A&E Services

Gareth Johnson Excerpts

Wednesday 24th June 2015 Commons Chamber

[Mr Reed]

I thank the right hon. Gentleman for that question. If he paid attention to the Francis report, he would learn that it was not the targets themselves that were to blame for the Mid Staffs tragedy, but the way they were applied in that hospital. That is clearly stated in both the first and second Francis inquiries; indeed, it was a point that the Prime Minister made on the Floor of this House when he reported to Members.

In the past 100 weeks, nearly 2.4 million patients have waited more than four hours in hospital accident and emergency units in England.

[Gareth Johnson (Dartford) (Con)]

Why does the hon. Gentleman think that in my constituency A&E targets have been met for 97% of patients, that in his own hospital in his constituency in England they have been met for 93% of patients, but that in Wales they have been met for only 83%?

[Mr Reed]

I am grateful to the hon. Gentleman for that question. Had he been in this House longer and paid more attention to these issues, he would know that the datasets comparable between England and Wales are not actually the same. He would know also that the last time we had a Conservative Government people in Wales were waiting two years for operations, and that nobody campaigns more than I do on behalf of hospitals in my area on the waiting times there.

In the past 100 weeks nearly 2.4 million patients have waited more than four hours in hospital accident and emergency units in England; almost half a million people have spent more than four hours on a trolley waiting to be admitted; and more than 1,500 have waited more than 12 hours to be admitted.

Those figures offer a stark analysis of the difficulties facing accident and emergency. Even in this week of the summer solstice, this Government’s A&E winter crisis shows no signs of abating. In a debate in January the Secretary of State for Health said that the NHS had just been through a tough winter, but the evidence from NHS England shows that accident and emergency departments have had two tough winters and are well on their way to a third tough summer. Under this Government accident and emergency is experiencing a permanent winter.

Health and Social Care

Gareth Johnson Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

Absolutely. I had a good visit to my hon. Friend’s county hospital, but I also remember seeing at Airedale hospital how reassuring it was for a vulnerable old lady to be able to press a red button on her armchair, be connected straight through to the local hospital and talk to a nurse within seconds. With that kind of service, that person is less likely to need full-time residential care. That is much better for her and more cost-effective for the NHS.

[Gareth Johnson (Dartford) (Con)]

Much has been made of finances during this debate. I do not know whether my right hon. Friend is aware of this, but Darent Valley hospital in my constituency underspent by some £250,000 last year while providing the best services in Kent. The challenge that it is still dealing with today is the legacy of the private finance initiative that created the hospital in the first place.

[Mr Hunt]

My hon. Friend has an excellent hospital, which I hope to visit at some stage. A third of the hospitals that are in deficit have PFI debts that make it much harder to get back into surplus. That is a persistent problem, and we are doing everything we can to help them deal with it.

The reality is that hard-working NHS staff have made terrific progress in incredibly tough circumstances in recent years. More than a million more operations were performed last year compared with five years ago, yet fewer people are waiting more than 18 weeks for their operation. Seven hundred thousand more people were treated for cancer in the last Parliament than the one before. Despite winter pressures, we have the fastest A&E turnaround times of any country in the world that measures them. There is more focus on safety than anywhere in the world post Mid Staffs, with 21 hospitals in special measures, seven that have exited special measures, and improvements in quality and safety at all of them.

There are more doctors and nurses than ever before in the history of the NHS. Public satisfaction with the NHS was up 5% last year; dissatisfaction is at its lowest ever level. The independent Commonwealth Fund found that under the coalition the NHS became the top performing health system of any major country—better than the US, Australia, France and Germany. That is not to say that there are not huge challenges, including the fact that by the end of this Parliament we will have a million more over-70s, so we need important changes, especially a focus on prevention, not cure. That means much better community care for vulnerable people so that we get help to them before they need expensive hospital treatment. Part of that is the integration of health and social care, which the right hon. Member for Leigh deserves credit for championing. It also means transformed services through GPs, including the recruitment of more GPs to expand primary care capacity, and a new deal that puts GPs back in the driving seat for all NHS care received by their patients.

Tobacco Products (Plain Packaging)

Gareth Johnson Excerpts

Tuesday 3rd September 2013 Westminster Hall

[Bob Blackman]

I thank my hon. Friend; I return the compliment on this occasion. As I said, it is key to prevent children from starting smoking in the first place. According to the analysis produced by statisticians at Cancer Research, which I do not think is disputed, 207,000 children under the age of 16 start smoking every year. If the Government wait for three years from December 2012, when standardised packages were introduced in Australia, about 600,000 children will begin to smoke before the Government take any action. That is very useful for Philip Morris and big tobacco, but what a tragedy for the children, their families and their communities in later life.

[Gareth Johnson (Dartford) (Con)]

I congratulate my hon. Friend on securing this debate. Does he not agree, though, that if we adopt plain packaging, the danger is that we will simply add to the mystique surrounding tobacco products, inadvertently encouraging more young people to smoke?

[Bob Blackman]

As I shall describe later, the evidence indicates the reverse; I will come to that in a few minutes.

I am pleased that the borough of Harrow, which I have the honour to represent, has a lower than average smoking rate. The latest data still estimate that 500 11 to 15-year-olds in Harrow currently smoke, which is 500 too many. I am sure that other hon. Members here have much higher smoking rates in their constituencies. Clearly, the Government’s duty to local authorities to promote public health means that they will have to take action against smoking.

Hospital Services (South London)

Gareth Johnson Excerpts

Tuesday 22nd January 2013 Westminster Hall

[Heidi Alexander (Lewisham East) (Lab)]

I am grateful for the opportunity to hold this debate today, Dr McCrea, and I am very pleased that other hon. Members are here in Westminster Hall to take part in it.

In the two and a half years that I have been the MP for Lewisham East, I have not known an issue to cause as much anger and concern as the proposals that are currently on the table to close the A and E department and the maternity department at Lewisham hospital. I know from my colleagues, my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) and my hon. Friend the Member for Lewisham West and Penge (Jim Dowd), that in the 20 or so years that they have served the people of Lewisham, they too have not witnessed such outrage and disbelief over an issue.

Lewisham is not the only place in south London where emergency and maternity services are under threat. There has been a long-running dispute about the future of St Helier hospital, and of course changes at any hospital will always impact on neighbouring areas. Patients displaced by the closure of one unit have to go elsewhere. Children who are hurt and elderly people who have had a bad fall do not disappear into thin air; they still need treatment. Mums-to-be still need somewhere to give birth. It is not possible to close and A and E department that sees 115,000 people a year and axe a maternity department in which more than 4,000 babies are born each year and not to expect other hospitals to feel the impact.

This issue affects not only Lewisham but people across south London. The real problem is that there is no free capacity in the other hospitals close by to deal with the demand for hospital services that will be displaced.

[Gareth Johnson (Dartford) (Con)]

I am grateful to the hon. Lady for giving way, and I congratulate her on securing this debate. She is making a very good point about the adverse effect that closing Lewisham hospital will have on neighbouring areas as well, especially, of course, with Queen Mary’s hospital also shutting both its A and E department and its maternity services.

Does the hon. Lady accept that the closure of Lewisham hospital will also have an impact on my constituency, including at Darent Valley hospital, with people seeking out A and E treatment or maternity services? In a hospital such as Darent Valley that already has its own capacity issues, there will be serious repercussions from closing Lewisham hospital—not only for the area that the hon. Lady represents but far beyond.

[Heidi Alexander]

I very much agree with the hon. Gentleman, and I think that there will be a ripple effect across the whole of south-east London and beyond if the A and E department and maternity services at Lewisham hospital close.

South London Healthcare NHS Trust

Gareth Johnson Excerpts

Tuesday 8th January 2013 Commons Chamber

[Mr Hunt]

We have followed to the letter the processes laid down in the law that the right hon. Gentleman’s Government passed. We followed the procedure extremely carefully. This is the first time that the procedure has been invoked, so we have taken extra legal advice to make sure that the processes followed strictly adhere to the letter of the law. I will continue to take legal advice, because I want to make sure that we absolutely follow the wishes of the House in how we carry out the procedure.

Unlike the right hon. Gentleman’s Government, we have introduced new safeguards for any major changes made to NHS services. Those safeguards did not exist when the right hon. Gentleman was Health Secretary. We have said that we will not accept any changes unless there is proper consultation of the local population, clear evidence and clear local clinical support. We made that commitment in the four tests, which did not exist under his Government.

I will not accept any of the changes that the special administrator proposes unless I am satisfied that all four tests have been met. They include proper local consultation, because I consider that to be extremely important.

[Gareth Johnson (Dartford) (Con)]

The report mentions an increase in elective surgery in Darent Valley hospital—my local hospital, which is just over the Kent border with south London. Although the hospital has enjoyed extra funding from the Government, it still has capacity issues. Will the Secretary of State ensure that the knock-on issues are taken into account before he makes any decision?

[Mr Hunt]

My hon. Friend makes a very important point. One of the most important things that I have to consider in the next 20 days is what he describes as the knock-on impact of all the proposed changes. I have a duty to find a solution that is financially and clinically sustainable for the South London Healthcare NHS Trust area. However, I need to consider the knock-on effects everywhere else, including in Lewisham and my hon. Friend’s constituency.

As well as legal advice, I will be seeking clinical advice and want to make sure that my officials agree with the financial considerations made in the report. I will consider all that advice in enormous detail before I come to any decisions.

Oral Answers to Questions

Gareth Johnson Excerpts

Tuesday 12th June 2012 Commons Chamber

[Gareth Johnson (Dartford) (Con)]

T4. The Minister is aware that a form of postcode lottery operates in the provision of IVF treatment at the moment. Does she agree that the Health and Social Care Act 2012 provides an excellent opportunity to end this lottery and allow a more equalised approach to IVF treatment?

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

Yes, and may I commend my hon. Friend on the work he has done in this area? In the reformed NHS, infertility treatment services will be commissioned by clinical commissioning groups, with the NHS Commissioning Board providing oversight and support. That will include the provision of resources and tools to enable CCGs to collaborate to commission infertility services. We will continue to expect those commissioning infertility treatment services to be fully aware of the importance of having regard to the National Institute for Health and Clinical Excellence fertility guidelines.

NHS Risk Register

Gareth Johnson Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Gareth Johnson (Dartford) (Con)]

It is a pleasure to follow the hon. Member for West Lancashire (Rosie Cooper), although I disagreed with much of what she said. If we had listened to organisations such as the British Medical Association in the past, we would not even have a national health service. The BMA opposed the very creation of the national health service, so we should take no lessons from such organisations. What we have heard from Opposition Members today shows their culture of saying, “Do as we say, not as we have done.”

Although I disagreed with much of what the hon. Member for West Lancashire said, I did agree with something that the shadow Secretary of State said when he was in charge of the Department of Health in September 2009. He said that Ministers and their officials need space in which to develop their thinking and explore options, and that the disclosure of the risk report may deter them from being as candid in the future, which would lead to poorer quality advice and poorer decision making. The right hon. Gentleman was absolutely right then and that ethos has run through Governments across the ages.

Like most Members in this House, I support the principle of open government. I support the fact that the Department of Health has divulged far more information since the general election. We all want open and free government, but that will inevitably always be up to a point. No Government since the dawn of time have felt it prudent to publish a risk register and divulge it in the public domain, whether it be a transitional register, a strategic register or any other kind of register.

[Bob Stewart (Beckenham) (Con)]

I have used risk assessments or risk registers in a different way. The military used them as a management tool to look at the worst-case situation and the best-case situation. We did not publish them or make them public for the simple reason that they would have worried people too much. They set out “what if” scenarios. That is why the previous Government did not publish them and why we do not want to publish them.

[Gareth Johnson]

My hon. Friend makes a valid and correct point. Governments need such registers to function efficiently and to cover every eventuality. As he pointed out, a risk register is a mechanism by which civil servants can candidly present a worst-case scenario to Ministers. It is not about what is expected to happen, but about what is the worst that can happen. Risk registers are therefore not Government policy, but preparatory documents.

[John Pugh]

Would the hon. Gentleman be surprised to know that I have here a national risk register that was published by a Department in 2012?

[Gareth Johnson]

Yes, I would be surprised if that had happened.

It would be wrong for there to be routine publication of risk registers without any kind of control. The beauty of risk registers is that they enable civil servants to think the unthinkable.

The hon. Member for St Ives (Andrew George), who is no longer in his place, made the point that there is a difference between the approaches of the Government and the Opposition. If we are honest with ourselves, we must recognise that every Opposition in this place has been guilty of some scaremongering. There is no doubt about that, so let us be mature about it. Whether it has been my party, the Labour party or the Liberal Democrats, we have all been guilty of a certain amount of scaremongering. Presenting a pessimistic view as a real likelihood is part of the game of political football. However, there is a huge danger that information from the risk register could end up misleading the public and giving them inaccurate information.

[Andy Burnham]

May I remind the hon. Gentleman that the words of mine that he referred to related to the strategic risk register? We are debating a different document today. He seems to misunderstand risk registers, because he described them as presenting a worst-case scenario. They do not, and I can provide him with the material showing that right now if he would like to see it. The examples that I read in my speech were given a likelihood rating. They were said to be likely to happen and not mitigated by the steps that had been taken. I am afraid he has not grasped that point, and he needs to.

--- Later in debate ---

[Gareth Johnson]

Risk registers play devil’s advocate and ensure that there are contingency plans for every eventuality. The shadow Secretary of State has mentioned the transitional document, but nothing in the motion mentions a transitional or strategic document. Those words are not used in the motion.

When information on doomsday scenarios is released in an uncontrolled manner, it is easy to see how it can be viewed as being what is expected to happen. If a best-case scenario is released in an uncontrolled manner, that can raise unwarranted optimism. Ministers need to be able to plan for the best and worst-case scenarios without being seen as either overly complacent or doom merchants. Good government is about examining theoretical risks and assessing potential problems and hypothetical scenarios.

The last thing we want is for a Government to tone down their risk planning through fear of propagating alarm or panic. We want civil servants to feel that they can fully paint the picture of the extremes that need to be prepared for, without tempering their advice. We do not want them to have to keep one eye on risk management and the other on how the information will be perceived by the public when it is divulged.

Governments need to consider the commercial ramifications of publishing risk registers. Will the sales of certain products collapse unjustifiably? Are there potential unforeseen consequences? We literally need a risk assessment of the publication of risk registers.

Darent Valley hospital, only the second private finance initiative hospital to be built, is in my constituency. The disabling effect of the agreement is only now being dealt with, thanks to the decisions of Ministers. I do not recall the previous Government rushing to disclose the risk register that was drafted in connection with that commercial decision. Perhaps they were wise not to do so.

Although we all instinctively want transparency to prevail in what we do, we need to think through the repercussions carefully. If the Government lose their appeal against the decision, they will have to disclose the information required, and I believe that there could be serious consequences. Disclosure of the risk register would herald not a new era of open government but rather an end to proper, full risk management. Proper transparency is about the Government publishing what they believe will happen, not what they do not believe will happen but are making contingency plans for. Open government will always be desirable to a point, but as with all previous Governments we should not be in the business of publishing every scenario for which every Department is preparing.

Public Health (Bexley)

Gareth Johnson Excerpts

Wednesday 26th October 2011 Westminster Hall

[Mr David Evennett (Bexleyheath and Crayford) (Con)]

I am grateful for the opportunity to raise the important issue of public health and the situation in my borough of Bexley, which is of great concern to many of my constituents and, of course, to me.

Regrettably, there are vast health inequalities in Bexley and south-east London. The difference in life expectancy for two men living in different parts of Bexley could be as much as or more than seven years. The reasons for that situation, both locally and nationally, are complex and are affected not only by access to the NHS or social care services, but by diet, activity, education and employment. Public health is therefore a matter of fairness and social justice.

As well as causing serious long-term health issues, health inequalities have a wider impact. We all know that obesity can lead to problems with diabetes and heart failure, that smoking kills tens of thousands of people every year and that alcoholism can cause liver failure and increase a person’s susceptibility to other diseases. Those associated illnesses can cause productivity losses for business, reduce school attendance for children and lead to high treatment costs for the NHS. If those problems are not addressed, we could face greater problems in the future, as my hon. Friend the Minister will appreciate.

I am very worried about the increasing number of people who are being classed as obese. The long-term consequences for those individuals and their families can be catastrophic if they do not take action, because they may subsequently experience problems such as heart disease and diabetes. I am particularly concerned about the number of children who are alleged to be experiencing weight problems. According to the national child measurement programme, one in four reception age children in my borough of Bexley is considered to be obese or overweight. That is an incredible figure and, by the age of 11, it rises to one in three. I am sure that the Minister shares my concern about that problem.

There is also an issue among adults. Nationally, the number of obese people in England has doubled since 1993, and the number of obese women has risen by half. Locally, in Bexley, one in four adults is to be considered obese. With trends suggesting that most children who are considered to be obese will remain so well into their adult lives—particularly if their parents are obese, too—the consequences are of real concern to individuals, as well as to society.

I am pleased that my colleague the hon. Member for Erith and Thamesmead (Teresa Pearce) and my neighbour my hon. Friend the Member for Dartford (Gareth Johnson) are here today. The issue does not stay within borough boundaries, because it goes across our area.

[Gareth Johnson (Dartford) (Con)]

I congratulate my hon. Friend on securing the debate. He cares passionately about health care in the borough of Bexley. He has mentioned that some of my constituents rely on services provided in Bexley and that, vice versa, some of his constituents rely on services in the Kent area. Does he therefore agree that it is essential to ensure that the relevant local authorities are aware of their obligations to each other, so that there can be some certainty about funding and budget setting for the councillors in the respective areas that we represent?

[Mr Evennett]

I totally agree with my hon. Friend. There is much cross-border health care traffic both from Bexley into Kent and from Kent into Bexley. That is the choice that people have and should have. Such a situation also reflects people’s needs, which should be met, so I endorse entirely what my hon. Friend has said.

Obesity is responsible for nearly half of all cases of diabetes, a quarter of heart problems and, in some circumstances, more than a third of cases of some cancers. The National Heart Forum estimates that those problems could get much worse and suggests that the number of people getting diabetes as a result of their weight could double by 2050. Financial considerations and costs must also be taken into account. It has been estimated that obesity directly costs the NHS around £4 billion a year. Of course, that does not take into account the cost of treatments and the care required for associated problems, which could and will be even more. In Bexley alone, diabetes costs the NHS £353 per person per year.

Last week, I attended a reception in the House of Commons for Silver Star, a charity campaigning for greater awareness of diabetes. I was pleased to meet Silver Star and learn about its work. I took one of its simple diabetes tests, and I am pleased to report that my glucose level result was 4.9, so I was deemed to be okay.

All the statistics highlight the challenge that we face and the number of people whom we need to assist. First, we must assess the problem’s cause, of which there are many—for example, poor choices, portion sizes, insufficient exercise, inappropriate advertising or a lack of culinary skills can all contribute to an individual’s problems. According to the Association of Public Health Observatories, just 30% of Bexley adults eat healthily, and the statistics on physically active adults in Bexley are significantly worse than the national average. Of course, every individual’s circumstances are different.

In some respects, we are fortunate in Bexley, as we were one of the first boroughs to achieve national healthy schools status for all our schools. However, I am concerned that a minority of adults who eat badly may be setting a bad example for their children. The figures on physically active children in Bexley are also significantly worse than the national average. That is not helped by the fact that the number of children being driven to school has doubled over the past 20 years, which is a national issue that is not confined to Bexley.

Of course, physical activity alone is not enough to address the problem. We need to think more carefully about what we eat and what we feed our children. England’s chief medical officer, Professor Sally Davies, recently said:

“Most of us are eating or drinking more than we need to and are not active enough. Being overweight or obese is a direct consequence of eating more calories than we need. Increasing physical activity is a part of the equation, but reducing the amount of calories we consume is key.”

This is why the Change4Life campaign is important. It provides helpful tips on all the changes that we could make to improve our lifestyles, and it is already directing help to nearly 500,000 people. The campaign’s core ideas—encouraging physical activity, cutting portion sizes, swapping particular foods, discouraging snacking, drinking less alcohol and reducing fat intake—are all sensible and manageable. I hope that more people will take advantage of those resources and take action themselves. I urge my hon. Friend the Minister and the Government to prioritise that approach.

Another issue of health concern is the problems caused by smoking. Smoking rates have remained broadly the same during the past few years. Tobacco consumption remains the greatest single cause of preventable illness and early death, and it is also a big contributor to health inequalities. I am encouraged that, nationally, more people are using NHS stop smoking services. The number of people who registered a quit date has increased in the past year, with an increase in success rates, too. That shows that people are willing to take action to help themselves, which should be encouraged.

I put on the record my support for the award-winning Bexley stop smoking service, which has been doing some excellent work to help my constituents quit smoking and lead healthier lives. The Bexley stop smoking service is led by Jo Woodvine and helps hundreds of people quit smoking every year by using a variety of different methods. I commend the work that it is doing, because its efforts are having an impact. One in five Bexley residents smoke, which is slightly below the national average. However, I am concerned that 17% of women in Bexley smoke through pregnancy, which, worryingly, is above the average. Smoking during pregnancy increases the risk of complications such as stillbirth, miscarriage, premature birth and low birth weight.

There are also age-related problems with smoking. Tobacco consumption is still most prevalent among the under-50s. Every year, more than 300,000 under-16s try smoking for the first time. By the age of 15, some 15% of children in England are reported as being regular smokers, which is incredibly worrying. I accept that action has been taken on this issue. The minimum age at which one can purchase cigarettes has been increased to 18 and the sale of cigarettes from vending machines has been banned. The Government have introduced a tobacco control plan to help reduce smoking, which takes account of the problems that I have highlighted relating to the prevalence of smoking among adults, children and pregnant women. I agree that steps must be taken to reduce the promotion of tobacco and to improve regulation to ensure that children are not drawn into starting smoking. If more is done to highlight the diseases that can result from smoking, then adults may be persuaded to quit.

The substantial cost to society from smoking is estimated to be more than £13 billion a year, which includes NHS treatment, productivity losses and clear-up costs. However, only £11 billion is raised in taxes from tobacco. The Government are therefore right to consider ways of making smoking less affordable, as a disincentive. Most importantly, the Government need to ensure that NHS stop smoking services continue to be properly supported. The all-party parliamentary group on smoking and health has highlighted how cost-effective those services are, estimating that the Government benefit by as much as £1.7 billion a year through the prevention of serious and costly diseases.

Alcohol dependence is another area of great concern, and it is a major public health issue. Dependent drinkers are the drinkers at greatest risk of admission to hospital for a range of illnesses. There are an estimated 4,000 dependent drinkers in my borough of Bexley, and as many as one in seven people are putting their health at risk by binge drinking. While those figures are not as high as in some other areas of the country, they are symptomatic of the wider problems facing our nation. The latest alcohol statistics for England show that one in four men and one in five women are drinking more than the recommended number of units in an average week. On average, children—yes, children—consume 11.6 units a week.

Excessive drinking also has a significant impact on our health service. For example, since the introduction of the Licensing Act 2003, which allowed 24-hour drinking, the number of hospital admissions due to acute alcohol intoxication has doubled and the number of admissions wholly attributable to alcohol has increased by 70% locally, which is broadly in line with national trends. Between midnight and 5 am, the majority of hospital admissions are alcohol related. I was, and remain, opposed to the liberalisation of the drinking hours in the 2003 Act, which was a grave mistake.

Many long-term problems—alcoholic liver disease, hepatitis and cirrhosis—can be caused by excessive consumption over a long period of time, and they can lead to organ failure. Deaths from alcohol-related liver diseases have doubled in the past 20 years, with the overall cost of alcohol-related harm now standing at £2.7 billion a year. It is therefore vital to address the situation. There are simple steps that individuals can take, such as tracking alcohol intake, ordering smaller quantities or reduced-strength drinks, or swapping their drinks for alcohol-free versions. While retailers and drinks manufacturers promote the Drinkaware campaign, the industry needs to do more.

I am concerned about tuberculosis in London and about the current guidelines on prevention. A report published by London Health Programmes in June stated that, between 1999 and 2009, the number of TB cases in London rose by 50%. London now has the highest TB rate of any capital city in western Europe and accounts for 40% of all cases in the UK. Those trends are worrying. In Bexley, there are currently less than 20 cases of TB per 100,000 of population each year. However, during the same 10-year period, the Department of Health issued new guidelines to primary care trusts that recommended the withdrawal of the universal BCG vaccine. TB is an infectious disease that can affect any part of the body. It is curable, but detection is crucial. Early detection can mean relatively simple and cheap treatment. If left undetected or untreated, as in 12% of cases, the disease can become drug resistant, meaning more complex treatment at a hugely increased cost. The approach to prevention and treatment of TB therefore needs to change.

I am concerned that family travel is not given enough consideration. Many Bexley children are taken on holiday to the Indian subcontinent or to sub-Saharan Africa during school breaks, particularly in summer, and might be exposed to the disease. Consequently, there is a potential risk that, when the family returns to the UK, others might come into contact with the disease. I appreciate that prolonged exposure is required in order to transmit the disease, but this might happen and I am concerned.

As London Health Programmes has identified, targeting has been inconsistent. High risk groups, such as the homeless and those with lower immune responses caused by other problems such as drug taking or alcoholism, have not been given enough attention. The recommendations made in the draft London TB plan, which aims to improve the early detection of TB and the effectiveness of treatment as well as to reduce the risk of transmission, must be carefully considered. In particular, the Government should seek to implement the proposal that all newborn children should be vaccinated within six weeks of birth to protect them from TB. This welcome suggestion could be an effective measure to prevent cases of the disease. However, it would not address the problem for children in my borough, who have still not received the BCG vaccine because the Department of Health felt that we did not have enough cases per 100,000 of population. I would like to see a limited programme in the next few years for children in London boroughs who have not received the vaccination.

Bexley is a very good place to live and work. I do not want to say that it is all negative, because it is not. There is a huge amount going on in Bexley that is to be commended, and I put that on the record. The vast majority of people in our borough are really good people—moderate, reasonable people—and educating, helping and advising them is the way forward. However, Bexley is not immune to increasing health issues. I hope that the Minister and the Department will support— I know this is not her brief, but I cannot resist the temptation to include this in my remarks—plans for a health and well-being campus to be established at Queen Mary’s hospital in Sidcup. If approved, this could begin in 2014 and provide vital services, such as primary and community care, GP services and hospital services, all on one site. As part of the plans, Bird college, a dance, music and theatre performance centre, hopes to be on the site as well, which could provide real benefits for public health. The strategic outline case has been submitted, and I hope that that important project can progress.

I also urge the Minister to consider the role that community pharmacies can play in helping to reduce health inequalities and public health problems. At the heart of the local communities that they serve, they are uniquely placed to offer advice to significant numbers of people. They can sometimes be more accessible than GP services, and they can be found in retail settings.

In conclusion, I congratulate my hon. Friend the Minister on all the tremendous work that she is doing on public health. The Government are right to prioritise public health and to ring-fence finance. I support strongly the transfer of increased responsibilities to local councils on public health issues. Fundamentally, I believe that education and awareness are vital. If public health problems are to be properly addressed, we need to ensure that everyone plays their part—schools, parents, businesses, charities, and local and national government—otherwise we could be storing up huge problems in our country, including Bexley. I am grateful for the opportunity to make these few points today, because it is very important to address public health issues for the future.

National Health Service

Gareth Johnson Excerpts

Wednesday 26th October 2011 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

Although the words “shocking legacy” are ringing in my ears, I find it difficult to believe them, given Labour’s legacy on the NHS compared with what it inherited in 1997. Expenditure was increased from £30 billion in 1997 to £103 billion when we left office, and we had record patient satisfaction ratings. It beggars belief that that can be considered a shocking legacy.

[Gareth Johnson (Dartford) (Con)]

rose—

[Grahame M. Morris]

If the hon. Gentleman does not mind, I will continue my introduction and give way in a moment.

I wish to recognise the contribution of the NHS staff, who are the source of great pride. They have done such a great job, and continue to do so, even in difficult circumstances, in delivering the very high levels of patient satisfaction reported in the recent surveys.

In November 2010, the Backbench Business Committee selected my application for a debate on the impact of the comprehensive spending review on the Department of Health, the NHS and public health. So many of the issues that have been raised are implanted in my mind, not least the loss of the funding for a new hospital that would have served many of my constituents in the south of Easington. I am concerned about the particular reference that has been made to that and I would be grateful if the Secretary of State or the Minister would deal with that in their closing remarks. A value-for-money assessment was made by both the Department of Health and the Treasury and it was found that the best way to take forward that proposal was with public funding, rather than through the private finance initiative route. The disingenuous position repeated by those on the Government Benches, including the charges laid against the Labour Opposition about our support for PFI, has been compounded. I remind right hon. and hon. Members on the Government Benches that in the case of the new hospital planned for my area we were directed to the PFI route, despite the criticism that has come from the Secretary of State and other Members on the Government Benches.

I am pleased that the motion focuses on the failed personal pledges of both the Prime Minister and the Secretary of State. A key promise was made to increase real-terms expenditure on the NHS, but it is another broken promise. It is probably the most fundamental one, as the NHS is such a beloved institution of the whole British public. Before the election, the Conservatives promised to protect the NHS and give it a real-terms budget increase year on year. The coalition document promised a 0.4% real-terms budget increase for the NHS over the spending review period.

I am sure that we all saw the expensive billboards before the election, to which my right hon. Friend the Member for Leigh (Andy Burnham) referred. They showed the Prime Minister, then Leader of the Opposition, saying:

“I’ll cut the deficit, not the NHS.”

That was not really about rebranding the NHS; it was more an exercise in conning the British public. Whereas Labour gave a guarantee to protect the front line of the NHS, the Health Secretary, then the shadow Health Secretary, saw a cynical opportunity to give a guarantee on spending. We now know from the Treasury’s own figures that that guarantee was false: it is a promise that has been broken. It was a guarantee that went against all the Tory mantra. We are constantly told by the Conservative party that public service delivery is not about how much we spend but about how we spend it—in fact, we heard that today from the Prime Minister in relation to police numbers. However, the Tory promise was never about protecting the NHS; it was about protecting the Tory brand.

Even the Tories’ biggest backers realise that the promise to increase funding on the NHS was a con. The Secretary of State cited James Purnell a little earlier, so perhaps I might cite Fraser Nelson, who is not a well-known socialist—he writes for The Spectator and is a right-wing commentator. He says:

“It has become clear now that there was a cynical competition to dupe the British public into believing that if they voted Tory at the General Election, the NHS would be safe.”

After 13 years of unprecedented rises in the NHS budget under Labour, and efficiency measures such as those on procurement—

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

It is a privilege to close the debate on the Government’s record on the NHS and to follow such excellent contributions from many hon. Members.

My hon. Friends the Members for Easington (Grahame M. Morris) and for Ealing North (Stephen Pound) rightly spoke of the waste of the Government’s NHS reorganisation. The Government have spent £850 million on redundancy payments for primary care trust staff who will be re-employed in commissioning organisations elsewhere. My hon. Friend the Member for West Lancashire (Rosie Cooper) rightly asked the Secretary of State, who is moving from his usual place on the Front Bench, why he was not aware that trusts are re-banding nurses in order to save costs. Labour Members, who talk and listen to front-line staff, know that only too well.

My right hon. Friend the Member for Rother Valley (Mr Barron) and my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), whom I was privileged to sit alongside in the Health and Social Care Bill Committee, rightly raised the risks of the Bill widening health inequalities and worsening patient care. My right hon. Friend was right when he said that the Bill will be one of the Government’s biggest mistakes.

The hon. Members for Stafford (Jeremy Lefroy) and for Central Suffolk and North Ipswich (Dr Poulter) rightly raised the important issue of the need to integrate health and social care and develop more community-based services, although Opposition Members believe that the Government’s NHS reorganisation, and their huge cuts to local council budgets and social care, will make that far harder, not easier, to achieve.

Before the general election, the Prime Minister made three key promises on the NHS. He promised no more top-down reorganisations; he promised patients up and down the country a bare-knuckle fight to save their local hospitals; and in both the Conservative manifesto and the coalition agreement, he promised that he would increase health spending in real terms in each year of the Parliament. Barely 18 months later, he is forcing through the biggest reorganisation in the history of the NHS—the NHS chief executive says that it is so large, it can be seen from outer space. Local NHS services in Bury, Burnley, Hartlepool and Chase Farm are not being saved or reopened as the Prime Minister and Secretary of State pledged, and, according to Treasury figures, spending on the NHS was cut by more than £750 million in real terms in the first year of this Government. That is three promises made and three promises broken by a Prime Minister who claimed that his personal priority was spelt out in three letters: NHS.

[Gareth Johnson]

Is the hon. Lady aware that in the past 40 years, real-terms spending on the NHS has been reduced on only five occasions, the majority of which were under a Labour Government?

[Liz Kendall]

I wish the hon. Gentleman had been here at the start of the debate, when it was made clear that the last real-terms cut in NHS spending was in the last year of the previous Conservative Government.

Doctors, nurses, patients and the public know the truth about this Government’s plans. When the NHS should be focused on meeting the biggest financial challenge of its life and on improving patient care, it has instead been plunged into chaos. At precisely the time that the NHS needs maximum leadership and financial grip, the Government’s reorganisation is creating havoc. First, they said that they would scrap primary care trusts and strategic health authorities, and replace them with GP consortia. Then they changed their mind, merging PCTs and SHAs in supposedly temporary clusters and replacing consortia with clinical commissioning groups and new clinical senates, and now they have changed their mind again: PCT and SHA clusters have apparently been saved as part of the Government’s huge new national quango, the NHS Commissioning Board, which will employ more than 3,000 people.

Professor Malcolm Grant, the Government’s own choice to run the NHS Commissioning Board, last week called the Government’s plans “completely unintelligible”. The very people who are supposed to be running the NHS are confused and wasting time trying to figure out ill-thought-through Government plans. That time and energy should be spent on patients. Far from cutting bureaucracy and saving taxpayers’ money, the Government are creating hundreds of new organisations and wasting more than £2.5 billion in the process, when this money should be spent on front-line patient care.

What has been the result of 18 months of a Conservative and Liberal Democrat Government running our NHS? Thousands of front-line clinical staff are losing their jobs and posts are being frozen, piling pressure on those who remain. [Interruption.] The Secretary of State shakes his head, but this month the Royal College of Nursing has surveyed 6,000 of its staff and made it clear that 20% of the nurses and health care assistants surveyed said that their job is going to be cut, that 40% are seeing recruitment freezes in their trust and that 13% are seeing bed and ward closures in their trust. Who is more likely to be accurate? The nurses and health care assistants working in our NHS, or the Government, who are denying that any of these changes are taking place?

The result is that patient care is going backwards. Far from what Ministers claim about waiting lists being fine, the number of patients waiting longer than four hours in A and E is now double that of last year. Twice as many patients are waiting more than six weeks for their diagnostic test, and six times as many are waiting longer than 13 weeks. Anybody who has waited, or has had a family member who has waited, more than three months even to get their test knows how worrying and frightening it is, yet the Government deny that there is a problem. Furthermore, 48% more patients are now waiting more than 18 weeks for their hospital treatment.

Despite all the evidence, the Government are in denial. They deny that the number of front-line NHS staff and the number of staff training places are being cut, yet a recent survey by the Royal College of Midwives has shown that six out of 10 SHAs have been freezing staff training places because of the cuts. Given that the Government promised 3,000 more midwives, that is a problem, particularly in constituencies such as mine that have increasing birth rates.

Care (Older People)

Gareth Johnson Excerpts

Tuesday 6th September 2011 Westminster Hall

[Gareth Johnson (Dartford) (Con)]

I congratulate my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) on securing the debate. She feels passionately about the subject and made a robust and fair-minded speech.

Care and services for older people are of increasing importance, and I agree with the sentiments already expressed about how we must deal with the issue sooner rather than later. It is a growing mushroom that must be dealt with fairly soon because the population in this country is getting older, which is placing strains on our systems. That is a good and positive thing—too often we hear about longevity in a negative way, but it is a marvellous tribute to medical science that we have people living longer than they previously did—but greater reliance is placed on our care home provision and local authorities have to adapt to the changes in pressure placed on them as a consequence. I have disagreed publicly with my local authority, Kent county council, on decisions it has made about care home provision in my constituency of Dartford.

I accept that the future lies in a public-private partnership in care provision throughout the country. The Government face a dilemma: they cannot afford indefinite free care home provision and they do not want to penalise those who have saved for their retirement. Free care home provision for all without tax rises is completely unaffordable—I agree with my hon. Friend the Member for Banbury (Tony Baldry) about that. Such rises, especially in the current climate, would have a huge negative impact on the finances of this country. Equally, we should not be punishing prudence and forcing the elderly to sell their homes to pay for care. Prudence should be rewarded by the state, not punished.

Health and safety legislation has often added to the cost of care provision. The apparent necessity for all rooms in a care home to have en suite facilities was used as part of a reason to close care homes in my constituency, yet residents in those care homes would say that what they want is their home preserved and not the health and safety considerations met. I recently visited Emily Court care home in Wilmington in my constituency. The residents echoed the sentiments I have heard in every care home I have ever gone to: they like the facilities, but what is most important to them is that it is their home. That drives the affinity they have for the place.

What has staggered me since the upheaval in my area with the closure of care homes is how easy it is in this country to close them. I find it incredible that no real security of tenure exists for residents in a care home. Travellers have some rights over land they settle on—that is obviously an argument for a different time—and squatters have rights over empty properties that they occupy, yet residents in care homes can be moved almost on a whim. That might need further investigation, because the consultation exercises before any care home closes concentrate a bit too much on the bricks and mortar involved and not enough on the people.

[Alison McGovern]

The hon. Gentleman says what a bugbear health and safety legislation was and then mentioned the lack of security of tenure for residents. I find it difficult to know whether he thinks we need more or less regulation, legislation or sub-legislative guidance. What mechanism does he think is best to improve some of the standards?

[Gareth Johnson]

The two issues are separate. When Southern Cross went bankrupt, for example, it blamed in part the increase in health and safety legislation, some of which was sensible and some completely unnecessary. Ensuring that people who reside at care homes have some rights over the land that they are living on is a separate matter. I do not see that as placing increased burdens on those running the care homes; it simply gives the individual residents the same rights that we would have if we leased a flat. Those living in residential care homes, who are perhaps among the most vulnerable in society, should surely have that extra protection. The challenge for the Government is to find a solution that is both affordable and fair—affordable, so that the Government can cope with the ageing population and the increasing demand on care homes, and fair, so that the elderly are not forced to sell their homes and lose out because of their earlier, sensible financial decisions.

[Esther McVey (Wirral West) (Con)]

I am delighted to take part in the debate, which echoes the conversation I had earlier in the week with the residents of Hoylebank in West Kirby about the diverse and huge issues involved. Those residents believe that they are part of an invisible generation. They would like to be visible and, like my hon. Friend the Member for Chatham and Aylesford, they are calling for a Minister for the elderly to go through everything thoroughly.

[Gareth Johnson]

I am sure that the residents in Hoylebank have similar difficulties to many residents all around the country: they are often screaming loudly and not being heard by anyone. It is incumbent on Government to listen to the messages we hear from care homes and to see where we can make improvements to their rights to ensure that their homes are protected as well as possible. We need to find a more sensible balance than is currently in place. Care homes provide a vital link in the health chain. The hon. Member for Birmingham, Erdington (Jack Dromey), who is not now in the Chamber, made the important point that if we reduce the availability of care home provision, the amount of so-called bed blocking in hospitals will inevitably increase, with all the extra difficulties and costs arising.

We all want to facilitate elderly people remaining in their homes as much as possible, but the ideal should be about choice and not about forcing people who want to go into a care home to stay at home, or forcing people who want to remain in their own homes to go into care. Their individual choice should be paramount, and their opinion should count for a great deal. I therefore look forward to the spring, when the Government intend to announce their intentions regarding the Dilnot report and what happens thereafter. I look forward to finding a balance that works for the whole of the older generation.