A and E (Major Incidents)

Barbara Keeley Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

My right hon. and learned Friend speaks with a great deal of wisdom as someone who has occupied this post and he is absolutely right. All Health Secretaries face pressures of the kind we are going through now and face difficult winters. Winter is always a difficult time for the NHS and, as the Prime Minister said, we need a short-term plan to help—that is what our plan of creating about 5,000 extra front-line clinicians this winter alone is doing—but we must also consider the long-term plan. That involves finding a better way of looking after vulnerable older people other than through A and E departments—that means better care in the community, better support from GPs and better community services—and that is exactly what we are doing.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Bolton Royal hospital is one of the hospitals declaring a major incident. The context is as follows. The Little Hulton walk-in centre was closed, when it saw 2,000 patients a month. Salford city council had £100 million cut out of its budget, so 1,000 people this year are losing care packages. I have an elderly constituent who was admitted to Bolton Royal following poor care. It is obvious that those things are causing the problem. When will the Secretary of State take responsibility?

[Mr Hunt]

We take responsibility and I take responsibility for everything that happens in the NHS. Let me tell the hon. Lady what we are actually doing, because there have been some serious bed capacity issues in Bolton. Bolton has had £3 million this winter to help deal with those pressures, which has included £340,000 to spend on additional beds in the hospital supporting the A and E department and more than £100,000 to pay for additional staff in A and E. Overall, compared with in 2010, there are 114 extra doctors and 571 extra nurses. She should welcome that, rather than trying to make a political issue of it.

Oral Answers to Questions

Barbara Keeley Excerpts

Tuesday 25th November 2014 Commons Chamber

[Mr Hunt]

I am a strong supporter of personal budgets. People who have complex medical needs want, above all, to have personal control over their own health care, and they will be extremely worried that the Labour party has now said that it wishes to abolish personal budgets.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

With regard to reducing patient choice, can the Secretary of State explain the sudden move to remove dialysis from being regarded as a specialised commissioning service, which is of great concern to a constituent of mine who is a renal patient and to the renal community? Will the Secretary of State now agree to a proper consultation—not over the Christmas holidays—and will he think again about that risky move?

[Mr Hunt]

We hope to have a public consultation on the matter. We are not seeking to restrict access to dialysis—far from it. We want to make it easier for people to access those vital services, and we have been putting more money into the NHS budget because we recognise just how important they are.

National Health Service (Amended Duties and Powers) Bill

Barbara Keeley Excerpts

Friday 21st November 2014 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I congratulate my hon. Friend the Member for Eltham (Clive Efford) on his excellent opening speech—I think it was one of the best speeches I have heard in the House—and on introducing his Bill so that we can review and reform some of the more pernicious effects of the Health and Social Care Act 2012. One of the worst was to force market tendering of services, meaning that millions of pounds are wasted on the process, money that should be spent on improving front-line patient care.

As a member of the Health Committee, I am very concerned about the increasing role that private companies are paying in providing NHS services. We recently looked at what is happening in Stoke and Staffordshire. There have been a few references to that in this debate and I will talk some more about it, but we looked at it under the label of the integrated care pioneers pilot. I want to talk more about that development as an example of just what can happen under this Government’s market framework—[Interruption.]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. There are a lot of conversations and I am struggling to hear the hon. Lady. If we need to have the conversations, can we turn them down a little?

[Barbara Keeley]

Thank you, Mr Deputy Speaker.

The clinical commissioning groups involved plan to tender by summer 2015 a £1.2 billion contract to deliver cancer services and end-of-life care for 876,000 people across the area. The witnesses we heard from made it clear that commissioning on a disease-specific basis like this is risky. There are only a few small-scale examples of that being done anywhere, and nothing on the scale of this project. Despite the risk, we heard some worrying things about local people or local MPs not being listened to and about a lack of consultation with or involvement of hospital-based clinicians. The Minister has just referred a number of times to letting doctors get on with running the NHS, but the CCGs involved in driving this pilot are not even involving or listening to local clinicians. I and other colleagues on the Committee found that bodies such as Healthwatch England and Macmillan Cancer Support were cheerleaders for—and in Macmillan’s case, a funder of—development work on a project that could end up privatising cancer and end-of-life care for almost a million people. I for one found that disturbing. I felt, and I know that some of my colleagues did too, that there was a conflict of interest. Healthwatch England was meant to be the consumer champion of health and care.

By contrast with what Government Members have said, there was also a fair amount of concern among Committee members about the role of Macmillan Cancer Support in funding the development work when many believe that the money they give to Macmillan goes directly to cancer care. Indeed, the example I saw on the Macmillan website yesterday was that a donation would pay for a Macmillan nurse for a period to help people living with cancer and their families receive essential medical, practical and emotional support. It does not appear to be a selling point for that charity that funds would be used on a project to privatise end-of-life and cancer care in Staffordshire and Stoke.

[Jeremy Lefroy]

As I have already said, I have major concerns about the form of the contract. The hon. Member for Stoke-on-Trent Central (Tristram Hunt) wrote, and I say this in defence of Macmillan:

“This is the context for our new cancer contract and we should not pass knee-jerk judgments upon new ideas which aim for better outcomes and efficiency.”

That is what Macmillan is after.

[Barbara Keeley]

I thank the hon. Gentleman for that comment, but the point is that Macmillan Cancer Support is using money fundraised by the public in ways that I do not think the public would approve of. That was the key thing we explored. It is not at all clear, if we look at the Macmillan website, how it is using approaching £1 million of the public’s money, donated on that basis.

[Valerie Vaz]

My hon. Friend mentions conflicts of interest. Is she aware that one of the companies bidding for the privatisation of cancer services is UnitedHealth Group, which was advised by the chief executive of NHS England?

[Barbara Keeley]

Indeed. Now that the shortlist for bidding has been announced for end-of-life care, we find that five of the shortlisted bidders are private companies, with only two NHS trusts on the list. For cancer care, there are three private companies and two NHS trusts. Given the seemingly headlong drive for change we found in those commissioning this large and risky contract, a great number of questions were left unanswered. For instance, despite the key role that GPs play in end-of-life care for patients choosing to die at home, the prime provider of end-of-life care will not have control over the actions of the GPs involved in that care unless a specific contract is drawn up and GPs are paid for extra tasks.

The contracts for cancer and end-of-life care are to be placed in early summer 2015, and I invite anybody with an interest in this to review the evidence and, in particular, the unanswered questions in the session the Health Committee held on 14 October. I have yet to find assurances in the evidence I have heard that the profit motive of private providers can be squared with the objective of improving cancer care and end-of-life care for patients.

[Chris Ruane (Vale of Clwyd) (Lab)]

Cancer care for north Wales is provided by bodies in the north-west of England. MPs on the Government Benches are saying that I, as a Welsh MP, should not have a vote on this matter. What does my hon. Friend think about that? Should I be concerned about standards of care and the privatisation of the English health service? My constituents will suffer if it is hollowed out and privatised by the Government.

[Barbara Keeley]

My hon. Friend absolutely should be concerned and I know that he is.

One of the elements of cancer and end-of-life care given to us as an example of where improvement is needed in Staffordshire and Stoke was patient transport. However, we know in the north-west that going to new private providers does not tend to help. We have already had a negative experience since patient transport was contracted out to the bus company Arriva.

A number of my constituents have had problems with Arriva’s patient transport. One contacted me following a wait of more than three hours for ambulance transport to be arranged for her husband. He has terminal cancer and needed to be transported back to Salford Royal after oncology treatment at the Christie hospital. That was the second time in three weeks that this terminally ill patient had to wait two or three hours for transport. Staff at the Christie hospital told my constituent that such long waits were common, despite the fact that many oncology patients are very sick.

[Mr Slaughter]

I am very grateful to my hon. Friend for giving way, particularly because the Minister did not in the course of his very long speech. Of course, that might have been because the main emergency hospital in my constituency, Charing Cross, is being demolished, losing all but 24 of its 360 beds, losing the best stroke unit in the country and losing its A and E, which, according to board papers, is moving from the site. There will be no emergency consultancy services at all. Is not what is happening on the ground very different from the jargon-filled rubbish we heard from the Minister today?

[Barbara Keeley]

Absolutely, and I am saying what is happening on the ground to a terminally ill cancer patient.

In her letter to Arriva, my constituent told the company:

“Your company should not have this contract if it displays such a lack of concern for very ill patients causing distress to both them and their relatives”.

Not only was the delay unacceptable to a terminally ill patient, but the reply to my constituent’s complaint was one of the worst I have ever seen, as we are talking about gobbledegook. For instance, the explanation for the long wait included the following sentence:

“When an outpatient booking is made, the expected outbound blocking is automatically populated, using the throughput assumption.”

The jargon that starts at the top permeates down even to the complaint handling. It took a lot more letters to get an apology for such appalling service and such a poor reply.

Another constituent has told me of unsuitable transport and untrained staff—we have heard about this happening across the country—sent to the home of a patient who needed to use a wheelchair. That meant that the patient missed their appointment and an important investigation of their health was delayed by a number of weeks. I trust that the commissioners driving the privatisation of cancer services in Staffordshire and Stoke are aware of just how wrong transport services can go with a private transport provider.

This Government’s measures have put competition and privatisation above the needs of NHS patients. The Health and Social Care Act has put pressure on regulators to make clinical commissioning groups and NHS trusts adopt tendering processes that are not in the best interest of patients. That means wasted money, resources and time. This Bill would remove these damaging reforms, and patient care would be prioritised instead of unnecessary competition. The Bill would not prevent competition within the NHS, but it would prevent competition at the expense of patient care.

Our national health service is different from other sectors and needs a different approach. Integration to improve patient care needs collaboration rather than competition. It is a great pleasure to be in the Chamber today to speak and vote in support of the Bill.

Physical Inactivity (Public Health)

Barbara Keeley Excerpts

Tuesday 18th November 2014 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Weir. I congratulate my hon. Friend the Member for Blaenau Gwent (Nick Smith) on securing such an important debate. We need to promote physical activity to people across the UK. The issue is important to me as a constituency MP in an area that has very low levels of physical activity. I am co-chair of the all-party group on women’s sport and fitness, and I encourage hon. Members to support that group. Last year, I was co-chair of the all-party commission on physical activity.

As an MP in the north-west of England, I am concerned that ours is one of two regions in the north with the highest levels of inactivity in the UK. In our region, 32% of the population is classified as inactive, which represents an inactivity level 5% higher than in the south-east. Reports demonstrate that deprived areas have higher levels of inactivity than the least deprived areas; the hon. Member for North Swindon (Justin Tomlinson) has referred to some of the reasons for that. The sheer cost of undertaking physical activity and classes sometimes gets in the way. My constituency is in the top 40 local authorities with the highest inactivity rates, and 33% of people are inactive. We need action locally to tackle the problems.

There are stark differences in inactivity rates not only between regions, but between men and women. There is a worrying gap between the rates of men and women who undertake exercise. The most recent figures from Women in Sport, which was formerly the Women’s Sport and Fitness Foundation, show that only slightly more than 30% of women in England aged 16-plus take part in sport or fitness once a week, compared with more than 40% of men.

In Salford, the gap is even greater, with only 25% of women taking part in weekly exercise. Figures from Sport England demonstrate that more men take part in activity than women in every age group up to age 65. That is serious, because being physically inactive shortens a person’s life span by up to five years and is responsible for 17% of premature deaths in the UK. Indeed, if everyone in England were sufficiently active, an estimated 37,000 lives would be saved every year. We must take that seriously.

I find it interesting that inactivity is as dangerous to health as smoking. Because women are less active than men, women are subject to an increased risk of ill health and premature death. The reasons for the gender gap in inactivity rates are well established. Women and young girls either face, or feel that they face, many barriers when it comes to sports participation. Barriers exist at both grass-roots sport level and elite levels. In the all-party group on women’s sport, we work to identify those barriers and the actions needed to remove them.

The all-party group pressed the Culture, Media and Sport Committee to hold an inquiry into women in sport, which it did. The Committee’s report, which was released in July this year, contained some interesting recommendations and confirmed many of the reasons for the gender gap in activity. It is not that inactive women do not want to play sport or to be active; research from Women in Sport showed that 12 million women, more than half of whom are inactive, want to play more sport. Many of the sports that are most popular with women, such as running and swimming, are done informally—that is an interesting clue—so they are outside the formal funding structures for sport.

Women make up 62% of participants in swimming, 42% of participants in tennis and 41% of participants in athletics, particularly running. I will come on to talk about running informally, because it is an attractive sport to women who have family responsibilities or other commitments that prevent them from taking part in team sports. There is also a clue in the figures for team sports. Only 7% of participants in football, 8% of participants in rugby union and 9% of participants in cricket are women. We can see a real trend there; women are tending to do informal sports such as running and swimming.

Many girls are put off exercise and sport at a young age, and too many girls end up thinking that sport is simply not for them. Sports such as football can seem entirely male, judging from the media coverage that they receive. Women’s sport accounts for only 0.5% of all commercial investment and only 7% of the media coverage of sport, which makes it even more difficult to encourage girls and women to participate.

In terms of financial reward, it is surprising that male footballers are paid millions of pounds every year, but women’s teams are nearly always amateur or semi-professional. Members of our England women’s football team are on contracts under which they are paid £20,000 a year—not £20,000 a day or a week, but £20,000 a year—and the England women’s rugby squad were not put on paid contracts at all until after they had won the rugby world cup. Every time I mention that, I get comments on Twitter stating that that is because of a lack of interest in women playing sport. I understand that 55,000 tickets have been sold for the England-Germany women’s football match at Wembley this Sunday, so perhaps that tide is turning.

Women’s and girls’ negative perceptions of sport often stem from negative experiences of physical education and sport at school. That point is supported by the Culture, Media and Sport Committee report. A survey carried out by Women in Sport found that 51% of girls felt deterred from physical activity by their experiences of school sport and PE. Many girls describe their experience negatively, citing a lack of choice, an overly competitive environment, a lack of confidence in their own ability and concerns about body image. It is essential that we change young girls’ perceptions of sport if we want them to be active for life. We must, as my hon. Friend the Member for Blaenau Gwent said, create exercise classes and sporting activities that actually interest girls.

I look forward to the campaign being launched by Sport England, which aims to change our perception of girls and women doing sport. The campaign is called “This Girl Can”, and it will aim to see more women and girls exercising regularly or playing sport with less fear of judgment, more confidence and more enjoyment.

I will mention two very worthwhile initiatives of the sort that we see springing up now. “Fatty Must Run” is a social media advice and support initiative and Twitter account run by Julie Creffield, and it helps people who are overweight and starting to take exercise. Another great initiative is the “Couch to 5K” running group in Blackburn, where volunteers support free group running sessions to encourage inactive people to run regularly. As part of our thinking about how to increase activity levels, we must look at similar wonderful, often voluntary, initiatives and find ways to support them.

It is time to focus on the scale of the problems we face with inactivity and health. I have mentioned that we could save 37,000 lives a year if everyone in the UK were sufficiently active. Women in the UK have the 10th highest rate in the world of cancers linked to physical inactivity. In 2012, there were nearly 79,000 deaths across the country from bowel, breast and womb cancers, of which an estimated 12,000 could have been prevented if women were more physically active. In Salford, the CAN-Move project aims to ensure that physical activity is part of the pathway for patients with breast, bowel or prostate cancers, and it offers those patients a 12-week physical activity programme. Such projects should be available more widely, but the most important thing is to focus on encouraging people to be physically active earlier, not simply when they already have a cancer.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

First, I thank the hon. Member for Blaenau Gwent (Nick Smith) for securing this debate on such an important topic. It is one of my personal passions, particularly while I have been in this job. It is evident from the contributions of so many colleagues, who made so many thoughtful points, that many share my passion for this area. I do not pretend to think that I can respond to every specific point that was raised, because it has been a varied and wide-ranging debate, which demonstrates Parliament’s appetite to get stuck into this topic. I will return to the powerful role that MPs have in increasing levels of physical activity if I have time towards the end of my remarks.

Society has changed a great deal, and that sits behind everything we have been debating this morning—why we have become more sedentary—and other Members have laid that out. I will not spend too much of my speech going over the evidence base, because it has been well covered by the hon. Gentleman and other Members, but the evidence base is well established for the problems that the level of physical inactivity in our nation is causing. I was pleased to hear Members talk about not only physical conditions, but mental health. I think dementia was also mentioned. There is an important evidence base for the fact that becoming more physically active can benefit people in a great many ways. One of my personal passions is how physical activity can impact on social isolation and exclusion; I will try and touch on that later. I will not reiterate what other Members have said on the statistics on how inactive we have become as a nation, because they are all on the record; I would prefer to use my time—I am conscious of leaving a little bit of time for the hon. Gentleman to wind up—by telling the House what the Government are doing.

I will say a few words about obesity. It is a slightly complex area, as I was saying to the hon. Gentleman just before we came into the Chamber. We are clear that all the expert evidence suggests that while physical activity brings the important health benefits that we have been discussing—such things as stronger muscles and bones and improved cardiovascular health and metabolic health, as well as some of the psychological well-being aspects—tackling obesity is fundamentally about eating and drinking less. That is what will lead to significant weight loss. That is not to belittle the role of physical activity, but to emphasise its importance. Physical activity cannot just be seen through the narrow prism of its role in weight loss, because it is bigger and more important than that and goes to the heart of so many well-being and other social issues. I am keen that it is not cast only in the light of weight loss. We need to understand its role in tackling obesity, not least in encouraging active lifestyles in children from the very start and not building up problems for future generations, but it is a little more complex than that.

[Barbara Keeley]

Will the Minister acknowledge that it is important for overweight people and large people to take exercise, because they will be healthier, whatever size they are, if they do that? There is a danger in focusing just on weight loss, instead of exercise. If people take exercise, it is likely to lead to a healthier lifestyle and a desire to lose weight.

[Jane Ellison]

Absolutely. I could not agree more with the hon. Lady. It is exactly why we should not just link obesity and physical activity together. It is better for everyone to move. I will come on to some of the conditions that are helped by that, but she is right that whatever someone’s age, weight or state of health, moving more is always a better option.

Members have touched on this, but it was an important moment when we saw prevention put right at the heart of the NHS with the publication of the “NHS Five Year Forward View”. Public Health England collaborated closely with the NHS on the prevention chapter of that forward view, which states:

“The future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.”

It cannot be said more profoundly than that that this issue is important. The attention given to that aspect of the forward view was heartening to me as the public health Minister, because I had not heard the prevention agenda put quite so much at the heart of the health debate in our country and related to the sustainability of our great public services to that extent.

Members have talked about shifting the narrative. With the best will in the world, Governments can only do so much. We have to shift the population’s thinking from where we are now to where we need to be. A couple of Members touched on the role of some of the major charities. I have been having conversations with some of the major health charities about how they can harness the reach and reputation they enjoy among our population. For example, Macmillan Cancer Support is famous for its wonderful cancer care, but it is a bit less famous for the excellent work it does with the Ramblers on the evidence base on walking as a key element of physical activity. I have been talking to Macmillan and others, including some of the big cancer charities, about what more they can do to get people to understand more widely the role of physical activity in preventing diseases, because those charities have enormous reach into the population.

I pay tribute to Breakthrough Breast Cancer on its message, “Raise your pulse, reduce your risk”, which is a campaign that tells women that 30 minutes of daily physical activity can reduce the risk of breast cancer by at least 20%. Arthritis Research UK launched a piece around understanding arthritis, which addresses exactly the point that the hon. Member for Worsley and Eccles South (Barbara Keeley) made in her intervention. It is tackling the misguided belief that someone should rest if they have joint pain and is trying to put some of its weight, resource and reputation behind simple messages on standing, walking and being more active, even for people with some of those physical challenges.

We have dwelled a lot on physical inactivity among the young, and I will come on to some of the things that the Government are doing to help that, but the most inactive generation is the oldest generation. Only one in 10 men and one in 20 women over 75 are active enough to stay healthy. I am lucky enough to have both my parents still with me—one is 80 and the other is just under 80—and very much active and healthy. My father is still cycling 50 miles a week at 78. I look at their lifestyles and I see how much can be gained from staying active as people grow old. It helps them to remain independent for longer and tackles some of the thorny issues of social isolation. Active older people are unlikely to be lonely. We must be passionate about the activity agenda for older people, as well as the sensible focus on getting the young into good habits.

On the role of Government, experience from across the globe shows that getting everybody active every day will work only if everyone is involved, including all levels of government, so I want to discuss what we have been doing recently, because the level of activity is good. At a national level and following up on the Olympic legacy—I chair a cross-ministerial group on the physical aspect of the legacy—we started “Moving More, Living More” as a cross-Government policy to get more people active. It stresses that physical activity is everyone’s business. If it just sits in a health silo, we will fail again. I have had conversations with Lord Coe, who recognises that we have been around this circuit before. Physical activity cannot just be a health measure; it must be embedded across all levels of Government and local government.

Following on from that, we have taken a much more granular approach and have provided a proper toolkit. Just last month, Public Health England published the “Everybody Active, Every Day” framework. It was going to be published early next year, but I urged it to bring that forward to this autumn, so that it was available to local authorities when planning their 2015-16 spend. We have provided £8.2 billion for public health over three years, and it is important that we also provide the best evidence base for how to spend that money for local populations.

I want to describe how the scheme was produced, because it has been a wide-ranging collaborative effort. I hope that MPs all received their toolkit. It might still be lurking in the inbox—we all receive a lot of e-mails—but please look for it, because it was designed to give MPs a role in promoting the agenda. The campaign was co-produced with more than 1,000 cross-sector organisations and individuals at national and local level. It was begun at a workshop in January this year. Since then, we have had nine expert round tables attended by more than 200 experts. Five regional forums have been attended by some 750 individuals, including people from local authorities. The “Moving More, Living More” policy and the recommendations of the all-party commission on physical activity—I see one of its members here—fed into the process. We held sector-specific presentations and workshops, bilateral meetings with Government and nine expert rapid topic overviews.

Good and promising practice has been collated, and we have also commissioned work on what constitutes such practice, with more than 960 submissions for assessment. I have also commissioned a review of return on investment data, which is critical for local government. A public consultation was held on the draft documents, with 183 submissions raising 550 specific issues. The output from the exercise, which was launched at the Oval last month, includes a toolkit, as mentioned, for elected representatives—I worked with Public Health England on the MP toolkit and we are looking at one for locally elected members as well—and free British Medical Journal-sponsored e-learning modules. Regarding the review of promising practice in communities, we have commissioned the Centre for Sport and Exercise Science and ukactive’s research institute to consider and rate submissions. We have also done some detailed topic overviews, in particular looking at some in-depth guidance for addressing complex issues around deprivation and health inequalities, which will respond to one of the points raised by the hon. Member for Blaenau Gwent.

I have attended a high-level round table with local government leaders, who I must say are a great deal more optimistic than the shadow Minister about their ability to deliver on this agenda. The meeting was cross-party and extremely positive, and I have seen many of the things that they have been doing. This is a collaborative effort right across local and national Government to take us to the next level in terms of an evidence-based approach to physical activity. Like the right hon. Member for Rother Valley (Kevin Barron), who spoke about public health sitting well with local government, I absolutely think that it has landed in the right place. I have seen some fantastic examples of real leadership, but we need to give local government the tools to do the job. We do not want people endlessly reiterating the evidence base and endlessly trying to work out what works and carrying out their own evaluations when that can be done at a national level through the resources of Public Health England.

The four areas within “Everybody Active, Every Day” are “Active society”, “Moving professionals”, which is about ensuring that our professionals are geared up to make every contact count, “Active environments”, and “Moving at scale”, which is about the big interventions—as opposed to small, excellent micro-interventions—that will really make a difference to the population. The framework contains a lot more detail, and I urge Members to have a look at it, because it is what we are now engaging with local government leaders on. I was asked about the data that local authorities have at their disposal and the Active People survey provides them with areas to target.

In addition to all that, my Department has given £11.4 million to the Change4Life sports club programme, through which 13,500 clubs have been established to help our children to be more active. Those clubs have deliberately been set up in areas of high childhood obesity and significant deprivation. We are also investing £180 million over three years into the primary PE and sport premium to improve health outcomes for primary-age children. We have provided £30.5 million to fund the School games organisers, who are responsible for delivering the games and co-ordinating Change4Life sports clubs. Much work is ongoing with the Department for Transport around cycling cities, and we have augmented its funding by putting money into five walking cities.

Sport England recently announced that it is also making more money available to help to get people more active. I echo everything that has been said today about women’s participation and removing barriers to entry. Some extremely good points were made. I welcome the fact that Sport England has recognised that and is looking to fund things that many of us would not traditionally recognise as sport and things beyond team sport. Like my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes), I remember the Lycra shame of the 1980s and the “feel the burn” movement. We do not want people to go to something once and then give it up. We must remove the barriers to entry. I heard about wonderful local government initiatives, such as T-shirt swimming days for people who do not want to swim in just a swimsuit, and other clever things.

However, we need to get the message out there, which much of the debate concentrated on. I must be honest that I do not believe the chief medical officer’s guidelines are well understood. They are difficult for health professionals to understand and the same is certainly true for the public. I have commissioned a piece of work from Public Health England to develop a mantra for physical activity similar to “five-a-day”, which, if not universally observed, is widely known and understood.

I hope that I have provided a sense of how we are trying to follow up on the Olympic and Paralympic legacies. Lord Coe has been clear that that will be judged over decades not years, because although the shadow Minister suggested that it has developed over the past five years, the problem has developed over decades, but we are taking action. MPs have a valuable role to play. It is a huge job, but we are making great strides towards getting everybody active every day. I thank Members for their participation in the debate.

Oral Answers to Questions

Barbara Keeley Excerpts

Tuesday 21st October 2014 Commons Chamber

[Mr Hunt]

When I started speaking out about poor care in England—one of the first things I did in this job—those on the Labour Front Bench said that I was running down the NHS. The result of my speaking out is that we are turning around failing hospitals and have 5,000 more nurses on our wards. The NHS in England is getting safer and better, and we want exactly the same thing for Wales.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

15. How many training posts for nurses were commissioned in England in each of the last three years.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

Between 2010 and 2013, 52,528 new pre-registration nurse training places were filled, and this year Health Education England has made 19,206 new places available.

[Barbara Keeley]

It is interesting that the Secretary of State cannot follow his own advice about not making operational matters in the NHS political footballs. Perhaps we can try again. The number of nurse training places has been cut by thousands since 2010—a key issue given the need of hospitals to reach safe staffing levels. The Royal College of Nursing has said that Labour’s plans for 20,000 more nurses are absolutely necessary. Does the Minister agree?

[Dr Poulter]

It is right that hospitals respond when there are not enough staff working there, if that is affecting patient care. That is why under this Government 2,500 more nursing staff are working now than in 2010. That is progress to ensure that we are facing up to challenges in care where they exist at local hospitals.

NHS Services (Access)

Barbara Keeley Excerpts

Wednesday 15th October 2014 Commons Chamber

[Andy Burnham]

I am interested to see this new friendship that my hon. Friend has struck up with the hon. Member for Clacton (Douglas Carswell) on the Front Bench. My hon. Friend is absolutely right. The promise was that there would be no top-down reorganisation. We told the Government that it would be a major mistake to break that promise. They broke that promise and now they are admitting it in private to newspapers. I will come to that point a bit later.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is worth saying to my right hon. Friend and to the hon. Member for St Ives (Andrew George) that all of us on the Health Committee were very concerned yesterday when we spoke to people in Staffordshire and Stoke, because they were talking about what seemed to be the privatisation of cancer and end-of-life care services. That seems to be going on much to the consternation of clinicians and radiologists who were not consulted; much to the consternation of NHS staff and of an awful lot of patients and people who live in that area. It is very concerning indeed that we find ourselves in that situation. That could be one of the biggest mistakes that is made in the NHS.

[Andy Burnham]

I am glad that my hon. Friend raised that point, as again it highlights the major difference between us and the Government. They were saying that we brought in private providers. Yes, that is true, but that was to bring down waiting lists for planned operations, such as hip and knee operations. As she has just rightly said, the Government are putting out to tender cancer services. That is a very different thing. The Government are presiding over a major increase in private ambulances providing blue light 999 services. That is a massively different policy from the one they inherited, which is why the points they have made simply do not hold water.

--- Later in debate ---

[Mr Hunt]

I will give way in a moment, but I want to make some progress.

I want to go through the arguments of the right hon. Member for Leigh in detail, but let me start with the elephant in the room: the massive financial pressure facing the NHS if it is to meet our expectations in the face of an ageing population. There are now nearly 1 million more people over 65 than when this Government came to office. Our economy then was nearly bankrupt. Despite those extraordinary challenges, this Government have been able to increase spending on our NHS—including on Leigh infirmary in the right hon. Gentleman’s constituency—because of our difficult decisions, which were opposed at every stage by the Labour party. Government Members know one simple truth: a strong NHS needs a strong economy.

On the day that unemployment fell below 2 million and the claimant count fell below 1 million, there was nothing in the right hon. Gentleman’s speech about the need for a strong economy to support our NHS and nothing about learning from the Labour Government’s disastrous mistakes, which were so bad that they were in fact planning to cut the NHS budget had they won the election. We should remember that countries that forgot about the deficit ended up cutting their health budgets—Greece by 14% and Portugal by 17%. [Interruption.] Well, these are the facts. We must never again in this country allow the poor economic decisions that have been the hallmark of every Labour Government in history.

[Barbara Keeley]

It is interesting that the Secretary of State is claiming credit for things where the data are based on Labour’s achievements with the NHS, while anything else is our fault. He talked about older people and the demographics of an ageing population, but what good does he think he is doing to that section of the population with £3.7 billion of cuts to social care? Particularly as we move to integration, how does he think that will help those people? In my local area, 1,000 people will lose their care package this year. How does he think that will help the NHS in Salford?

[Mr Hunt]

I will tell the hon. Lady what we are doing: we are integrating the health and social care systems through the Better Care fund—a £3.9 billion programme—which is something that Labour could have done in 13 years in office but failed to do. That will make a massive difference to the social care system. Let us move on to some of the detailed arguments.

--- Later in debate ---

[Mr Hunt]

That is the point. We get all sorts of rhetoric from Labour, but when we look at its record of running the NHS—whether its disastrous record in England previously, or its disastrous record in Wales today—we see the real face of Labour policies on the NHS, and no one should ever be allowed to forget it.

There has been a lot of discussion about reorganisation. The right hon. Gentleman criticised reorganisation as if it were the last thing in the world that a Labour Government would do, but the previous Labour Government had nine reorganisations in just 13 years. Following the conference season, we know that Labour wants to have yet another one by effectively abolishing clinical commissioning groups in all but name and making GPs work for hospitals. There is widespread opposition to that policy across the NHS.

The right hon. Gentleman has repeatedly claimed that the reforms have cost £3 billion, but the audited accounts show that the reforms will save nearly £5 billion in this Parliament and £1.5 billion a year thereafter. These are the words of the National Audit Office—[Interruption.] He should listen to this, because this is about an independent audit that relates to a key part of his case. These are the words of the National Audit Office in its 2013 report:

“The estimated administration cost savings outweigh the costs of the reforms, and are contributing to the efficiency savings that the NHS needs to make.”

Will he publicly correct the record and accept what the National Audit Office has said, which is that the reforms saved money? The man who is never short of a word is suddenly silent. I have the National Audit Office report here, so he can see for himself. The reforms saved money.

If the right hon. Gentleman wants to talk about wasting money, I am happy to do so. The management pay bill doubled under Labour, compared with a 16% drop under this Government. The private finance initiative schemes left the NHS with £79 billion of debt. The IT fiasco wasted £12 billion. We will take no lectures on wasting money from the party that was so good at wasting it that it nearly bankrupted the country, let alone the NHS.

[Barbara Keeley]

Will the Secretary of State give way?

[Mr Hunt]

I will make some progress.

The right hon. Gentleman said that the reforms have made it harder to access NHS services. The opposite is true. Scrapping the primary care trusts and strategic health authorities meant the introduction of clinical leadership, which he wants to abolish, and allowed the NHS to hire 6,100 more doctors and 3,300 more nurses. Those members of staff are helping the NHS to do 850,000 more operations every single year compared with when he was in office. How can he possibly stand before the House and say that access to NHS services is getting worse, when nearly 1 million more people are getting operations every year compared with when he was Health Secretary?

--- Later in debate ---

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The Government argued that the current NHS reforms—their NHS reforms—would result in major savings to the NHS, making our system more “responsible, efficient and affordable.” I am sure that many Labour Members will agree that reforms under the Health and Social Care Act 2012 have failed to deliver a single one of these aims. The NHS is costing more and delivering less, the quality of care it provides has declined and hard-working staff, particularly GPs, nurses and staff in A and E, are bearing the brunt of the Government's misguided and irresponsible measures.

It seems that senior Cabinet Ministers may think the same as Opposition Members. As we have heard, The Times quoted one as having said:

“We’ve made three mistakes that I regret, the first being restructuring the NHS. The rest are minor.”

I think that it is about time Government Members owned up to their mistakes, and started to share their opinions openly with the House.

The reorganisation caused upheaval in every part of the NHS. Primary care trusts and strategic health authorities were abolished, and commissioning responsibility was transferred to NHS England as well as to clinical commissioning groups. The chair of a health and wellbeing board told me last Friday: “I am left more confused by the NHS England role than by anything I have seen over decades of involvement with the NHS.” More than 440 new organisations have been created, but all the evidence now shows that that has been done at a heavy economic and social cost. Some £3 billion has been wasted on altering the structure of the NHS rather than being spent on front-line patient care, and the reforms have consistently failed to be delivered within budget. In July last year, the National Audit Office stated that the cost of their implementation had been 15% more than originally expected.

Of course, we hear counter-claims from Ministers. When I tried to intervene on the Secretary of State, he would not take an intervention on the issue of management and reorganisation costs. It was interesting to hear what was said yesterday by Kieran Walshe, professor of health policy and management at Manchester business school, on Radio 4 about the savings claimed by the Secretary of State. He said that the Government had under-counted the costs of reorganisation, even to the extent of accepting nil returns from some strategic health authorities. Most tellingly, he said that the best way in which to test the facts was to talk to people in the NHS who had lived through the reorganisation. He said that he had not talked to anyone who thought that the reorganisation had made the NHS more efficient and more productive. He had not talked to anyone who thought that the trauma of total reorganisation and redesign was worth while. None of us understands why PCTs were replaced by CCGs, or why NHS England was created. He also said:

“I don’t think you will find anyone who thinks the new system costs less to run”.

We know that the financial difficulties of the NHS have worsened, not improved. For the first time, foundation trusts have found themselves in deficit, along with trusts that are not foundation trusts. Figures from Monitor showed that 86 out of 147 trusts were in the red, and that there had been a deficit of £167 million in the first quarter of 2014-2015. Alongside that, not surprisingly, we are seeing a decline in patient care. In all areas of the NHS, pressures are mounting and the quality of care is declining. The number of people waiting more than a week for an appointment with a GP is up. A survey of patients in Salford for our CCG showed that a third of the patients who responded had had to wait for days for an appointment, and one in seven Salford patients had had to wait for a week or more. That is better than the national picture, but it is not good enough. For the first time, the NHS has missed its cancer treatment target; and NHS workers have felt the need to go on strike—the largest strike of its kind in over 30 years. We have an NHS in crisis.

As we know, there are many challenges in addition to the damage that has been inflicted by the Health and Social Care Act 2012. We have heard about the mounting demographic pressure on health services. However, despite the increase in the number of people aged over 80, the Government have slashed local authorities’ budgets, causing them, in turn, to change eligibility for social care. I believe that that is one of the most serious failings. My city council in Salford has been subjected to savage cuts of £100 million, and—I mentioned this earlier, and I shall keep on mentioning it—1,000 people in Salford will either lose care packages or not qualify for care this year.

[David T. C. Davies]

Does the hon. Lady think that members of the public should vote against any members of any political party who have imposed a cut on the NHS anywhere in the United Kingdom?

[Barbara Keeley]

I am not going to answer hypothetical questions like that. I am talking about local authority budget cuts, and the parlous state in which social care will find itself after £3.7 billion has been taken away from it.

Constituents have told me about care staff working locally who have been allocated too little time to devote to the people in their care. That is a scandal. I have been told that a single care worker was sent out when two were needed to care safely. I have also been told about patients in nursing homes who have not been properly changed or helped to eat by care staff who are rushing to manage their work load. That is the reality, and it is not the way in which to create a sustainable health and social care system. I therefore wholeheartedly support Labour’s alternative plans. We must create an NHS with the time to care.

I agree with my right hon. Friend the Member for Leigh (Andy Burnham) that we must repeal the Health and Social Care Act 2012 before it causes any additional lasting damage to a health system of which people in this country are rightly proud, although they will not be for much longer. I shall be here on 21 November to vote for the private Member’s Bill. We must find ways of providing the resources to cope with the challenges that the NHS will face. As my right hon. Friend said, Labour has pledged to raise £2.5 billion for the NHS Time to Care fund, which will provide 20,000 new nurses, 8,000 more GPs, 5,000 new homecare workers and 3,000 more midwives. And do we need them? Yes we do.

We must also move towards an integrated model of health and social care. That integration in itself will not solve the financial problems the NHS faces, but moving to a model that allows for equal consideration of all a patient’s health and care needs can improve services and should reduce duplication. Above all, we must place patients and carers back where they belong, at the heart of a health and social care system that works for them and puts their needs before those of the providers and the ridiculous and convoluted commissioning structures that we have been arguing about in the debate today.

Ebola

Barbara Keeley Excerpts

Monday 13th October 2014 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right that what happened in Dallas is of great concern. We need to listen to our colleagues in the Centre for Disease Control in the US as they try to understand exactly what happened. If they decide that we need to change the protocols for protecting health care workers, we will of course take that advice extremely seriously. At the moment, their scientific assessment is that there was a breach in protocol, not that the protocols were wrong. Until we identify what those breaches were, we cannot be 100% sure. We are working very closely with them and we have a good and close working relationship. We will update our advice to UK health care workers accordingly.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I thank the Secretary of State for the answers he has given so far, but my right hon. Friend the Member for Leigh (Andy Burnham) asked whether he was satisfied that all relevant NHS staff, including all GPs, know how to identify Ebola, know the precautions to take with patients presenting, and know the protocols for handling Ebola. I did not get a sense from the Secretary of State’s reply of how complete that knowledge is. He has talked a lot about receptionists, and that is important as they are in the front line of risk, but hospital cleaning staff and cleaning staff in GP practices are also at risk if such patients present.

[Mr Hunt]

The hon. Lady makes an important point, but I reiterate the point I made earlier to another hon. Member. The risk level to the UK general population remains low, so the measures we are taking are precautionary because of a possible increase in that risk level. As part of that, we are sending advice to everyone we think might be in contact with anyone who says that they have recently travelled to the Ebola-affected areas and who displays those symptoms. That is why alerts have gone out to hospitals, GP surgeries and ambulance services to ensure that they know the signs to look for and are equipped with that important advice.

Pancreatic Cancer

Barbara Keeley Excerpts

Monday 8th September 2014 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure as always to speak with you in the Chair, Mr Chope. I congratulate my hon. Friend the Member for Scunthorpe (Nic Dakin) on the excellent way he opened the debate and the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw) on working with my hon. Friend to secure the debate and his very moving contribution. I join them in congratulating Mrs Maggie Watts on gaining more than 106,000 signatures for the petition. Anyone who takes or promotes petitions through social media will know what a mountain 100,000 signatures is to climb.

Mrs Watts started the e-petition to help to push pancreatic cancer higher up the political agenda, to raise the disease’s profile and to encourage more funding and research into it. That is certainly starting to happen with the debate today. As Mrs Watts has said,

“pancreatic cancer has been neglected both in terms of funding and awareness for way too long.”

The fact that her husband stood

“no better chance of survival in 2009 than his mother did in 1969 demonstrates completely how little progress has been made.”

As the petition states, pancreatic cancer is the

“5th leading cause of UK cancer death, with the worst survival rate of all cancers”.

Yet, as we have already heard, it receives only about 1% of the research spend. Further, the five-year survival rate of less than 4%, as we have heard,

“hasn’t improved in over 40 years, whilst survival rates for other cancers have.”

It is worth looking at those survival rates. The current survival rate for bowel cancer is 54%; it was 22% in 1971. The current survival rate for breast cancer is 84%; it was 56% in 1971. For prostate cancer, to which I recently lost a friend, the current survival rate is 81%; it was 31% in 1971. From those figures, we can see that pancreatic cancer lags behind. Clearly, as has already been discussed, more funding and more public awareness are vital so that progress can be made, both in earlier detection, to which hon. Members have already referred, but, ultimately, in better survival rates.

Pancreatic cancer is termed the silent killer. As we have heard, many of its symptoms mirror other, less critical illnesses. We have also heard that GPs may not recognise these early enough, looking first at other possible causes, resulting in lost time before diagnosis. That is serious because in many cases the prognosis will be terminal by then. It is quite a disturbing fact that deaths from pancreatic cancer did not just stay the same but increased between 2002 and 2013, while deaths from most other cancers declined.

It is clearly difficult that the signs and symptoms of pancreatic cancer can be late occurring and non-specific. As my hon. Friend the Member for Scunthorpe said earlier, these non-specific symptoms may lead to patients being treated or investigated for other more common illnesses, such as gallstones, before a diagnosis of pancreatic cancer is made. This in turn can mean significant delays in diagnosis and treatment, including potential curative surgery. As we have heard—I am sure we will come to this point and put more questions to the Minister on it—we are talking about patients whose symptoms and diagnosis do not fit our system. Our system needs to change, so that these patients get the investigations and diagnosis they want.

[Stephen McPartland (Stevenage) (Con)]

Is the hon. Lady as shocked as I am that apparently 48% of people are diagnosed with pancreatic cancer following an emergency admission, as opposed to following a referral from their doctor or following a screening?

[Barbara Keeley]

Yes, indeed I am. As is always the case in these debates, I was coming to that point. We have had an excellent briefing from Pancreatic Cancer UK, which says that there are symptoms that lead patients to visit their GPs. As the briefing said:

“If patients can present at an earlier stage and GPs are better trained and supported to identify and investigate the possible signs of pancreatic cancer, more people will be diagnosed at a stage when curative surgery is still an option.”

The NHS England cancer patient experience surveys have shown that more than 40% of pancreatic cancer patients visit their GP three or more times before being referred to hospital. I found examples in case studies that were many more times than that. Some people, as in the tennis ball example mentioned by my hon. Friend the Member for Scunthorpe, went to GPs 10, 15 or 16 times. That is not acceptable. By comparison, figures show that 75% of all cancer patients combined are referred to hospital after only one or two visits to their GP. That is as it should be for this dreadful disease.

The hon. Member for Bracknell (Dr Lee), who is no longer in his place, spoke about the difficulties for GPs. Pancreatic Cancer UK found in a survey it conducted that, although most GPs could list one or two of the symptoms of pancreatic cancer, half of GPs were not confident that they could identify the signs and symptoms of pancreatic cancer in a patient. All these facts underline the need for better awareness of pancreatic cancer. Leading charities want to see a campaign based on the specific symptoms of pancreatic cancer.

The briefing reminds us of the need to challenge perceptions of pancreatic cancer as a disease affecting small numbers of elderly, male patients. Although it is true that incidence increases with age and the majority of cases are reported in older patients, it may be that they would be younger if the diagnosis and investigations were better. However, about 25% of cases still occur in people under the age of 65. We have heard examples concerning people in their 40s. The disease affects men and women equally.

Pancreatic cancer awareness month in November, which the hon. Member for Redditch (Karen Lumley) referred to, will help raise awareness. We know the awareness-raising value of storylines such as the one in “Coronation Street” with Hayley Cropper, which developed the pancreatic cancer that led to the character’s death and helped to create a great upsurge in internet traffic, inquiries and donations to pancreatic cancer charities. Like my hon. Friend the Member for Scunthorpe, I pay tribute to Julie Hesmondhalgh for her support for campaigns and for the petition that led to the debate. We need to see much more of that.

We have had excellent briefings for the debate, but I wanted some insight into treating pancreatic cancer. I asked a doctor working in palliative care. He described his thoughts and his experience of treating patients with pancreatic cancer in these words:

“The issue is not only one about cure rates but that pancreatic cancer presents a massive challenge to the health service in terms of the consequences of this awful disease.

The symptom burden in patients with pancreatic cancer is both substantial in the number of patients affected but also in the intensity of those symptoms.

From the research, 75-80% of patients present with pain at initial presentation. Of these, 44% of the patients admitted to a palliative care setting have severe pain.

Because of the anatomy of the pancreas, many of these patients will have infiltration of the coeliac plexus causing neuropathic pain which is often difficult to treat and may require complex pain interventions including nerve blocks.”

Another important factor is, of course:

“Pain is linked with depression and anxiety…it underlines the importance of treating pain.

Whereas, overall, advanced cancer patients…have a 30% chance of developing major depressive illness this rises to 50% for pancreatic cancer one of the highest instances of depression for any cancer.

The incidence of obstruction of the bile duct is common requiring hospital admission for stenting in the last months”—

and weeks—

of life when patients would rather be at home.

In short, not merely in terms of survival and early diagnosis is pancreatic cancer a major health issue, it constitutes a major burden of symptoms and distress for patients and their families, requiring careful, sensitive integrated care between primary care, hospital staff, oncology and palliative care services.”

Low awareness of pancreatic cancer among GPs and the public, late diagnosis and poor survival rates are not the only issues we have to deal with. Even after people are diagnosed, there is a huge burden of symptoms for the NHS to treat. Those symptoms can mean misery, depression, pain and surgical complications for the patient with pancreatic cancer. As the Minister will know, not all patients are able to benefit from the type of careful, sensitive, integrated care that has been described as what they need. It is clearly an aspiration for the health service, but it is not always achieved.

There is much to do, and the Minister has already been asked to take several actions, but I will ask her, too, because we should all press those points. What action could the Minister take, and what action is she taking, to boost public awareness of pancreatic cancer? It is vital that its symptoms should be better understood by the general public. What can she do to boost awareness among GPs and other medical professionals of pancreatic cancer signs and symptoms? As we have heard and will repeatedly hear, survival rates remain stubbornly low, and mortality rates have been increasing even as they fall for other types of cancer. Will she consider ensuring the development of specific awareness campaigns through appropriate media? The success of the “Coronation Street” story underlines the importance of that for all aspects of the campaign. What action will she take to end the state of affairs in which a patient can be pictured as a tennis ball? What can be done to give GPs more direct access to CT scans or ensure that patients with symptoms that could be pancreatic cancer have all the appropriate investigations in a more timely way?

As my hon. Friend the Member for Scunthorpe and the all-party group have said, it is time to change the story. I hope that the debate will ensure that change takes off, from today.

Special Measures Regime

Barbara Keeley Excerpts

Wednesday 16th July 2014 Commons Chamber

[Mr Hunt]

I pay tribute to the staff in Stafford hospital. I also make the point that, even through the four years when those terrible examples of care happened in the hospital, much excellent care was happening, too, and the hospital had dedicated and hard-working staff. This has probably been tougher for them than for anyone else in the whole NHS. I thank my hon. Friend for the way in which he has campaigned for his local hospital. No one could have done more for their local services. I agree with him that we must implement the very detailed recommendations of the TSAs quickly and in full, and ensure that we give every bit of support necessary to both Stafford and UHNS to ensure that that merger works.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The Health Secretary talked about denial of the past, but that was a bit rich given that Conservative Ministers gave Jimmy Savile a managerial post at Broadmoor. He wants to think about that a bit more.

In view of the disgraceful care failures the Health Secretary detailed, I find it surprising that he relies on inspection to raise standards and ignores the obvious impact of cuts of £3.7 billion in social care budgets. Does he not see that inspection will not fix the parlous state of social care?

[Mr Hunt]

I am afraid that that is the difference between Government and Opposition Members. The hon. Lady says that there was denial over Jimmy Savile, but I stood at this Dispatch Box and apologised to relatives and members of the public for the mistakes relating to Jimmy Savile. I do not call that denial; I call it facing up to the past.

Of course, inspection is not the only answer, but the reason it was so wrong to abolish the expert-led inspections we used to have in social care is that the first step, if we are trying to improve standards, is at least to know where the problems are. Until we have those expert-led inspections, we will not know that. The next step is to work out how to solve the problems. We will be doing both.

Oral Answers to Questions

Barbara Keeley Excerpts

Tuesday 15th July 2014 Commons Chamber

[Norman Lamb]

My right hon. Friend is absolutely right to focus on the importance of better care fund plans, including the interests of carers. The planning guidance that was issued in December made it clear that the plans should include the well-being of carers. Updated guidance will be issued very soon, and will reinforce the central importance of carers’ being part of the plans. We do not yet have a final picture, but we are keen to ensure that all plans include the interests of carers.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Last week I raised with the Prime Minister the case of a 62-year-old man who is caring for his wife, who has Alzheimer’s. When he sought an urgent GP appointment for her, he was told that it would take five weeks for her to see her GP and two weeks to see any GP, or he could take her to Salford Royal hospital’s A and E department. Does the care Minister think that that is acceptable, and will he now back the creation of a duty for NHS bodies to identify carers, so that they and the people for whom they are caring are given the support and the priority that they deserve?

[Norman Lamb]

No. I do not think that that level of wait is acceptable, which is exactly why we are promoting the better care fund. We want to bring together disparate parts of the system so that care is shaped around the needs of patients, and that has been widely supported throughout the system. I should also mention that the hon. Lady’s party colleague Baroness Pitkeathley was incredibly positive about the Care Act, saying that it was the biggest advance in her 30 years of working in the interests of carers. I wish that at some point the hon. Lady would just acknowledge all the good things that the Government have done in carers’ interests.

--- Later in debate ---

[Jane Ellison]

I congratulate my hon. Friend on her great campaigning on this issue, and on the really good results that she has had. As she says, we have recently consulted on changing the regulations under the Medicines Act 1968 to allow schools to hold inhalers in the way that she has described. There was overwhelming support for such a change, and we will lay the necessary statutory instrument this week to enable the change to come into force on 1 October.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

T6. On nurse-patient staffing ratios, it has been reported in the Health Service Journal that out of 139 trusts surveyed, 119 failed to fill their registered day nurse hours, 112 failed to fill their registered night nurse hours and 105 failed to fill their registered nurse hours across day and night. Is it not time for Ministers and NICE to state straightforwardly that a ratio of one nurse to eight patients or better is the only way for patient safety?

[Mr Jeremy Hunt]

NICE has taken the sensible decision to issue its guidance. It does so independently, but we are not making it mandatory on the advice of the chief nursing officer and many other chief nurses across the country for the simple reason that if we have a mandatory minimum, that can become the maximum that trusts invest in and many wards need more than 1:8. That is why NICE’s guidance was so important today.