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Topical Questions

Volume 571: debated on Tuesday 26 November 2013

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.