House of Commons
Tuesday 14 January 2014
The House met at half-past Eleven o’clock
[Mr Speaker in the Chair]
Oral Answers to Questions
The Secretary of State was asked—
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.
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.
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.
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)
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.
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.
5. What steps he is taking to promote the health and well-being of older people. (901948)
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?
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.
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
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 care.data 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.
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
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—
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.
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.
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?
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.
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?
IT Systems (Army Recruitment)
The Army entered into a partnering contract with Capita in March 2012 to manage the recruitment of regular and reserve soldiers. That is an Army-led initiative designed to free up military personnel from recruitment-related administrative tasks and to improve both the quantity and quality of Army recruits. It will play a key role as we transition the Army to the new Army 2020 structures.
I should make it clear to the House that the Army has not outsourced its recruitment; it remains in overall charge of recruitment and will continue to play a major role in attracting and mentoring recruits. Capita’s role is to manage the supporting processes by which a would-be recruit becomes an enlisted regular or a fully trained reservist.
As I have explained to the House previously, there have been initial difficulties with that recruiting process as we transition to the new recruiting arrangements with Capita. In particular, we have encountered difficulties with the IT systems supporting the application and enlistment process. The decision to use the legacy Atlas IT platform was deemed at the time to be the quickest and most cost-effective way of delivering the new recruitment programme. An option to revert to a Capita hosting solution was included in the contracts as a back-up solution.
I was made aware in the summer of last year that the Army was encountering problems with the integration of the Capita system into the Atlas platform. Since then we have put in place a number of workarounds and mitigation measures for the old IT platform to simplify the application process, and we have reintroduced military personnel to provide manual intervention to support the process.
Having visited the Army’s recruitment centre in Upavon on 30 October, it became clear to me that, despite the Army putting in place measures to mitigate those problems in the near term, further long-term action was needed to fix the situation. It was agreed in principle at that point that the Atlas system was not capable of timely delivery of the Capita-run programme and that we would need to take up the option of reverting to Capita building a new IT platform specifically to run its system, which will be ready early next year.
In the short term, we have already taken action to bring in a range of initiatives that will make it progressively easier and quicker for applicants, both regular and reserve, to enlist. As I informed the House in December, we have taken a number of actions, including: the introduction this month of a new front-end web application for Army recruitment; a simplified online application form; more streamlined medical clearance processes; greater mentoring of recruits by local reserve units through the application, enlistment and training process; and the reintroduction of reserve unit recruitment targets and the provision of recruitment resource to reserve unit commanding officers. With an improved Army recruitment website, streamlined medicals and an increase in the number of recruiting staff, recruits should see a much-improved experience by the end of this month.
As we move forward, we are looking at further ways of improving the management of the recruiting process in the intervening period before the introduction of the advanced IT system now being developed in partnership with Capita, which is expected to be deployed in February 2015. We have just launched a new recruitment drive for the Army, both regular and reserve, which will remind the House and the public that the Army is always recruiting and continues to offer exciting and rewarding careers in both the regular and reserve forces.
I thank the Secretary of State for that statement.
In these first few weeks of 2014 there is no danger of auld acquaintance being forgot with this Secretary of State and Government. It may be a new year, but is it not the same old story of complacency, inefficiency and a lack of transparency at the Ministry of Defence? Here we go again. The Secretary of State has been forced to come to the House of Commons to try to explain catastrophic failures costing millions of pounds of taxpayers’ money. This time it is an IT fiasco. It did not have to be like this.
Will the Secretary of State acknowledge that many in this House, myself included, warned that the Government were taking risks with Britain’s security by not fixing the reserve recruitment crisis before reducing numbers in the regular Army, and now we have the IT debacle? Does he accept that, just like the mess the Government made of privatising procurement, his entire armed forces reform programme is in danger of collapsing, too?
I asked the Defence Secretary specifically about the IT problems and Capita on the Floor of the House on 20 November 2013. Did he not say that everything was in hand? It is clear that the computer said no, but the Defence Secretary said, no problem.
Does the Defence Secretary remember telling the House on 4 November 2013 that there had merely been “teething problems” with the IT support for Army recruitment? If today’s reports are accurate, I would advise the Defence Secretary to seek dental advice elsewhere, because today we have learned that the problems are even worse than anyone thought and still have not been fixed.
Will the Defence Secretary tell the House which Minister signed off the deal and who has been responsible for monitoring it? Will he confirm that the project, costing £1.3 billion, is almost two years behind schedule and will not be fully operational until April 2015 at the earliest?
The Future Reserves 2020 report, placed in the Library on 18 December—I am sure it was only a coincidence that that was the day on which the House rose for the Christmas break—confirms that an improved IT system will be developed in partnership with Capita. Will the Secretary of State confirm how much that will cost? Is it the figure of nearly £50 million that has been reported in the papers today?
Will the Secretary of State also confirm that £15.5 million has been spent building the existing flawed computer system behind the project? Finally, is it correct that this continuing disaster is costing taxpayers £1 million every month?
On 10 April 2013, the then Minister of State, the right hon. Member for South Leicestershire (Mr Robathan), said that
“the Recruiting Partnering Project with Capita…will lead to a significant increase in recruiting performance.”—[Official Report, 10 April 2013; Vol. 560, c. 1134W.]
Is there any Member of this House, any member of our armed forces or, indeed, any member of the British public who still believes that?
The blame for the mess we are now in lies squarely with the Government. We cannot take risks with our armed forces and we cannot gamble with our nation’s safety and security. Does the Defence Secretary not need to get a grip and sort out this shambles?
That is precisely what I am doing. Perhaps the hon. Gentleman should remind himself that the initial gate business case for this project to outsource recruiting was approved in July 2008, so I hope we are not in dispute over the principle.
The hon. Gentleman mentioned an IT debacle. Yes, there are big problems with the IT and I have told the House on repeated occasions that we have IT challenges. There are problems with IT in Government. The hon. Gentleman speaks as if he was not a member of the Government who spent £13 billion on a health computer system that we had to write off and £400 million on a work and pensions computer system that had to be written off.
What we are doing now is gripping this problem and addressing it. That means, in the short term, workarounds and putting additional manpower into the system to provide additional support. Short-term solutions include the new front-end web application, which will go live over the next two weeks, to improve the experience of applicants accessing the platform.
The hon. Gentleman asked about the costs and I can give him some figures. The Capita solution will cost about £47.7 million to produce a full new IT platform. The alternative Atlas IT platform proposal would have cost about £43 million, so the additional cost of the Capita solution is about £4.5 million. He asked about the £15.5 million of sunk cost. Our initial estimate is that about £6.7 million of that represents costs that will have to be written off, but that will be subject to a proper audit process.
The hon. Gentleman asked about the additional cost—the running cost, as it were—of the interim solution that we have put in place. It comprises additional payments that have to be made and the cost of the additional manpower that has been delivered into the system. That is currently running at about £1 million per month. The solution that we have adopted and that we have now approved—going ahead with Capita platform and placing the integration risk back on Capita—is judged to be the quickest way of eliminating that ongoing expenditure and the best way of delivering a permanent solution for the benefit of the Army and the taxpayer.
I again suggest to the Secretary of State that plans to replace 20,000 regulars with 30,000 reservists will cost much more than the Government envisage, leading to false economies and a waste of taxpayers’ money. Given the tens of millions of pounds already wasted on this IT shambles, will he outline how much more it will cost to put it right? Does this not reinforce the point that the Government should now halt and stop the disbandment of regular units until we are sure that the plan to replace them with reservists is both cost-effective and feasible?
Let me deal with the cost point first. The overall programme, the Capita recruiting partnership project, has a budget of about £1.3 billion over a 10-year period. As I have just outlined, the additional cost of the IT platform is estimated to be £47.7 million.
Repeating the question that he has asked many times, my hon. Friend asked whether it is appropriate to replace 20,000 regular soldiers with 30,000 reservists. That is not what we are doing; we are changing the shape of the British Army and we are changing the role of reservists, whom we intend to fill specialist roles and provide resilience in the case of a prolonged future deployment. He makes a regular versus reserve point, but I should be clear with him that the recruiting platform is used for regular and reserve recruitment: it affects both regulars and reservists.
I declare a non-pecuniary interest as I chair Knowsley Skills academy, which has a 100% success rate in preparing candidates for entry into the military.
Does the Secretary of State accept that, regardless of who initiated the project, the problem is not the IT system, but the fact that the online recruitment model is flawed? It does not allow those doing the recruiting to identify at an early enough stage what candidates have to do to get up to the necessary standard to meet the requirements. He needs to go back to a professional soldier looking candidates in the eye and telling them what they need to do to get up to the required standard.
There is some truth in what the right hon. Gentleman says. One measure we have already put in place for reserves recruitment is reverting to an early face-to-face interview over a weekend session, where it is possible to deal with several processes in one hit, rather than stringing them out over a much longer period, which was how the system was originally set up.
It is clear to me that the original concept did not give a big enough role to front-line reservist units in managing the process of attracting recruits and then mentoring them through the pipeline to the point at which they join stage 1 training. We have now put that right, with recruitment budgets and recruiting targets allocated to reserve unit commanding officers, who will be held to account for delivering the recruiting targets. From the reserve units that I have visited and the COs to whom I have talked, I know that they are very glad to have back that role and responsibility.
In welcoming the recent package of changes and the work of the new and energetic major-general at the Army recruiting group, Major General Chris Tickell, may I suggest to my right hon. Friend that one of the key lessons to learn is the importance of developing distinct pathways towards the same ultimate aim? That applies not just to the recruiting group, but to other areas such as the military secretary’s department and the wider personnel function. That is what is done in every other country in the English-speaking world.
I pay tribute to my hon. Friend. It is largely as a result of his insistence on that point that I have become focused over the past four or five months on the importance of maintaining that distinct ethos, not just in the recruitment process, but elsewhere in the reserves. I agree with him entirely.
Millions wasted on planned “cats and traps” on aircraft carriers, millions wasted on a failed GoCo and millions wasted on a failed IT system—will the Secretary of State tell us how many members of the armed forces would still be in their jobs if it were not for the millions that have been wasted by this Government’s failures?
Unfortunately, the hon. Lady forgot the £1.6 billion that was wasted by deliberately delaying the aircraft carrier contract because of a shortage of £300 million of cash in-year. The restructuring of the British Army is a long-term strategic response to the fiscal environment and the post-Afghanistan challenges that we face. The size of the Army is right for the future.
No, I did not. It is Atlas that has failed to deliver an IT platform that Capita can utilise effectively.
To answer the question of the hon. Member for Colchester (Sir Bob Russell), just under 1,000 personnel are involved. Some of them have been surged into front-end recruiting and are acting as military recruiters on the ground, and others are providing manual support for administrative tasks that should be, and ultimately will be, carried out by the IT platform.
Not long after the Secretary of State visited Upavon, it was visited by a number of members of the Defence Committee, including me. It was clear that there had been problems for quite some time. The Capita representatives said that there was no reality in what they were being asked to deliver. When did he and his Ministers first become aware that there was a serious problem with the project?
As I said earlier, in early summer last year, it became clear that there were problems in integrating the Capita processes with the Atlas IT platform. It was when I visited Upavon in October that I formed the conclusion that there was no way of resolving the Atlas problem, and that we had to revert to the Capita option and place the integration challenge back with Capita to deliver a platform and a process.
Complex IT problems are common in the public and private sectors. It is important that steps have been taken to put the problems right. Will my right hon. Friend come back to the House in the near future to convince us that the targets on the recruitment of regulars and reserves are being met, so that the wider public can be confident that the problems have been resolved?
As was mentioned by the shadow Secretary of State, just before Christmas I published the trajectory of recruiting targets for the reserves that we will have to meet to deliver on our commitment of 30,000 trained reservists by 2018. I have given the House a commitment that we will publish the out-turn figures on a quarterly basis. Aside from the numbers, anyone who looks at the Army recruiting website will start to see measurable, noticeable improvements by the end of this month, as some of the interim solutions start to take effect.
The Secretary of State still seems confident that these are initial difficulties that can be overcome. I am not so convinced. I think that they are systemic problems. These problems shed light on his decision to reduce the regular Army before the reservists are fully tested. Now that he knows about the problems, will he say in his own terms at what stage he will say that these are no longer initial problems and that we need to review the situation properly because there is a systemic failure in his approach?
To interpret the hon. Lady’s question, I am clear that the problems with the ICT platform are not initial difficulties. We have made a clear decision that the Atlas platform is not fit for this purpose and have asked Capita to develop a dedicated platform for Army recruitment.
However, I think that the hon. Lady is probably referring to the wider challenge of recruiting the necessary reserve numbers. She is right to say that there are two components to that. There is the technical challenge of processing recruits through the pipeline. I have admitted to the House on a number of occasions that the system is very clunky, which is partly but not exclusively because of problems with the ICT platform. There is also the wider challenge, in the face of societal change and public attitudes, of encouraging people to want to join the Army Reserve and encouraging employers to want to support employees in joining the Army Reserve. It is very early days, but the signs are encouraging. I have no doubt that I will continue to report to the House as the evidence becomes more readily available over the course of the year.
In answer to my hon. Friend the Member for Salisbury (John Glen), my right hon. Friend referred to the reservist recruiting targets that he set out before Christmas. He has also indicated to the House when he first became aware of the IT problems. Will he confirm that the targets that he set out for reservist recruitment took into account the problems that he has outlined to the House in his statement today?
The fact that Atlas is not fit for purpose and the mess that we are in suggest that there was a fundamental flaw in the design of the project and in the project management thereafter. When such mistakes occurred under the previous Administration, the Conservative party regularly asked for somebody to resign. Who will take responsibility for this failure?
The hon. Gentleman might like to reflect on the previous Administration’s record of taking responsibility for their failures. Hon. Members who are interested in the IT challenge in government will recognise that there is always a tension between the desire to utilise existing platforms and contracts to deliver IT in an effective and efficient way that provides value for money, and the fact that the Department shoulders the integration risk. By asking Capita to develop a process using the existing Atlas platform, the Department effectively accepted the integration risk. We are now asking Capita to shoulder the integration risk by developing a platform that is purposely designed for its process.
I welcome the statement by my right hon. Friend today and his action to recruit reservists. However, the continued uncertainty over the Rifles reservist base in Truro is having an impact on recruitment. Will he give an update on his consideration of the case that I have made to keep the Rifles reservist base in Cornwall? People in Cornwall really do want the opportunity to serve their nation in this way.
My right hon. Friend the Minister for the Armed Forces tells me that he discussed that issue recently with my hon. Friend. We are looking at the decision on reserve basing in Cornwall. We have announced our plans for reserve basing, but have indicated that there is flexibility in those plans. We must, of course, recruit where the recruits are available. We recognise that necessity.
The Secretary of State referred to streamlining medical requirements as part of this process. We have all had people in our constituencies who have attempted to join the armed forces, but subsequently found that their bodies were not robust enough to fulfil the process. That is damaging for them and costly for the armed forces. Will the Secretary of State assure the House that streamlining the process will not lead to more people dropping out as a result of being unable to fulfil medical requirements further down the line?
The hon. Gentleman makes a good point, and there are two parts to the problem. One is the time it is taking us to get medical records from GPs, and we are addressing that specific problem. Even if that is overcome, however, there will still be a time lag in getting medical records from GPs. We are looking at whether we can use a system similar to that used in officer cadet training units in universities, where recruits can answer a simple medical questionnaire to enable them to begin taking part in some carefully defined activities. That would capture and get them engaged in that first flush of enthusiasm, rather than leave them sitting on the bench for months, waiting for medical records to come through from their GP.
Given the IT challenges we face, will the Secretary of State confirm that we are still on track to meet our recruitment targets? With the rebalancing of the Army’s regular reserve forces, will he say what more is being done to encourage those who have served as regular officers and soldiers and completed that service, and who might now consider service in the Territorial reserves and take advantage of that experience?
My hon. Friend makes a good point, and recruiting ex-regulars is an important part of our strategy for building the reserves, not least because ex-regulars drop straight to the trained strength if their regular Army service is recent enough. As he will know, we are currently offering an enlistment bounty for ex-regulars to join the reserves, which reflects some part of the cost saving that we make through not having to take ex-regular recruits through the full reserve training process.
This administrative quagmire is the latest part of what is becoming a worrying and costly pattern of events under the Secretary of State’s stewardship. He had a good reputation for competence around Whitehall before he took up his latest job. What has happened?
The important thing in a Department as large and complex as the Ministry of Defence, with a budget of £33 billion a year, is not to pretend that we can operate the vast range of contracts and arrangements we have in place without some failures. That is never going to happen. The challenge is to grip failure when it becomes apparent, and to manage and resolve it as quickly and efficiently as possible. I am prepared to stand on my record of delivering that kind of outcome.
As an officer commanding the Royal Air Force recruiting offices in Newcastle and Middlesbrough, I saw at first hand the challenges of recruiting particular trades and branches—at the time it was aerospace systems operators, and Royal Air Force regiment gunners. Will my right hon. Friend say what implications and consequences there have been for Royal Navy and Royal Air Force recruiting as a result of some of the challenges with Army recruiting in recent months?
The platform that the Army is putting in place is ultimately intended to deliver for all three services, but at the moment it is the Army that is principally affected by those problems. I understand that Royal Auxiliary Air Force recruitment is going extremely well at the moment.
On 11 December—about a month ago—I asked the Minister of State, Cabinet Office, the hon. Member for Ruislip, Northwood and Pinner (Mr Hurd), why the Government had not planned the ICT better so that the new recruitment processes and Ministry of Defence systems would work better. He said:
“What we have done is to put in proper controls and create the conditions in which smaller and leaner organisations can come in and offer better value.”—[Official Report, 11 December 2013; Vol. 572, c. 225.]
Back in the real world, how many recruitment applications have fallen between the cracks of this failed system?
I have heard Capita referred to as a lot of things, but not normally as “smaller and leaner”. The hon. Gentleman is referring to precisely the tension that I mentioned a few moments ago—between the desire to allow smaller players to come in, provide IT solutions to the Government and utilise existing IT solutions, and the desire to ensure that the integration risk lies with the supplier. My view is that the Government are poor at managing integration risk, and I suggest that a solution that may look superficially good value, but which transfers integration risk to Departments, is probably to be viewed with some suspicion.
The Secretary of State explained that the interim solution will lead to an improvement in recruitment numbers over the next few weeks, and that we should start to see that improvement come through. Will he therefore explain why the interim solution is not capable of being turned into a much cheaper long-term solution?
There are a number of elements to that. I said that potential recruits seeking to access the system will notice an improvement in the quality of the IT platform, principally because the front end—the web-based portal through which they will access the system—will be replaced at the end of January by a system that is now running but still being trialled before it goes live. The system will work, but that is by applying additional manual resource, which, as I have already told the House, is costing us £1 million a month. The purpose of the partnering contract is to take about 1,000 personnel who were involved in the administration of recruiting out of that role, and save about £300 million a year. In the long term we still need to harvest that saving, and it will be necessary to have a proper ICT solution to do that.
That is difficult to say because, by definition, when we talk about recruits falling through the cracks, we are essentially talking about people who have become frustrated with the delay in the process and simply dropped out and gone away. We are seeking to track those people and to go back and re-engage them, as it were, but I know from anecdotal evidence—e-mails I get in my personal e-mail account—that a number of people have just got fed up with the system and given up. The Army is acutely conscious that we cannot afford to waste any potential recruits.
Will the Secretary of State confirm that the Royal Marines are outside this Army recruitment system because they come under the Navy recruitment platform? I am slightly alarmed to hear that he intends to roll this system out to the Navy and the RAF. What lessons might the Army learn from naval and RAF recruitment, and what efforts are being made to recruit from our great pool of cadet forces across all three services?
There are several questions there. First, the IT platform—the management of the process—is intended to provide a tri-service platform, and once it is fully operational, it will provide savings to the Navy and Air Force as well. Cadets provide an opportunity to showcase careers in the armed services, and we know that significant numbers of recruits have cadet experience. I want to be clear that we should support young people who join the cadets, and when they are interested in a career in the armed services, we should support them to explore the possibilities of such a career. As my hon. Friend will know, we are also committed to rolling out an increased number of combined cadet forces in state schools, to mirror the great success that those established combined cadet forces in independent schools have already demonstrated.
The Defence Committee report published today expresses concern that the rate of voluntary outflow from the armed forces is way above the long-term average. It also mentions the problems in pinch-point trades. What is the Secretary of State doing to address those problems? Would it make sense to modify the redundancy scheme, at least in the short term, until the recruitment problems are overcome?
I can assure the hon. Gentleman that nobody who is in an area where we have a shortage is eligible for redundancy. The redundancy programme essentially addresses the changed structure of the Army. At the same time, we have an over-supply in certain areas and a chronic shortage in others. In the short term, we are paying retention bonuses in pinch-point trades, particularly in the Royal Navy—sea-going engineering skills and nuclear engineering skills are in desperately short supply. We are actively managing the work force with retention initiatives. In the longer-term, we must grow the skills we need. We are working with the Department for Education and the Department for Business, Innovation and Skills to ensure that we generate the nuclear engineering skills the armed forces need as the UK civil nuclear industry regenerates.
Having undertaken recruitment programmes for some of the largest companies in the world, I can reassure the Secretary of State that such large initiatives always take time. This is not a sausage machine; it is about getting the right people for our armed forces. I urge him not to be too concerned with obsessing over quarterly targets.
I am sure my hon. Friend’s advice is sound, but hon. Members, who are focused on the challenge of reaching the 30,000 target by 2018, will want to hold the Government to account on the interim recruiting targets. However, my hon. Friend is right in another important respect. Changing how we recruit is not just about getting additional numbers in at the top of the hopper. It is about improving the efficiency of the process; ensuring that we get a greater percentage of initial applicants accepted; and ensuring that a greater percentage of those who are accepted for enlistment make it through to the completion of training and join the trained reserve strength. Making the process more efficient will save us money and deliver us the results we need.
Yesterday, I questioned Department for Work and Pensions Ministers about Capita’s failure to deal expeditiously with cancer patients who apply for the personal independence payment. Today, the Secretary of State for Defence asks hon. Members to have confidence in Capita sorting the recruitment mess out. Why should the country and the House have any confidence whatever in the capacity of that organisation to do that?
Outsourcing services is here to stay. At the cost that regular Army soldiers represent to us, we cannot contemplate using them to perform administrative tasks in the recruitment process in future. Those tasks must be outsourced to be sustainable. We are confident that Capita has a solution. At the outset of the contract, we chose not to adopt the Capita solution, but to go with extant departmental policy, which was to use the existing Atlas platform. We have now reversed that decision for the Army recruiting programme.
Based on the figures the Secretary of State has given today, the original decision to try to integrate the Atlas platform seems strange. When that decision was taken, was there no contingency plan? Given the history of trouble with Government IT projects and the importance of the project, what consideration was given to a contingency plan when the decision was taken?
The contingency plan was put in place and the fact that there was a risk was clearly recognised at the time. The contracts with both Capita and Atlas were written to allow for a reversion to a Capita-hosted solution if the Department decided that that was necessary. That is what we have done.
Registration of Stillbirths
Motion for leave to bring in a Bill (Standing Order No. 23)
I beg to move,
That leave be given to bring in a Bill to amend the Births and Deaths Registration Act 1953 to provide that parents may register the death of a child stillborn before the threshold of 24 weeks gestation.
My wife and I are very fortunate to have three teenage children. All were born healthily and without complications. We, like other hon. Members, are lucky, but other parents —I suggest that there are more than many would realise—have not been so fortunate. Some experience loss through miscarriage, often repeatedly; some give birth routinely but experience the pain of losing a child within days, weeks or months; and some go through all the trials and tribulations and highs and lows of pregnancy only to give birth to a stillborn child. It is to try to help those parents that I am introducing this Bill.
Perinatal mortality rates—stillbirths and neonatal deaths of babies within 28 days of being born—remain worryingly high in the UK. In 2012, 7.4 deaths per 1,000 live births were recorded. That was little changed on the year before, although an improvement of about a third from 30 years ago. That is better than some of our European counterparts, but worse than most. It is also nothing like the progress that has been made on preventing cot deaths, which, after much high-profile attention and the “Back to Sleep” campaign in the 1990s, have fallen dramatically by two thirds in less than 20 years.
Other countries, such as Holland and Norway, have reduced their mortality rates much more dramatically, yet, in the UK, we continue to see wide variations geographically and demographically. For example, the stillbirth rate in the south-west of England is 4.7 per 1,000 live births; in the north-east, it is 5.8, a 23% difference. There are big differences between age groups and mums from different ethnic backgrounds.
The simple fact is that 3,558 babies were stillborn in England and Wales alone in 2012. One in 200 pregnancies ends in stillbirth after 24 weeks—it is 15 times more common than cot death. That equates to nearly 10 babies every day. That is 10 mothers who have lost a child after completing more than half the term of a pregnancy. They then have to go through the pain of childbirth to see a baby who will not grow up. In 2011, the figure was 3,811 babies, and in 2003, it was 3,612. The situation has not improved in the last decade.
I am not the first hon. Member to raise the issue in the House. I pay tribute to my hon. Friend the Member for Daventry (Chris Heaton-Harris), who has worked tirelessly through debates, and through his work with constituents and Sands, the excellent stillbirth and neonatal death charity. I also recognise the work that Health Ministers and the Department of Health have done with the Royal College of Obstetricians and Gynaecologists, and with the Royal College of Midwives, to promote better research into causes, develop a stillbirth prevention programme and examine variations in clinical practice.
I am using this opportunity to reiterate the challenges we still face over perinatal mortality rates, but the situation is worse, hence the focus of my Bill. A stillbirth is classified as such only if the gestation period is 24 weeks or more. One day less, and that stillbirth becomes a non-viable delivery, or is more commonly referred to as a mid-trimester miscarriage. There are no central records of exactly how many babies are born in that way, so they do not form part of the perinatal mortality figures.
Without wishing in any way to downplay the importance and pain of a miscarriage, particularly for new parents struggling to have their first child, the experiences are different. That was brought home to me most starkly by the story of a constituent of mine, Hayley, who came to see me before Christmas, campaigning for a change in the law.
Last year, Hayley was pregnant. For nearly 20 weeks, she carried the child of her partner Frazer. She felt the baby kicking. She went through all the other ups and downs of a first-time pregnancy. Sadly, after around 19 weeks, something went wrong, and Hayley and Frazer’s baby died unborn. It was not a miscarriage, and the following week Hayley had to go through the pain of giving birth to a baby that she knew was no longer alive. She had to take powerful drugs to induce the pregnancy. She experienced contractions. She went into Worthing hospital and had pain relief. The following day in June, she gave birth to her baby, Samuel. She held Samuel in her arms. She and her partner took photographs, had his hand and footprints taken and said their goodbyes.
Fortunately, Hayley was given good support by the clinical staff at Worthing hospital and had bereavement guidance later. She has an understanding employer in West Sussex county council. She was also fortunate to find a sympathetic funeral director. The funeral took place two weeks later.
To all intents and purposes, Hayley went through all the experiences of pregnancy and the pain of childbirth endured by any other mother, but they were coupled in this case with the unimaginable grief of a parent who has lost a child before they could ever get to know him. She did not just go through a stillbirth: she had a still baby; she became a mum. The crucial difference is that Hayley’s and Frazer’s baby is not recognised in the eyes of the state because he was born before 24 weeks’ gestation. If he had survived until 24 weeks and one day, he would have been recognised and the death properly registered in a register of stillbirths, forming part of the statistics I referred to earlier. More than just adding to the statistics though, that would have been the acknowledgement of an actual, individual baby. To add further insult to injury, Hayley had to hand back her maternity exemption certificate straight afterwards.
That stark difference surely cannot be right; it adds insult to the unimaginable pain that the parents have already had to suffer. Until the passing of the Still-Birth (Definition) Act 1992, which amended the Births and Deaths Registration Act 1953, the threshold was 28 weeks, so prior to that even more babies went unrecognised in official records. That change followed a clear consensus in the medical profession on the age at which a baby is considered viable. Since then, in fact, there have been cases of babies born before 24 weeks who have, incredibly, survived.
It is true that there is an informal procedure for hospitals to issue so-called commemorative certificates for foetuses that are not classified as stillbirths. They provide parents with a certificate that records their pregnancy loss before 24 weeks. Sands has produced a template of a certificate of birth and encourages all hospitals to adopt it. However, it is unofficial and counts for little in the eyes of the state.
Late last year, Hayley became pregnant again, but sadly suffered a miscarriage after five weeks. Coming hard on the heels of the stillbirth, this was a further huge blow for her and her partner. The effect was no less tragic than the earlier stillbirth, but the experience was a very different one. Yet the stillbirth and the miscarriage are treated as just the same in the eyes of the law, and it is this inequity that I want to put right.
My Bill would provide for the official registration of stillborn babies below 24 weeks’ gestation. It would not be based on a crude time threshold of what is deemed a viable foetus, but on the experience of giving birth. Hayley and Frazer’s baby would be recognised as having existed; Samuel’s death would have been registered. That would go some way to providing some comfort to parents such as Hayley and Frazer at an unimaginably painful time. It would provide some form of closure and allow them to move on more easily. It would also provide more data to aid the analysis of why such stillbirths happen and, hopefully, of what can be done to jump-start a resumption in falling numbers from the last decade’s plateau. For those who say that the physical act of registering a dead child alongside those registering a healthy birth could open up wounds and exacerbate the grief of the parents, I am sure that a more discrete and empathetic procedure could easily be devised.
The Bill has nothing to do with changing the law on abortion. It does not propose to change the status quo with regard to entitlement to maternity benefits and bereavement entitlement, although I think official recognition would make it easier to secure appropriate empathy and flexibility from employers. The Government have already made changes, rightly, to maternity allowance guidance to ensure mothers whose babies are stillborn after 24 weeks receive benefits they are legally entitled to, and the process has been made easier.
My Bill proposes a modest measure that requires minimal changes to legislation and little cost to the state, but for mums like Hayley, and her partner, and thousands of others struggling to have children, it has the potential to make a huge difference in helping them to handle the grief of a loss that most of us could not imagine. It is the right thing to do, it is the right thing for this House to do, and I commend it to hon. Members.
Question put and agreed to.
That Tim Loughton, Chris Heaton-Harris, Mr Gary Streeter, Paul Burstow, Tracey Crouch, Sarah Teather, Mr Frank Field, Andrea Leadsom, Mrs Caroline Spelman, Pauline Latham and Jim Shannon present the Bill.
Tim Loughton accordingly presented the Bill.
Bill read the First time; to be read a Second time on Friday 28 February, and to be printed (Bill 153).
Offender Rehabilitation Bill [Lords]
Consideration of Bill, as amended in the Public Bill Committee.
New Clause 1
Probation Service Reform: Parliamentary Approval
The Secretary of State may not undertake a national restructure or reform of the provision of probation services unless the proposals have first been laid before, and approved by a resolution of, both House of Parliament.’.—(Jenny Chapman.)
Brought up, and read the First time.
With this it will be convenient to discuss the following:
New clause 4—Piloting of probation reform—
‘The Secretary of State may not undertake a national restructure of the provision of probation services until the proposals have first been subject to an independently evaluated pilot scheme, and the results of that evaluation laid before both Houses of Parliament.’.
New clause 5—Provision of probation services: report to Parliament—
‘(1) The Secretary of State must lay before both Houses of Parliament a report on the performance of all providers contracted to provide officers to perform the duties of supervisor or responsible officer as described in this Act after one year of this Act coming into force.
(2) The report must include—
(a) an assessment of the information made available by each provider to the public, and their assistance to the Ministry of Justice in its performance of duties under the Freedom of Information Act 2000; and
(b) an update on what measures were included in each contract to allow the Secretary of State to penalise a provider that fails to perform to national standards or fulfil its contractual obligations, and on what occasions these measures have been brought into force.’.
New clause 6—Review of the effectiveness of prison services in delivering the Transforming Rehabilitation Strategy—
‘The Secretary of State may not undertake to introduce competitive tendering for the provision of probation services until a review of the prison service’s ability to implement the Transforming Rehabilitation Strategy has been conducted, and the results of that review laid before both Houses of Parliament.’.<