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Volume 573: debated on Tuesday 14 January 2014

The Secretary of State was asked—

Atrial Fibrillation

NHS England is responsible for promoting awareness of atrial fibrillation among health care professionals, and the new NHS improvement body, NHS Improving Quality, is encouraging GPs to detect and manage atrial fibrillation by promoting the use of GRASP-AF risk assessment tools. My hon. Friend will know about that as it is supported by the all-party group on atrial fibrillation, which recently published a helpful report on AF. I pay tribute to the work of my hon. Friend and his colleagues on that.

What steps are the Government taking to improve the uptake of National Institute for Health and Clinical Excellence-approved medicines and alternatives to warfarin for the treatment of atrial fibrillation to reduce the incidence of AF-related stroke?

NICE has issued technology appraisal guidance to the NHS on the use of newer anticoagulants—I think there were three in 2012—for the treatment of atrial fibrillation. NHS commissioners are legally required to fund treatments recommended by NICE in its technology appraisal guidance.

Mr Speaker, there is a crisis here. The fact is that half of those who suffer from AF—as a member of my family does—do not know they are suffering from it and are not diagnosed. If they are not diagnosed, that leads to great expense to the health service because they are very prone to having a stroke. Even when doctors know about AF, they say inappropriately, “Have an aspirin as part of your medication.” Some 25% of doctors recommend aspirin, and that is very dangerous. When will the Minister wake up? AF is a dangerous condition and it is very expensive.

The hon. Gentleman is right to say that it is a serious condition, which is why GPs need to take it extremely seriously and ensure that they look at the tests, and particularly at those who are susceptible to AF. We will get new NICE guidance in the summer on some aspects of self-monitoring, which will be an opportunity to remind all clinicians of their responsibilities.

There is a community resuscitation strategy for the whole of Northern Ireland, and my constituents in Strangford, the Ards peninsula and Crossgar have examples of that. Will the Minister consider a community resuscitation strategy for England and Wales, similar to the one we have in Northern Ireland? It would help in this case.

I am happy to look at that. It is obviously an NHS England responsibility, but I will ensure that I draw its attention to the scheme that the hon. Gentleman mentions in Northern Ireland.

Winter Pressures

2. What steps his Department has taken to ease the short and long-term effects of winter pressures on the NHS. (901945)

12. What steps his Department has taken to ease the short and long-term effects of winter pressures on the NHS. (901956)

In the short term, a record £400 million has been assigned to help the NHS through this winter, with £250 million announced in August, much earlier than before. For the long term, we are restoring the link between GPs and vulnerable older patients by bringing back named GPs for all over-75s—something that was broken in 2004.

I thank the Secretary of State for that answer. My constituents, including a family who came to my surgery on Saturday, are frustrated by the brick walls that sometimes seen to exist between different bits of the health service, and which are all the worse in urgent and traumatic winter cases. Different health services in Norwich have come together in Operation Domino to improve services in the face of demand, and they have used winter funding money to run a new style of urgent care unit at Norfolk and Norwich hospital. Does my right hon. Friend agree that Norfolk is leading the way?

I congratulate the health services in Norfolk—and indeed in Norwich—on what they are doing to break down those barriers. That is the key issue, and this year I am working closely with the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), to merge the health and social care systems—a £4 billion merger—to ensure that medical records can be shared across all the different systems, and that there is a named accountable doctor for the entirety of people’s time outside hospital. I hope that will make a difference in Norwich as elsewhere.

My constituency has a high proportion of elderly people. What steps is the Secretary of State taking to reduce admissions of elderly people to hospital this winter?

We are doing a very great deal and the £400 million announced to help the NHS through the winter is a record amount. My hon. Friend will be pleased to know that a lot of that money is being spent not inside A and E departments but in the community to help GP practices, and to try to recognise properly that for many older people—particularly vulnerable people with dementia —a busy A and E department is not the best place to go when something goes wrong, and if we possibly can we should avoid it.

Is it the case that worries about winter pressures are greatest in A and E, and that the crisis in A and E is entirely of the coalition’s own making? Ministers have been warned about cuts to elderly care and letting GPs off the hook on office hours and opening in the evenings and at weekends, and about the increasing costs of locum staff. They have been warned but they have not acted. What will the Secretary of State do now, late as it is, to ensure that A and E has enough doctors to see patients safely through the winter?

The Opposition try to talk up a crisis in A and E, but unfortunately, such talk does not withstand the facts. Let us look at the facts on how A and E is doing and perhaps the right hon. Gentleman will understand. We are seeing 2,000 more people every single day within the four-hour target than were seen when Labour was in power; we have 20% more A and E consultants; and the waiting time to be seen in A and E is half what it was under the Labour Government. However, we are doing more: we are addressing the long-term pressures in A and E, including the barriers to the social care system, which were mentioned in an earlier question, and the lack of good primary care alternatives. That is why we are restoring named GPs for the over-75s.

A and E is in crisis across the country, but getting people out of hospital in a suitable time frame is also important. What is the Secretary of State doing to better connect the health service with other social care providers? Does he acknowledge that, in places such as Telford and Wrekin, there has been a substantial cut in continuing health care funding, which means the system is in danger?

Thank you for that guidance, Mr Speaker. Let me assure you that this winter, a lot is happening in Telford to break down the barriers between the health and social care systems. One big change we are championing—it is starting to happen for the first time—is a seven-day social care system, so that hospitals can get people assessed and discharge them at weekends. With respect to the hon. Gentleman, if he looks at the facts, he will see that that is beginning to happen in a way that it did not when Labour was in power. He should welcome it.

I congratulate my right hon. Friend on the planning for, and the extra resources he has committed to, relieving winter pressures in A and E departments. What effect does he expect the additional combined budget for health and social care to have on admissions to A and E, particularly of older people?

We know that every year, 1.2 million of 5.2 million admissions to hospitals are avoidable if we have better alternatives in the community. The Government believe that restoring that personal link between doctors and the people on their lists—the people in their communities—who could often be much better looked after outside hospitals is the way to deal with that. That is why we are making that major change to the GP contract—it is the biggest change since named GPs were removed in 2004. That will benefit my hon. Friend’s constituents and those of all hon. Members.

Before Christmas, the Secretary of State said that the A and E crisis is behind us. However, NHS data released last Friday show that patients have just experienced the worst week in A and E so far this winter. The A and E target was missed; 103 trusts failed to meet their individual target; and, shockingly, more than 5,000 patients were left waiting on trolleys for more than four hours—more than double the number in the previous week. The Secretary of State asks us to look at the facts, but those are the facts. They are apparent to all except, seemingly, him. Is he really still of the view that the crisis is behind us?

Let us look at those facts for last week and compare them with the facts in the identical week when the right hon. Member for Leigh (Andy Burnham), the shadow Health Secretary, was Secretary of State. When he was Secretary of State, 362,462 people were seen within four hours. Last week, we saw 365,354 people—3,000 more people—within the target. A and E is doing better under this Government than it ever did under Labour.


3. How many mesothelioma cases are being treated by the NHS; what strategies have been adopted for treatment and prevention of mesothelioma; and if he will make a statement. (901946)

In 2011, 2,238 people were diagnosed with mesothelioma. NHS England has set out guidance on the diagnosis, treatment, care and support of patients with that serious disease. That will deliver access to high-quality and consistent services across England. Both clinicians and patients are involved in the development of the guidance. UK legislation requires the active management of asbestos in buildings to prevent further exposure.

The number of full-blown mesothelioma cases is expected to peak next year and then decline. The Department of Health is best placed to say whether that is happening. Will the Minister assure the House that the Department is carefully monitoring the situation and is in close contact with the Health and Safety Executive with a view to ensuring that our public protection measures are adequate for the challenge we face?

The right hon. Gentleman is right to say that it is a very serious situation, and we of course keep a very close eye on it. Higher-risk work with asbestos must be licensed by the HSE, which has recently published an updated approved code of practice, “Managing and Working with Asbestos”. The code provides guidance and practical advice to companies, because we do not want more people being exposed in the way that so many have been in the past.

There is particular interest in this dreadful disease in my constituency because of the location of a factory that used asbestos. Can the Minister assure me that further research into treatment for this condition will be carried out in conjunction with research institutions in Wales and in conjunction with the Welsh Government?

Obviously, health is a devolved matter, but research goes across the United Kingdom. In 2012-13, we spent £2.3 million on research into this disease through the National Institute for Health Research. The hon. Gentleman may be aware that during the passage of the Mesothelioma Bill, which has recently passed through this House, ministerial colleagues agreed to write to the Association of British Insurers. The Department of Health is seeking to set up meetings with the ABI and the British Lung Foundation to explore how insurers can individually sponsor specific mesothelioma research.

Locums (Accident and Emergency)

4. How much has been spent on medical locums in accident and emergency departments in each year since 2009-10. (901947)

Staff employment is a matter for NHS trusts and we do not collect that data centrally. We recognise the challenge in recruiting and retaining A and E doctors, who can take up to six years to train. However, growth in the medical work force has kept pace with the increase in attendances since 2010.

I am sure the Minister will agree that it is a grotesque situation where a trainee doctor working as a locum is paid as much as a fully qualified doctor. That is the result of not listening to legitimate concerns during the passage of the Health and Social Care Act 2012, so will the Minister not blame women in the work force or overpaid doctors but do something quickly to stop this drain on public money?

I hope the hon. Lady will be pleased to hear that under the current Government we have reduced locum costs to the NHS by about £400 million. That is, of course, good medical practice: it is good for patients to receive better continuity of care from permanent doctors. In A and E, specifically, we have seen the work force grow by more than 350 since 2010.

Last week, my son had to visit A and E in Brighton and spent the week in hospital. Will the Minister join me in thanking the hard-working doctors and nurses, including locums, in Brighton for their outstanding care and dedication, and for the excellent service they provide?

Yes. My hon. Friend will be aware that I have a particular knowledge of his local trust. I pay tribute to the dedication of the many high-quality front-line staff working there, and to those who put in extra hours to work as locums, usually from within the existing trust work force, who often have to cover maternity leave and other periods of staff sickness.

17. The Minister talks complacently about improvements in A and E consultants, but in Queen’s hospital in Romford only seven of the 19 posts have permanent A and E medical doctors in post. Surely he is fiddling while Rome is burning. People are not getting the service they need, while he is spending a fortune on locums. (901961)

The important point the hon. Lady has to remember is that it takes six years to train an A and E consultant, so it would be much better to put the question about advanced work force planning to the former Secretary of State, the right hon. Member for Leigh (Andy Burnham), rather than to members of this Government. Since we have taken charge of medical education and training, the number of those entering acute common training—those who may go on to become A and E consultants—has increased. We are now seeing a complete fill rate for those entering that training—something that the previous Government were not able to achieve.

How much of this difficulty might be caused by excellent staff working part time in accident and emergency? On a recent visit to the emergency department at York hospital trust, I was struck by the excellent work done by doctors, many of whom, by choice, worked long shifts three days a week. Will my hon. Friend look into this matter?

I will certainly do that and write to my hon. Friend to reassure her, although members of staff who work part time often put tremendous effort into their work, and we often get well rewarded by the broader experience they bring as a result of being part time, so there are benefits to having part-time staff in the NHS.

Figures out today show a staggering 60% rise in spending on locum A and E doctors under this Government—in some trusts, 20 times more—because they cannot recruit staff. It has now come to light that Ministers were warned about this problem three years ago. Dr Clifford Mann, president of the College of Emergency Medicine, said that when he tried to raise this issue, he was left feeling like

“John the Baptist crying in the wilderness”.

Why did Ministers ignore an explicit warning in 2011 from the top A and E doctor in the country?

The first warnings about the challenges facing A and E were put to the previous Government in 2004. The shadow Secretary of State was a Health Minister in 2006 and Secretary of State in 2009-10, but he failed to act adequately to deal with the shortages. It takes six years to train A and E consultants, so it will take six years to deal with the problem. The good news is that under this Government enough doctors are entering acute care common stem training to fill the places available.

Order. I do not wish to be unkind to the hon. Gentleman, but his answers almost invariably suffer from the failing of being far too long. It is nothing to be smug about; he really has to improve.

Mr Speaker, sometimes it takes a long time to rewrite history, which was what the Minister was just doing. The first warnings did not come in 2004. Dr Mann said:

“The first warning signs were three years ago when we failed to recruit 50% of our posts. Those concerns were raised at the time.”

Why does he believe his concerns were ignored? He blames “decision-making paralysis” caused by a top-down reorganisation no one wanted and nobody voted for. Ministers dismantled work force planning structures, making redundant the very people who could have done something to stop the locum bill spiralling out of control. Will he now concede that breaking the coalition agreement promise of no top-down reorganisation has weakened the NHS and made the A and E crisis worse—[Interruption.]

It is the right hon. Gentleman who needs a lesson about not rewriting history. Dr Mann said that this issue had been building for the past decade. When the right hon. Gentleman was Secretary of State and before that a Minister in the Department, he failed to make those long-term work force decisions and also signed up to the European working time directive, which exacerbated the problems on medical rotas. Those were decisions that he made. He created this crisis; we are fixing it and increasing the number of doctors working in A and E.

Older People

We will ensure that everyone over the age of 75 has a named GP responsible for delivering proactive care for our most vulnerable older citizens in the best tradition of family doctors. Through our £3.8 billion better care fund, we are also merging the health and social care systems to provide more joined-up health and social care.

Dementia is a terrible blight for an increasing number of older people. Last week, I had the great privilege of opening Henffordd Gardens in Hereford, a supported living scheme that will allow dementia sufferers in my constituency to enjoy a better quality of life for longer and is a model of good practice for the country. Will the Secretary of State join me in congratulating Herefordshire Housing and all those who have worked so hard to bring this plan to fruition?

I absolutely join my hon. Friend in congratulating Herefordshire Housing. One of the key things about people with dementia is that relatively small adjustments to their homes can make it possible for them to live at home healthily and happily for much longer under the care of a husband, wife or partner without having to go into residential care. Those are precious years that we should treasure and do everything we can to facilitate, so I am delighted that that is happening, and he will be pleased to know that, thanks to the Government’s initiative, it is happening all over the country.

Figures from the House of Commons Library show that £1.8 billion has been cut from social care budgets since 2010. Does not that imply that delayed discharge among older people will be driven upwards because the finances are just not there to look after them?

I think the figures the hon. Gentleman is talking about are efficiencies and not actual cuts. [Laughter.] Well, Members should look at the figures carefully. If they are the figures from the Association of Directors of Adult Social Services, that is what they will find. If the hon. Gentleman looks more specifically at the figures related to delayed discharges, he will find that, year on year, the number attributable to the social care system went down by 50,000 bed days in the last year.

One of the principal ways of promoting the health and well-being of older people in my constituency would be a rapid sign-off for the rebuild of the Townsland hospital complex. I recognise that the decision lies with NHS Property Services, but will the Secretary of State join me in using whatever influence we have to put pressure on it to get a move on?

I have spoken to my hon. Friend about the scheme, which sounds excellent. Obviously we want to encourage it, while working within the correct processes. The Under-Secretary of State for Health, my hon. Friend for Central Suffolk and North Ipswich (Dr Poulter), has agreed to meet him to do all we can to speed it along.

One of the things that some older people would like is to move closer to their families. Will the Secretary of State update me on what discussions he is having with the Scottish Government on the portability of home care packages across the border?

We are very keen to make home care packages much more portable. There are problems with home care packages across the board, particularly the 15-minute slots that, frankly, are completely unacceptable. We are definitely looking at that issue and I encourage the hon. Lady to talk to the Minister responsible for care services, my hon. Friend the Member for North Norfolk (Norman Lamb), to get more details on the progress we are making.

Does my right hon. Friend agree that the question asked by my hon. Friend the Member for Hereford and South Herefordshire (Jesse Norman) is the most important single question facing the health and care system? Do not too many elderly people—the greatest single source of growing demand on the health and care system—experience our system not as a national health service but as a national illness service? Is not the challenge facing the system to ensure that, as people live longer, we enable them to get greater quality out of those extended life years?

As so often, my right hon. Friend encourages us to raise our heads above the horizon and to look forward. He is absolutely right. There will be 1 million people with dementia by 2020 and, as he knows, most of those will have other long-term conditions alongside dementia. The name of the game will be looking after people so they can live healthily at home, which will be the focus of health policy.

Regular social interaction and a comfortable home environment are critical to the health and physical and mental well-being of older people. Has the Secretary of State carried out any assessment across Government or within his own Department of the effect of cost of living pressures and cuts in local services on the home environment, and on older people?

We are very conscious of that, which is why we introduced the triple lock on pensions and protected pensioners from the brunt of the cuts that this Government, sadly, have had to make to deal with the deficit we inherited.

Dementia is the disease that people over the age of 50 say they fear the most and it is one of the biggest challenges for our society and for our health and social care systems. One of the ways to meet that challenge is through research, and the coalition Government is to be commended for the doubling of spending on research into dementia by 2015. However, it will take another decade, until 2025, for this Government or a future one to double it again. Will he reconsider that? Surely there needs to be greater ambition and greater pace to deliver the cures, the solutions and the prevention we need.

I commend my right hon. Friend for his work on dementia when he was working at the Department of Health. We are doing our bit as a country but we will not be able to do it on our own. Dementia is an incredibly difficult disease to crack, which is why, in December, the Prime Minister hosted a G8 summit to encourage other leading countries to increase their investment in dementia. We secured a commitment that they would significantly increase that investment and we want to encourage the private sector to do the same.


The Department of Health is currently leading a review of the 2010 adult autism strategy for England, “fulfilling and rewarding lives”, and we will publish a revised strategy by the end of March.

Given some of the difficulties encountered by local areas in developing and sharing innovative practice in progressing the strategy he has just talked about, what consideration has the Minister given to the National Autistic Society’s proposal for an innovation fund as laid down in its “Push For Action” report?

I thank the hon. Lady for her question. The National Autistic Society is doing fantastic work, working closely with the Government. It has put this idea forward and we are considering it seriously; it has real merit. We shall announce our decisions when we announce the results of the consultation in March.

What plans does my hon. Friend have to use the review as an opportunity to bring forward programmes that will increase autism awareness among the general public?

My hon. Friend raises an incredibly important point. Awareness is still far too low. We are now in a position where the legislation is in a good place and we have a good strategy, now being reviewed. There remains, however, an awful lot of work to do on implementation on the ground and on making a real difference to the lives of people with autism.

GP Extraction Service

7. What representations he has received on IT and data security issues relating to the GP extraction service; and if he will make a statement. (901950)

Sharing and linking GP and other data—lawfully, securely and appropriately—helps to improve care and provides a solid basis for research to benefit everyone. In addition to more than 100 items of correspondence on the GP extraction service received since July 2013, the Department of Health has also had representations on these issues from the Solicitor-General.

I strongly support the better use of data and ICT to improve national health services, but it must be done securely and with informed patient consent, especially when the data are to be sold on. Yet the Health Secretary admits that he has not carried out any risk assessment of the move to a paperless NHS. Has a risk assessment been carried out for the extraction service and, if so, will he commit to publishing it and any recommendations made?

We have, of course, constantly assessed it. I hope the hon. Lady is not criticising the principle of improving and joining up care through better passing of data between services, which obviously has to be a very good thing. Let me reassure her that making available patient-identifiable information to third parties without the patient’s consent or on some other legal basis would be illegal. Information is held securely.

I congratulate Ministers on the reforms to open data and transparency, which have been a powerful catalyst for accountability and improvement in the health service—in particular, the reforms. The Minister will be aware of my ten-minute rule Bill on the subject. Will he give us some assurance on the steps that the Department is taking to ensure the integration of data between the care and the NHS sector?

I can reassure my hon. Friend that the absolute heart of what we are doing on joining up data is ensuring that we join up data better and promote integration. Some of that will come from the £3.8 billion we are providing for more joined-up and integrated care between health and social care as part of our integrated care fund, or better care fund as it is now termed.

I think the hon. Lady will find that it was getting harder under the previous Government. It was not helped by the fact that, as we know, although it was not the fault of GPs, the contract that GPs were presented with by the previous Government made it difficult for many patients in many parts of the country to access primary and community care out of hours.

Capping Care Costs

Everyone will be protected against catastrophic costs by the insurance that, in line with the Dilnot commission recommendations, the cap provides from April 2016. We are currently considering the responses to the recent consultation on how the cap will work, and will publish draft regulations and guidance later this year.

Thanks to tough decisions from this Government, we can look forward to a time when people will no longer have to sell their home to afford care, but what can be done to raise awareness of this landmark policy so that older people, and indeed younger people, can be reassured?

I thank my hon. Friend for that question, and I am immensely proud that this coalition Government are reforming a grossly unfair system—something that should have happened a long time ago and is massively overdue. This Government completely recognise the absolute importance of an awareness-raising campaign, which will be carried out by local government, national Government and the financial services industry.

Ministers have repeatedly claimed that no one will pay more than £72,000 in care costs, but given that the cap will be based on the rate local authorities charge for care and not the actual amount people have to pay, will the Minister confirm that people will have to pay more than £72,000 and that the so-called cap is not a cap at all?

People can always choose to spend more than local authorities deem it necessary to spend in order to secure care. However, we are implementing exactly the scheme that Andrew Dilnot recommended, and when he announced his proposals they were welcomed by the hon. Gentleman’s own party as a significant advance.

Health Care (East Midlands)

Clinical commissioning groups in the east midlands will receive increases in funding in 2014-15. Specifically, Lincolnshire West CCG will receive an increase from £1,111 to £1,124 per head of population, and Lincolnshire East CCG will receive an increase from £1,249 to £1,258 per head.

Does the Minister recall the very worrying Keogh report, published last year, which showed that Lincoln hospital in particular had a higher than average mortality rate? Some of us felt that if we had a stroke or a heart attack, it would be a lot safer for us to be taken to the nearest big city, such as Leicester or Nottingham. Will the Minister join me in welcoming the fact that Lincoln hospital has made progress since then, and is now expected to have a below-average mortality rate?

My hon. Friend is right to draw attention to the fact that the Government have taken seriously the need to deal with poor care where it exists. We have proudly taken a stand on that. It is also important for hospitals to understand that although they are making progress, there is still much more work to be done. I am sure that my hon. Friend and I are both keen to support the Care Quality Commission, Monitor and other regulators in order to ensure that care continues to improve in Lincolnshire.

There are currently 28,000 diagnosed diabetics in the city of Leicester, and it is clear that the whole of the east midlands—indeed, the whole country—faces a diabetes epidemic. What steps is the Minister taking to ensure that the CCGs and health and wellbeing boards in the east midlands work together and focus on prevention?

That is a very good question. Local health and wellbeing boards are an excellent vehicle for the adoption of a more joined-up approach throughout health care, enabling other key players in the health and wellbeing sector to drive forward improvements. It is for the boards to consider the local issues outlined by the right hon. Gentleman, such as increasing obesity and other public health challenges, and to ensure that they work with and direct funding towards local communities. The Government have provided 40% of their public health funding for that purpose.

My constituency is served by the Yorkshire and East Midlands ambulance services. Could we not make better use of our ambulance services and benefit those who require emergency admission by enabling paramedics to convey fewer patients and provide more care from the back of ambulances? I realise that that will probably necessitate tariff reform.

It is true that many parts of the medical and health care work force can contribute to the delivery of high-quality care, and paramedics have an opportunity to do that. As part of our “Refreshing the mandate for Health Education England” initiative, we will be considering how we can make progress in that regard during the coming months and years.

I wish you and Ministers a happy new year, Mr Speaker. We certainly hope that it is a much happier new year for NHS patients.

In the last 52 weeks, almost two in 10 patients who arrived in accident and emergency units at the University Hospitals of Leicester NHS Trust waited for more than four hours. In 2011, the local risk register for Leicester, Leicestershire and Rutland primary care trust cluster warned that the Government’s reorganisation of urgent care services would lead to the

“risk of…inability to develop a resilient, predictive, high quality, Urgent and Emergency Care System.”

Given warnings from local risk registers about the disastrous impact of the Government’s reorganisation, and following the worst week of the winter so far for accident and emergency services, will the Secretary of State come clean, act transparently, and publish the warnings contained in the national risk register?

I remind the hon. Gentleman that the last Government never published risk registers. The policy that we have adopted is therefore entirely consistent with theirs. However, as the hon. Gentleman will recognise, it is not for Whitehall to micro-manage local commissioners and health care services. Decisions of that kind need to be made locally, by local commissioners working with patient groups in the best interests of patients and local communities.

Counselling/Therapy (Regulation)

We support the system of accredited voluntary registration established by the Professional Standards Authority for Health and Social Care. It has already accredited counselling and psychotherapy registers and others are seeking accreditation.

But the Minister knows that under this Government the number of people referred to psychotherapists and counsellors has tripled to 1 million at a cost of £400 million, and some of them are faced with so-called gay to straight conversion therapy. When will he support my Bill to regulate psychotherapists and ban so-called “gay cures”, which cause enormous trauma among their victims and are being promoted this Thursday at a big conference in Westminster?

As I am sure the hon. Gentleman is aware, the reason there have been increased referrals to therapists is that this Government are investing in early intervention and ensuring we invest in improving access to the psychological therapies programme so we can get to people with mental health problems much earlier and give them better support before they reach the point of crisis.

If I may beg your indulgence for one second, Mr Speaker, on the hon. Gentleman’s specific point about gay to straight conversion therapy, I also find that absolutely abhorrent in principle, but the issue is—it is an important issue and he should listen to this—that if we were to ban or put in place regulations on that it may have unintended consequences. That may stop counsellors practising who are supporting people coming to terms with their sexuality. That is an important service, and I hope we can support it on both sides of this House.

Accident and Emergency Social Care

11. What assessment he has made of the effect of social care budget changes on the number of accident and emergency attendances. (901954)

13. What assessment he has made of the effect of social care budget changes on the number of accident and emergency attendances. (901957)

16. What recent assessment he has made of the effect of social care budget changes on accident and emergency attendances. (901960)

Although councils have reduced social care budgets, the evidence suggests that this is not having an impact on the NHS. In fact, the data published by NHS England show that councils are getting better at getting people out of hospital at the appropriate time.

The National Audit Office reports that cuts to social care led to nearly 500,000 delayed bed days in accident and emergency in 2012-13, so will the Government see sense and commit to investing in lowering the eligibility threshold to moderate, ensuring that older and disabled people’s needs in Easington and throughout the country can be met in their community so they do not need to present to A and E causing further pressures on it?

Taking the hon. Gentleman’s question in the spirit he intends, I think there is a misunderstanding of the statistics. We need to reduce the pressure on A and E, and evidence from NHS England already shows that improvements in how social care works with the NHS over this Parliament are delivering improvements to care. In 2011-12 there were about 523,000 bed days lost because of delays attributable to social care, but in 2012-13 the number had fallen to 476,000, a drop of nearly 50,000. That shows that social care is working well to reduce pressure on A and E.

I am absolutely amazed at the answer the Minister has just given. Stoke-on-Trent, which, despite the local authority having to cut a third of its budget, has managed to make cuts—or efficiency savings as the Government would call them, of course—and move money into social care. Despite that, however, it still has less to spend this year than it had just three years ago, and that is resulting in people not getting social care because of cuts to the budget and to eligibility. When is the Minister going to wake up and do something about it?

There is always a lot of political smoke around this, but spending has roughly been flat in cash terms according to the Association of Directors of Adult Social Services survey and councils are budgeting to spend more this year than they were last year on social care. In addition, we are setting up the integrated care fund of £3.8 billion to better join up health and social care, and that will help to improve the care available to patients as well as reduce pressure on budgets.

But Government budget cuts have forced Salford local authority to change its eligibility criteria. For 1,400 people it is going to be zero-day social care, not seven-day social care, and even our excellent Salford Royal hospital is going to struggle when those 1,400 people find that the hospital is the only option for them. Age UK says these cuts make “no financial sense” and are “morally wrong”. When are Health Ministers going to see that point?

I make two points. First, the eligibility criteria began to change under the previous Government, so it is wrong of the hon. Lady to try to make political points which do not stand up to scrutiny. Secondly, I am disappointed that she is unable to recognise that there is very good integration of health and social care in Salford, in her own constituency. That is a model that we could look at to see how good care can be delivered elsewhere.

I am delighted that Cornwall has been chosen as a pioneer area for joining up health and social care. It is the only pioneer area to be led by the voluntary sector. Will the Minister meet me and the Cornwall team to enable us to deliver that care in Cornwall?

I can confirm that the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), will be delighted to meet my hon. Friend to take that further, and that he and I will be visiting Cornwall in the next few months to see at first hand the excellent work that is being done there.

Would the Minister like to congratulate the Northamptonshire Healthcare NHS Foundation Trust, Kettering general hospital and the Northampton General Hospital NHS Trust for coming together to form the frail and elderly crisis hub in Northamptonshire, to prevent unnecessary admissions of elderly people to local accident and emergency departments?

I would very much like to do that. It is important, given that we sometimes have adversarial discussions on these matters, to highlight the examples of good practice. The example in my hon. Friend’s local area of Kettering is exactly the sort of initiative that we need to see elsewhere in the country. That is why we have given £3.8 billion to better support the integration of health and care.

Changing working practices in hospitals is an important way of reducing pressures on social care and on A and E. Will my hon. Friend join me in praising the staff of the George Eliot hospital, who, through changes to working practices implemented under the supervision of the Keogh process, achieved the second-best A and E four-hour target performance in the country over the busy Christmas and new year period?

My hon. Friend is absolutely right to highlight the fact that integrated care working, better intermediate care and ensuring that GPs work closely with accident and emergency departments are exactly the kind of factors, along with joining up health and social care, that take pressure off A and E departments. I am delighted that things are going so well in his local area.

Happy new year, Mr Speaker.

People want a care system that gets the best results for patients and one that makes the best use of taxpayers’ resources, but under this Government they are getting neither. Half a million fewer people are now getting social care services to help them to continue to live at home, and half a million more older people are being admitted as more expensive hospital emergency cases that could have been avoided. Will the Minister tell us how that record represents good care and good value for taxpayers’ money?

The point I made earlier is that the number of cases of bed blocking due to social care delays has decreased under this Government. Also, it was the previous Government who began to change the eligibility criteria. Labour Members talk about a crisis in social care, but per-head funding for social care fell in the last term of the previous Government. That is the legacy that we are dealing with, and we are sorting it out—

Order. I do not wish to be unkind to the Minister, but I am quite interested in making progress with Back-Bench Members, who have had to wait too long.

NHS Croydon

14. What assessment he has made of the causes and effects of the 2010-11 financial losses of NHS Croydon; and if he will make a statement. (901958)

As my right hon. Friend knows, an independent report published by NHS London in June 2012 identified a systemic failure of financial management within NHS Croydon, which caused an inaccurate picture of the organisation’s financial position to be presented. However, the report found that that there was no adverse effect on local patient care.

In 2011, NHS Croydon posted a surplus of £5.5 million. This was later corrected to an overspend of £23 million—an error of £28 million. Two years later, no one has been found culpable, no one has accepted responsibility and officials are refusing to answer questions. Does the Minister accept that unless someone is held responsible, the responsibility will lie with her?

My right hon. Friend is right to feel frustrated. The report did not find any one individual responsible; it found systemic failings. What really matters is what has been done to ensure that this sort of thing does not happen again, or that the chances of it happening again are minimised. Following the publication of the report, NHS London wrote to all the primary care trusts outlining the lessons to be learned, and my right hon. Friend will be relieved to hear that all clinical commissioning groups’ chief financial officers have been subject to a rigorous independent assessment and appointment process.

We come now to topical questions. It would be good to get through the list and beyond, so may I just remind Back Benchers and Front Benchers alike that topical questions and answers are supposed to be brief?

Topical Questions

I know that the whole House will wish to join me in remembering Paul Goggins at our first Health questions since his tragic death. He campaigned with great distinction on a number of health issues, including contaminated blood, mesothelioma and services at Wythenshawe hospital. I had the privilege of visiting a GP surgery in his constituency with him, and I know how much this utterly decent and selfless man cared about the health of his constituents. He has so sadly passed away, and the whole House will want to honour his memory and pass on our condolences to his family.

I certainly associate myself with the Secretary of State’s remarks. Will he undertake to look carefully at The 1001 Critical Days manifesto, which was recently launched by the right hon. Member for Birkenhead (Mr Field), the right hon. Member for Sutton and Cheam (Paul Burstow), who is in his place, the hon. Member for Brighton, Pavilion and me? Will he look at what more can be done to provide a comprehensive care pathway for the perinatal period?

Yes, we are looking at that closely, with the Minister responsible for paediatric services doing so particularly closely. In principle, we support what my hon. Friend is trying to achieve with that document and we welcome its contribution to the debate.

Last week, we heard shocking revelations about the reasons behind the Government’s U-turn on minimum unit alcohol pricing. In particular, researchers at Sheffield university have confirmed that they were asked by government not to publish a report that would have undermined the Government’s decision to shelve minimum unit pricing. Why were Ministers so keen to suppress the report? Will the Secretary of State please tell us why some of our country’s leading public health experts are accusing Ministers of deplorable practices and of dancing to the tune of the drinks industry?

On the hon. Lady’s substantive point, the reports for the British Medical Journal investigation, which I read in full, did not say that at all and in fact confirm that that was not asked, so what she says is not quite right.

On the wider point, over the past two weeks we have heard a succession of attacks from the hon. Lady and the Opposition about dealings with industry and business. This Government have set out to work in partnership across business and industry, with public health experts and local authorities, to tackle some of these really big public health issues. It is simply incredible that the Labour party believes that these big issues can be taken seriously without engaging with business. Instead of demonising businesses, let us hear some praise for those such as Lidl, which yesterday announced that sweets would be removed from all its checkouts across the country, in response to its customers—a voice that is too little heard by the Labour party.

T2. Will the Secretary of State join me in congratulating the UK Chronic Fatigue Syndrome/Myalgic Encephalopathy Research Collaborative for providing a mechanism for ME charities, researchers and clinicians to work together in a co-ordinated way? What support will his Department give research into the causes of and treatment for ME? (901934)

I am not the Secretary of State, but I would be very happy to join my hon. Friend in congratulating the collaborative, which is doing excellent work to generate more CFS/ME research. Spend by the National Institute for Health Research has already doubled in two years, and more funding applications are welcome. The NIHR has awarded nearly £0.9 million to the collaborative’s deputy chair for a senior fellowship studying paediatric CFS/ME.

T4. Given that tomorrow Staffordshire county council intends to confirm devastating cuts to services for those with special needs, including the closure of the purpose-built Kidsgrove day centre in my constituency, does the Secretary of State agree that it is time now for the council to wait and at the very least share its detailed needs assessment and future action plan before forcing these cuts through? (901936)

I am very happy to look into the issue that the hon. Lady raises. Obviously, some very big changes are happening in the Staffordshire health economy, and the purpose of those is to improve services for everyone, so if she gives me the details of her concerns, I will happily look at them.

T3. At the end of last year, the Prime Minister hosted the very successful G8 summit on dementia. What plans does the Secretary of State have to continue, and indeed enhance, the UK’s global leadership on tackling dementia in 2014? (901935)

My hon. Friend is absolutely right. That is a critical job that we must do this year. The purpose of the G8 summit was to wake up the world to the huge threat posed by dementia, as the world woke up to the threat of HIV/AIDS in the 1980s and the threat of cancer in the 1960s. We need to continue that work. Summits will be going on in America, Canada and Japan over the course of the next couple of years, and we need to keep up the momentum, because everyone agrees on the need to do such work.

T5. On 1 January, the York Teaching Hospital NHS Foundation Trust ceased providing antenatal advice classes for pregnant women and refers them instead to online advice on its website. Is that an approach the Government support, and will they urgently invite the National Institute for Health and Clinical Excellence to review the change in policy and look at its effectiveness? (901937)

I am sympathetic to the point that the hon. Gentleman raises, and I am happy to meet him to discuss it further so that we can see whether the matter needs to be addressed.

T6. On any given day in the Derriford hospital in Plymouth, 75% of patients are over 65 years of age and rising. Does that not demonstrate the demographic pressures that face our acute hospitals, and what more can this Government do to ensure that people, especially elderly people, are treated in the community? (901938)

We are doing a huge amount, but the first thing is to ensure that there is someone in the NHS who is accountable and responsible for all vulnerable older people outside hospital, because out-of-hospital care is where we need to have the big revolution. There will be a big change in April with named GPs for the over-75s. The integration of the health and social care systems is the next step. I hope that my hon. Friend will see real progress for his constituents.

T7. The Secretary of State has had a letter from 118 specialists about the MenB—meningococcal B— vaccine. It is available to parents who pay privately, but denied to most of our children by the Joint Committee on Vaccine and Immunisation. Will the Secretary of State agree to meet the families of children who have had meningitis B and consider all the points raised by the clinicians before letting the JCVI rule out access to the vaccine? (901939)

I recognise the real concern over the previous advice given by the JCVI. I hope that the hon. Gentleman agrees that, on something as important as this, it is helpful to have an independent body coming to these decisions and making a ruling. When a ruling is made, we are legally bound to accept the advice, which means that there is a measure of independence. I have met families campaigning for the MenB vaccine. We are waiting to hear what the JCVI says in February. We should let it come to its conclusion after re-reviewing all the advice and the literature.

T8. The Government’s decision to increase our dementia research budget was welcome news, and the G8 conference agreement to share research among all G8 members was an important development too. Does my right hon. Friend agree that there is a role for MPs in helping to keep constituents informed about scientific developments that may lead to significant progress? (901940)

I do agree, and I congratulate my hon. Friend on his work. I know that he is meeting Alzheimer’s Research UK next month in his own constituency. This matter is something in which we can all be involved in our own constituencies. There is a lack of willingness to talk about dementia. Many people are frightened of it, and the more we can do to raise the profile of this condition, the more we can give people hope that something can be done about it.

Although I support the principles of the Better Care Fund, does the Minister recognise that, in the context of severe cuts to local authorities and cuts in the NHS, the top-slicing of existing budgets is not sufficient? To encourage the kind of innovation that we need to get better integration, we must have additional funding.

The Government are getting on and implementing integrated, joined-up care. I remember talking about it constantly when the hon. Lady’s party was in government, and nothing ever happened. We are taking concrete steps to join up the system with the benefits of the £3.8 billion Better Care Fund.

T9. The Secretary of State is aware of the plans being developed by Milton Keynes hospital to expand its A and E capacity. In the interim, will he set out what assistance he can provide to ease short-term pressures? (901941)

I can confirm that the Department of Health is investing an additional £250 million over the next two years in A and E, with NHS England also allocating an additional £150 million for the current year. Milton Keynes has been allocated £2.8 million to support local initiatives to relieve pressures on A and E, and I know that, as a great champion for his local hospital, my hon. Friend will welcome that additional support.

Given the ongoing crisis in A and E units in the UK, particularly in the area I represent in Northern Ireland, will the Minister confirm whether the Health Minister in Northern Ireland has had discussions about possible solutions to finding and recruiting extra doctors?

I am not aware of any direct conversations with Ministers here, but as the hon. Lady will be aware, the Minister responsible for A and E services is my right hon. and noble Friend Earl Howe. I will write to her about the discussions that have been had with the noble Lord and Health Education England.

T10. I warmly welcome initiatives such as the introduction of personalised GP care for the over-75s, but what more can be done to ensure that personalised care treats the individual’s well-being as opposed to merely a collection of symptoms? (901942)

We want people to be treated as individuals, not a bundle of illnesses. That personalised care must happen not only out of hospitals but in hospitals, too. We want doctors to take responsibility for the whole stay and to avoid that sense of people being passed from pillar to post. That is an area in which we hope to announce some important changes shortly.

In an earlier response, the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), expressed his dislike for the working time directive. Would the Secretary of State be happy to revert to a situation in which patient safety, already compromised at weekends, is further compromised by over-tired doctors?

No one wants to go back to the bad old days of junior doctors working all the hours God gives, but the working time directive has had a negative impact on patient safety. It has made training rosters more difficult and it has meant that there is less continuity of care as people do not see the same doctor when they go back to hospital. We need to look at whether we can do that better, because it is not helping patients.

By Christmas, almost 2,000 staff at Kettering general hospital had received their flu jab—that is about 60% of front-line staff. Would the Secretary of State like to congratulate the hospital and its members for its bid to become the acute trust in the east midlands with the best flu jab record for three years in a row?

Absolutely. I am very encouraged that across the NHS trusts have had a much higher uptake of flu jabs for staff than in previous years, but Kettering is leading the way.

At the excellent James Cook University hospital between 19 December and 1 January, 49 ambulances were delayed for more than 30 minutes, 168 beds were blocked and 82% of admitted patients had been treated within 18 weeks, rather than the Government target of 90%. Why does the Secretary of State think that that is the case?

Because there is sustained pressure throughout the NHS. Across the NHS, hospitals and ambulance services are doing very well in the circumstances. I am happy to look at the hon. Gentleman’s specific concerns to make sure that his local NHS trust is doing everything it should.

Is the Secretary of State aware that every fast food outlet in the United States displays the number of calories for each portion of food that it sells? Given that some fast food restaurants in this country, such as McDonald’s, already do that, does he believe that more should be done to make all fast food outlets in this country display the number of calories so that people are educated before they make a choice about what they are going to purchase?

My right hon. Friend is quite right to say that that is a real priority. The responsibility deal, on which we have worked with our partners, means that 70% of fast food and takeaway meals sold on the high street in the UK have clearly labelled calories, but there is always more to do. This is a priority for the responsibility deal and we are working closely with our industry partners to make more progress.

Does the Minister believe that social isolation, which is a key contributor to the health and well-being of older people living on their own, has got worse or has improved under this Government?

I think that social isolation, if we are honest about it, has got worse over quite a long period, particularly as extended families have been dispersed far and wide. The answer has to be for the whole of society and must involve statutory services working together with the voluntary sector. In Cornwall, one of the pioneers in integrated care, there is a fantastic collaboration between the voluntary sector and the statutory sector to ensure that they directly address the problems with loneliness.

What steps is the Secretary of State taking to ensure that the number of cancer indications treated in this financial year by stereotactic ablative radiotherapy does not fall below the number of treatments delivered in the 2012-13 financial year?

That is an area that the hon. Lady and I have discussed at some length. I know that she feels strongly about it. We have meetings coming up to discuss it and I think that it would be easier to deal with her detailed points in those meetings.