflect more equitably the age of the public?

I commend my hon. Friend for the campaigning he does for high standards in his local trust. That has not been easy because, as he says, there have been a lot of problems there, although I hope he thinks that we are beginning to turn a corner. The decision on the funding allocations will be made by NHS England before Christmas, and the things that he says will, of course, be taken into account.

Yesterday we learned that the number of people suffering from hypothermia has soared by almost 40% on this Government’s watch. This morning the Office for National Statistics revealed that the number of older and vulnerable people who died unnecessarily last winter jumped by 29%. For every person who tragically loses their life over the winter months, eight more are admitted to hospital, putting huge strains on our crisis-ridden accident and emergency services. Will the Secretary of State please tell us what he is going to do about it?

I do not think I have yet answered a question across the Dispatch Box from the hon. Lady, so I welcome her to her post. I just say that she should be careful what she chooses to turn into a political football, because hypothermia admissions, as Public Health England said in August, are very closely linked to the number of cold days over a winter and the length of that winter. We had a particularly difficult winter last year, but the number of winter deaths was nearly 20% higher under the previous Government, when the right hon. Member for Leigh (Andy Burnham) was Health Secretary.

Social Care Budget Changes

8. What assessment he has made of the effects of social care budget changes on attendances at accident and emergency departments. (901265)

Joining up health and social care is an absolute priority for this Government. The NHS will provide £900 million this year and £1.1 billion next year to support social care services with a health benefit and to promote joint working. In 2015-16, we will introduce a £3.8 billion pooled budget for health and social care. The number of bed days lost because of delays attributable to social care was nearly 50,000 lower in 2012-13 than it was in 2011-12.

In the first two years of this Government, there was a frightening 66% increase in the number of people aged 90 and over coming into accident and emergency in a blue-light ambulance. When will the Minister accept that cuts to elderly care have increased pressure on the NHS, and are a major cause of the A and E crisis?

First, it is worth us all recognising that there is an increase in the number of frail elderly people in our society living with chronic conditions and that that is putting additional pressure on accident and emergency departments. The numbers have increased by over a million a year since 2010. However, the fact that there has been a reduction of 50,000 in the number of delayed discharges demonstrates that the social care system is doing incredibly well, and we should pay tribute to social care workers across the system who are doing so well to ensure that that improvement is taking place.[Official Report, 4 December 2013, Vol. 571, c. 13MC.]

Bottlenecks in A and E are certainly not new, and they are not aided by the mantra that acute hospitals should be able to manage with fewer acute beds. On my hon. Friend’s point about shared and integrated planning, is he prepared to go further and push the Government in the direction of shared and integrated budgets as between health and social care?

I thank my hon. Friend for that question. We are creating a pooled budget in 2015-16 with this £3.8 billion fund. I can remember in opposition frequently making the case for integrated care and not really getting much of a positive response from the then Government. As the Chair of the Select Committee, my right hon. Friend the Member for Charnwood (Mr Dorrell), said, the great thing is that this Government are actually doing it.


We have made excellent progress in improving the health care of our veterans by investing £22 million to support their physical and mental health. The Government have also made available £35 million of the LIBOR bank fines to support veterans and armed forces projects.

I thank the Minister for that response. Will he outline the steps being taken to ensure that there is a co-ordinated approach between those commissioning services for veterans, including Salisbury district hospital, which does so much to service the veterans in Wiltshire, so that that they get the right revenue at the right time and do not go into deficit?

My hon. Friend is right to highlight the importance of co-ordinating veterans services, and getting the continuity of care right between a soldier or a member of the armed forces leaving the armed forces and being looked after by the NHS. I hope he will be reassured to hear that in terms of specially commissioned services, we now have nine super-prosthetic centres available for veterans who have lost limbs, 10 specialist mental health teams looking after veterans, a 24-hour mental health support line for veterans and many other measures. We are also making IVF available to veterans who have lost genitalia as a result of combat injuries.

Given that health is a devolved matter, is the Minister satisfied that the Administrations in Wales, Scotland and Northern Ireland are providing similarly sufficient services for our veterans?

Obviously, we work closely with the devolved Administrations on all such matters. We have UK armed forces, and with health being a devolved responsibility, it comes to each part of the United Kingdom to put in place the right support. On the whole, that is done very well, but I am particularly proud of the efforts the Government have made on veterans’ mental health and on specialist prosthetic centres, which can be commissioned by the devolved Administrations if they wish to make such facilities available.

Many veterans are young men and women, and I know from my own constituency case work that a tremendous burden is often placed on elderly parents in caring for them, especially if they are suffering from post-traumatic stress disorder. Does the Minister agree that better integration between medical services in the armed forces and the NHS will benefit those families as well as the veterans themselves?

My hon. Friend speaks with considerable knowledge of the subject from her tradition and strong record of service. She will know that an important aspect of providing proper support for veterans is ensuring that we give their families the right support. We are working very closely with armed forces families and services charities to ensure that we do exactly that. That is why we have also put in place mental health first aid support for the families of servicemen and women to ensure that families know how to support veterans when they run into difficulties with post-traumatic stress disorder.

Children’s Hospices

10. What assessment he has made of the effectiveness of section 64 grants in supporting children’s hospices. (901267)

We are aware how vital the annual grant of more than £10 million is to children’s hospices and we have pledged to continue it while we work with hospices to develop a per patient funding system to ensure that hospice services from 2015 can be funded locally and on an equitable and transparent basis.

I am grateful to my hon. Friend for that answer. Since the introduction of the grant in 2006, children’s hospices now reach 75% more children and families and provide vital services. Can he assure me that the funding agreement will be in place by 2015?

Let me first pay tribute to the amazing work of so many children’s hospices around the country. I know that Little Harbour in St Austell in my hon. Friend’s constituency has benefited from the grant and, indeed, from the increase in the grant last year. It is absolutely the intention both to work with hospices to get this right and to introduce the new system in 2015.

Will the Minister join me in sending condolences to Gemma and Aaron Rolf and Jack, the parents and brother of six-year-old Sophie Rolf, who had an inoperable brain tumour and died, sadly, yesterday? Sophie and her family raised thousands of pounds to bring children’s facilities to the Earl Mountbatten hospice on the island. Those facilities were recently opened and will be a lasting tribute to a very special little girl.

Absolutely. I offer my condolences to the family of Sophie. The remarkable selfless fundraising done by such families does much to provide care for others and that will be a remarkable legacy for a fine young girl.

Cross-border Health Care (Wales/England)

11. What discussions he has had with NHS hospital trusts on taking account of the interests of patients in Wales who depend on hospitals in England. (901268)

As my hon. Friend knows, officials from NHS England frequently meet the Welsh Government to discuss the issue of health care provided in England for Welsh patients. He will know that NHS England has a duty to consider the likely impact of any commissioning decision it makes on people who reside in an area of Wales that is close to the border.

Does my hon. Friend agree that when commissioners for NHS hospital trusts in Shropshire are considering where to locate services, account must be taken of the needs of patients in Montgomeryshire, the vast majority of whom are dependent on Shropshire hospitals, particularly the Royal Shrewsbury hospital?

My hon. Friend is absolutely right to highlight the fact that cross-border health care is an area of great concern. There is a requirement to take note, as he says. The work is ongoing and I am happy to have those discussions with him.

It is not only patients local to the border who access treatment in England. Patients from as much as 90 or 100 miles away in the west of Wales—for example, young babies—access treatment on the Wirral. However, does the Minister agree that it is in the interests of hospital trusts in England to take patients from Wales, as it has been demonstrated that they often make the difference between a viable and non-viable service?

Of course, it is possible, depending on clinical need, for clinicians to recommend treatment in England. The hon. Gentleman knows that there are ongoing discussions, some of which are quite difficult, but the intention is obviously to ensure that we get the best health care for everyone. I would urge the Welsh Government, in particular, to consider ways in which they can review how arrangements are made in Wales. There have been calls for a review of hospitals in Wales, not least the one today from the Royal College of Surgeons.

Hospitals such as the Royal Shrewsbury hospital, dealing with patients from both sides of the border, have historically incurred additional administration costs in dealing with the two separate authorities. What work is the Minister doing to find out what the costs are and whether she can help meet them in the future?

We are aware of those additional costs, and I know that my hon. Friend recently met my right hon. and noble Friend the Under-Secretary of State for Health. We are very conscious of those costs and of the difficult decisions. It is the subject of ongoing negotiation between the Welsh Government and NHS England.

Orthopaedic Surgery

12. What lessons he has learnt from the findings of the report of Professor Timothy Briggs on improving the orthopaedic surgery published in September 2012, entitled “Getting it right first time”. (901269)

In 2012 Ministers welcomed the publication of the report and acknowledged that its recommendations could help build on improvements in orthopaedic care. I believe that my right hon. Friend the Secretary of State met Professor Briggs.

NHS England is now responsible for securing high-quality outcomes. Peter Kay, the national clinical director for musculoskeletal services, is also supportive of the report’s findings.

Growing numbers of orthopaedic consultants accept that collaboration across networks of hospitals could improve the quality of orthopaedic care, which frankly has not always been good enough in the past. Will my hon. Friend accept the recommendations of the “Getting it right first time” report?

We know that NHS England has welcomed Professor Briggs’ recommendations. They are contributing to a substantial body of work on orthopaedics, with the sole objective of improving outcomes for patients. I am sure that my hon. Friend will welcome the fact that this year for the first time data about surgical outcomes have been published at both hospital and consultant level, with the objective of driving up quality and supporting patient choice.

“Our Children Deserve Better”

14. What steps he has taken in response to the findings of the report by the Chief Medical Officer, “Our Children Deserve Better: Prevention Pays”, published in October 2013. (901271)

The chief medical officer’s report warmly welcomes the Government’s commitment to increasing health visitor numbers and support in the early years, and I shall be working with the children and young people’s outcomes forum to inform future improvements in children’s health.

My hon. Friend the Minister will know that about half the burden of mental health disease can first be identified during the teenage years. In her report, the CMO says that our information about the prevalence of childhood mental health problems and the level of under-diagnosis of mental health problems among that population is out of date. When will the Government commission the next survey? The last one was done in 2004. Is it not time to do another?

My right hon. Friend raises important issues. I should like to pay tribute to the work that he did in expanding children’s talking therapies and IAPT—improving access to psychological therapies—services to make better provision for mental health support. He is right to highlight, as the CMO did, the fact that we do not have enough data on children’s mental health. That has been a historical problem, and we are looking at ways to improve the data so that we can use them to improve health outcomes in mental as well as physical health.

In Devon and Cornwall since the beginning of this year there have been three occasions when children as young as 12 and 13 with acute mental illness have been detained in police cells instead of an appropriate place of safety, and 25 occasions when children of 17 and under have been so detained. Will the Minister meet me to discuss how we can end this appalling situation and make sure that all children who are detained under section 136 are seen in an appropriate location?

My hon. Friend is right to highlight this problem, which is unacceptable. My hon. Friend the Minister of State is looking into it. A lot of anecdotal evidence is stacking up that this practice is happening. We do not find it acceptable, and I or my hon. Friend will be happy to meet her to discuss the matter further and ensure that it is stopped.

NHS Walk-in Centres

The information is no longer collected centrally. Since 2007, under the changes introduced by the previous Government, the local NHS has been responsible for walk-in-centres, and it is for local commissioners to decide on the availability of these services.

Official NHS figures show that attendances at accident and emergency departments have increased more than three times faster under the Tory-led Government than under the Labour Government. Does the Minister regret allowing so many walk-in centres to close?

As I outlined, there are not any official figures, because the data are now held locally. Monitor carried out a survey of some trusts, but that is not a measure of all trusts. The hon. Gentleman wants to look at the reasons why there have been changes to walk-in centres. There was a reduction in central funding of over 90% under the previous Government. I believe that the right hon. Member for Leigh (Andy Burnham) was a Minister at the time; if the hon. Member for Kingston upon Hull East (Karl Turner) wants to look at the reasons for that, he should perhaps ask his right hon. Friend why he reduced central funding for walk-in centres by 90%.

In 2005, under the Labour Government, Crawley hospital had its accident and emergency department closed. Now we have an urgent treatment centre that has increased its operating hours and the services that it provides. What advice can the Department give to clinical commissioners about how we can expand urgent treatment centres?

My hon. Friend is absolutely right to highlight that these are local decisions that need to be made by local commissioners, because what looks good in Crawley will be very different from the needs in Bradford. That was the very reason that underpinned the previous Government’s decision to transfer responsibility for these services to local commissioners, but we often need more co-located services, because the Monitor survey picked up the fact that in the past, far too often, walk-in centres were isolated in the community; people did not know how to access them, or when they could do so. Monitor also recognised that there was duplication of effort, and sometimes patients who needed to be seen in accident and emergency were treated, inappropriately, in walk-in centres.

Alternative Therapies

16. What recent consideration he has given to banning the use of NHS funds for provision of alternative therapies. (901273)

As my hon. Friend will know, the provision of alternative and complementary therapies is decided by clinical commissioning groups, which obviously must take into account local health needs and priorities.

I thank the Minister for that answer. Many parts of the NHS are under intense, relentless financial pressure, so how can it be right that we spend millions of pounds a year on remedies that have no scientific basis, other than through their placebo effect?

My hon. Friend is quite right to highlight that value for money is very important. It is for local commissioners, not the Department, to decide how funding is spent to meet the needs of the populations whom they serve, but crucially, clinical commissioning groups are responsible for achieving value for money as regards the services that they commission, as well as for delivering improvements in the quality of care, and better outcomes for patients.

Topical Questions

I need to correct the record. In the House on 30 October, I said that it took 21 minutes longer for the average person to be seen in A and E under the previous Government—a figure that was repeated by the Prime Minister in Prime Minister’s questions. My Department made a statistical mistake: it turns out that under Labour, the average person took not 21 but 44 minutes longer to be seen. I apologise for underestimating the improvements made under this Government.

When people have mental health problems, waiting too long for talking therapies can lead to poor recovery, relationships falling apart, and job loss. What progress has the Minister made in establishing and delivering maximum waiting times for talking therapies?

The hon. Gentleman is absolutely right: this is a big priority for the Government. We are a big fan of talking therapies. We have taken huge strides in improving take-up, but there is still a long way to go, and we are looking at introducing access standards, so that there is a maximum time beyond which no one has to wait.

T3. What measurable progress is being made in improving data sharing, not just between hospitals and general practitioners, but between the NHS and social services, to avoid bureaucracy and additional cost? (901251)

My hon. Friend has taken a great interest in this topic, and he is absolutely right to do so, because if we are to give integrated, joined-up care, in which people deal with NHS professionals who know about them, their medical history, their allergies and all the other important things, it is vital that, if they give their consent, their medical record can be accessed. That needs to be from GP surgery to hospital to social care system. Under the named GP policy that we have announced, there is a big opportunity for care homes to access GP records and keep them updated daily, so that GPs are kept in daily contact with how some of the most vulnerable people are doing.

Today I want to put to the Secretary of State new evidence that the A and E crisis is deepening, and having a serious knock-on effect on ambulance services. Information from police forces reveals that cases in which police cars have to ferry patients to A and E are far more widespread than people realise; in some areas, it happens on a daily basis. One ambulance service is now using retained firefighters to attend calls, and—this is how bad things have got—another ambulance service has seen a 350% increase in the number of 999 calls attended by taxis. Does the Secretary of State think that it is ever acceptable that when a patient dials 999, a taxi turns up?

I am afraid that that is utterly irresponsible. We are hitting our A and E target, and we are hitting our ambulance standard. When the right hon. Gentleman was Health Secretary he missed the ambulance standard for October, November, December and January. He is trying to talk up a crisis that is not happening. He should think about people on the front line and, just for once, put patients before politics.

The country will have heard the complacency from the Secretary of State. He needs to explain why he spent Friday afternoon making panicked phone calls to hospitals up and down the country that were missing their A and E target. He did not condemn the use of taxis, which is unacceptable but is happening on his watch because ambulances are trapped at A and E, unable to hand over patients. That means that 999 response times have got worse and large swathes of the country, right now, are without adequate ambulance cover. Is it not time that the Secretary of State was honest with the public and admitted the scale of the crisis facing the NHS this winter, and took action now to prevent it from engulfing other emergency services?

We will take no lessons in complacency from the party that did so little to sort out excess deaths in hospitals such as Mid Staffordshire, Morecambe bay, Basildon and Colchester, and many other hospitals. The truth is that, compared with when he was Health Secretary, we see nearly 2,000 more people every single day within the four-hour standard. We are doing much, much better: we have more A and E doctors, and the NHS is doing extremely well. I know that for him it is always politics first and patients second but, for once, he should be responsible and think about the people on the front line.

T4. In contrast to the previous Government’s lack of focus, what have this Government done about hospital infection control, with particular reference to data management systems? (901252)

My hon. Friend makes an important point, and I hope that he will be reassured that under the current Government, clostridium difficile and MRSA rates are both about 50% lower than they were under the previous Government. We will continue to make sure that we reduce unacceptable hospital infections.

T2. Following Francis and Keogh, and in creating a more open and accountable NHS, will the Secretary of State, in the spirit of total transparency that he favours, order foundation trusts to publish all their board papers, have exactly the same publishing requirements as non-FTs, and hold all their board meetings in public? (901249)

I absolutely encourage that transparency. In fairness, the hon. Lady will accept that this Government have done more to improve transparency in the NHS than any Government have ever done. I would encourage all FTs to be transparent about their board meetings, but they are independent organisations, and we have learned—[Interruption.] Well, this was legislation that her Government introduced, and we have learned that it is important to give people autonomy and independence, because they deliver a better service for patients.

T6. Cambridgeshire and Peterborough clinical commissioning group receives one of the lowest amounts of funding per head in the country. The Government’s own fair shares formula, which takes account of factors such as population, age and deprivation, says that we should have £46.5 million more each year. I know that it is not his decision, but does the Minister think that the new formula should be implemented? (901254)

My hon. Friend makes some important points about the funding formula. He will know that for the first time this year, it will be set independently by NHS England, and I am sure that it will take on board the points that he has made. He will recognise, however, that there are many other determinants of the funding formula, such as deprivation, which it will want to look at and take into account.

T5. The last time I asked the Secretary of State about the £30 million-worth of cuts forced on hospitals in Brighton and Sussex, he said that it was all down to local discretion. Does he admit that behind his rhetoric about protecting the NHS budget there still lies a real 4% cut to the centrally dictated national tariff? Does he acknowledge, therefore, that hard-working nurses and doctors have to do more with less money while patients suffer? Will he reverse those cuts? (901253)

Can I explain to the hon. Lady that the reason for the 4% efficiency savings is that, although we protected the budget in real terms, demand for NHS services has gone up by 4% year in, year out, so we need to find those efficiencies? Within that, it is incredibly important that we do not make false economies in relation to the number of nursing staff, which is why last week’s announcement on our response to the Francis report will make a big difference, and we have already begun to see more nurses.

T7. Given the more than 30% increase in the past five years in the cost to the NHS of prescribing stoma appliances, what action is the Minister taking to promote training for stoma patients in alternative management techniques, such as colostomy irrigation? (901255)

My hon. Friend may know that specialist NHS stoma nurses offer a range of support and advice to help patients adapt to life with a colostomy, and this advice can cover colostomy irrigation, if appropriate. This is supplemented with patient literature on colostomy, which is widely available in the NHS.

Further to question 15, I understand that responsibility for walk-in centres has been devolved. Why does that necessarily prevent central Government from collecting those figures centrally? It is pretty staggering that a Minister should turn up and say, “Well, the decisions are made locally so we just don’t bother finding out.”

That is a question that the hon. Gentleman had much better address to his own Front Bench, who made the decisions to devolve these responsibilities locally. When it comes to commissioning health services, we believe it is down to doctors and nurses, who are now leading clinical commissioning on the front line, to determine which services are appropriate in local areas. There were clearly concerns about the way that urgent care centres had previously been commissioned. That is why so many of them are now being relocated and co-located in accident and emergency departments.

T8. The Secretary of State is well aware that the all-party group on cancer has campaigned long and hard for the monitoring of one and five-year survival rates as a means of promoting earlier diagnosis, cancer’s magic key. Is he confident, though, that the mechanisms are sufficient to ensure that those clinical commissioning groups that are underperforming in relation to their one and five-year survival rates will face concrete action to improve earlier diagnosis, given the recent OECD report suggesting that 10,000 lives a year could be saved in this country if we matched European average survival rates? (901256)

My hon. Friend is right to champion early diagnosis and he has raised these issues in the House on many occasions and with me. Improving cancer survival is a key priority for this Government. We aim to save an additional 5,000 lives each year by 2014-15. Clinical commissioning groups have a duty on early diagnosis. It is part of their crucial outcomes indicators set, and they will be held to account for that because we cannot deliver those improvements in cancer outcomes without early diagnosis.

When the Government decided to slash council budgets and, therefore, adult social services, did they know what effect that would have on hospitals, particularly A and E, and decide to carry on anyway, in which case they are too callous to be running the NHS, or did they not know, in which case they are too stupid to be running the NHS?

Throughout this Parliament we have ensured that extra funding has gone into social care to recognise the fact that council budgets have been under strain. The point that I made earlier—that there has been a 50,000 reduction in delayed discharges to social care—demonstrates just how well they are doing under significant pressure.

T9. What progress have the Government made in driving up standards and transparency in hospitals, social care and general practice? (901257)

The Government’s response to the Francis report demonstrated that openness and transparency are critical. As a result of the steps that we have proposed, this will be the most open health system anywhere in the world. That is something we should be very proud of.

I need to press the Minister on this. Does he really expect people to believe that cutting £1.8 billion from local authority care budgets—Stoke-on-Trent has lost a third of its overall funding—will have no impact on the A and E crisis?

Labour still seems to be in complete denial about the crisis in public finances that we inherited in 2010 owing to failures by the Government whom the hon. Gentleman supported in managing public finances. What we are doing is introducing a £3.8 billion fund to pool health and social care. It amounts to a substantial shift of resources to preventing ill health and it will do exactly what we need to do for social care.

May I thank the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), for recently opening a walk-in centre in Morecambe? May I also set the record straight, because the centre had been closed under the previous Government? Does he not think that it is a shocking indictment that in 2006 the NHS was cut by 9% in the region—

Order. First, topical questions are supposed to be brief. Secondly, the Minister is not responsible for what happened in 2006. We will have a very brief reply and then perhaps we can move on.

It was a great pleasure to open the walk-in centre in Morecambe, which was led by local commissioners to meet local clinical need.

The European Union has just agreed a trade deal with Canada that excludes health care, so will the Secretary of State ensure that the proposed EU trade and investment agreement with the US also excludes health care?

We are looking at that very closely. We are big supporters of having a free trade deal between the EU and the US, but we do not want to do anything that would affect the fundamental principles, values and practices of the NHS.

The new review into children’s heart units feels very different, and I am pleased that everything is on the table. However, I was concerned to learn that the task and finish group has decided to meet in private. Given the group’s importance in decision making, and remembering the experience of the Safe and Sustainable review, does my hon. Friend agree that, in the interests of openness and confidence, the group should meet in public?

My hon. Friend has been a great and sustained champion of that cause in this House and in speaking up for his local hospital and his constituents. NHS England is clear that all substantive decisions on the new review on congenital heart disease will be made by its full board, which meets in public, so there is no question of a major decision being taken in private. With regard to the sub-groups, including the one he mentioned, their papers and minutes are all published, but for practical reasons none of them meets in public, and that is normal practice. However, all major decisions will be taken in public by the full board.

The Minister will know that following the neuromuscular services review an explicit commitment was made to fund a care adviser and paediatric consultant post for the west midlands. Is he willing to meet me, patients and representatives of the Muscular Dystrophy Campaign to discuss the service and that commitment?

I would be happy to do so. I understand that NHS England is scheduling a meeting with Birmingham Children’s Hospital NHS Foundation Trust, which I hope will make some progress in ensuring that there is sufficient co-ordinated care for people with muscular dystrophy in the west midlands.

In the past two weeks I have had to visit accident and emergency units in Redditch and in north Wales, unfortunately with members of my family. Although health is a devolved matter in Wales, will my right hon. Friend the Secretary of State invite his counterpart in Wales to spend some time at the great A and E unit in Redditch to see for himself the stark differences between the two services?

I would be delighted to do so. He will see the impact of not cutting the NHS by 8%, which is what Labour has done in Wales, which means that in this country we are hitting our A and E targets and in Wales they have not hit them since 2009.