NHS Reorganisation

Paul Burstow Excerpts

Wednesday 16th March 2011 Commons Chamber

[The Minister of State, Department of Health (Paul Burstow)]

I start by thanking the right hon. Member for Wentworth and Dearne (John Healey) for attending the Liberal Democrat conference last Saturday. Unfortunately, no one knew who he was when he arrived. Had he been more clearly identified, I am sure he would have received a very warm welcome from delegates, because he was welcome, as was the registration fee he paid. He will know that I gave my Liberal Democrat colleagues a guarantee on Saturday that, along with other members of this Government, we will listen to every word that Liberal Democrats said at that event.

I agreed with my hon. Friend the Member for Southport (John Pugh) when he said that it was important that we should drop the rhetoric and listen. However, I am not absolutely certain—if I can say this gently to him—whether his contribution entirely measured up to his own statement. Dialogue, yes, but dialogue is not diatribe. Let me also tell him that had the amendment in the name of Conservative and Liberal Democrat Members been selected, I would have urged hon. Members to vote for it, because it sums up the Government’s approach. We are listening to concerns and seeking to strengthen and improve the Bill, and we will continue to do so.

However, that is not what Labour is about. Labour’s purpose is very clear indeed. Those on the Labour Front Bench let the cat out of the bag a few weeks ago when the hon. Member for Islington South and Finsbury (Emily Thornberry) said in Committee that

“many of our amendments seek to undermine the Bill entirely and in every way possible”.––[Official Report, Health and Social Care Public Bill Committee, 3 March 2011; c. 448.]

That is not about improving the Bill; that is about trashing it. Sometimes it seems like we are debating two entirely different Health and Social Care Bills. One is the Bill currently in Committee—the real Bill. The other is the phantom Bill that has been conjured up by Labour Members—a hall of mirrors constructed by the Labour party and the unions that bears no resemblance to the real Bill, and is a gross distortion of so many of its provisions. Let me deal with some of the myths that have been peddled in today’s debate.

First, let me address the charge of privatisation. I thought that the

“ideological battle over using private and third sector providers”

was “over,” and that

“What matters to the public is not who provides but how well a service is provided.”

That is not just my view; that is the view of the Labour Business Secretary from 2008, the former Member for Barrow and Furness. He was a long-standing Health Minister who took that view then and, I suspect, holds it today. My right hon. Friend the Member for Charnwood (Mr Dorrell) was absolutely right: the involvement of the private sector is not new to the NHS. Indeed, involving the private sector was certainly not new to the last Government. Labour imposed private sector treatment centres on the NHS, guaranteed the private sector higher prices and, through all that, institutionalised cherry-picking in the NHS. Indeed, it is a scandal that in none of the Opposition speeches was there any sense of an apology for the £250 million spent on the private sector for doing absolutely nothing.

Instead of loading the dice in favour of the private sector, which is what Labour did, we are correcting the balance, creating a fair playing field for the full range of providers—something that Labour said in its manifesto it would do, but which it is running away from in opposition. We have tabled amendments to the Health and Social Care Bill to put beyond doubt the fact that there will not be price competition, but there will be quality competition, to ensure that, unlike Labour, we will not see differential prices set on the grounds of ownership. Under our plans there will be less competition on price than there is now and more competition on quality.

[Angela Smith]

Shirley Williams described the level playing field to which the hon. Gentleman refers as “lousy”. How would he respond to that?

[Paul Burstow]

I am looking forward to further dialogue with my noble Friend to ensure that we deliver the important improvements to the NHS that will ensure that unlike Labour, which cherry-picked and set up contracts with the private sector that undermined the NHS, we deliver a level playing field that delivers good quality care, chosen by patients not politicians.

The debate has shown that we continue to share an enduring commitment across the House to the notion that the NHS must be based on need and free at the point of use. That is what the Bill entrenches and what it will secure. Our plans are all about offering more choice to patients, more accountability for the public and more autonomy for front-line professionals. It is easy for the Opposition to attempt to caricature and distort those policies, but they are based on our belief that we need an NHS that is not about looking up to Whitehall for its lead, but about looking out to its communities and ensuring that it delivers the quality services that make a difference to our constituents.

The purpose of the motion is very clear. It is nothing to do with listening; it is all about scaremongering, opportunism and grandstanding, and the House should throw it out. We will continue to listen and to improve the Bill, but we will not do it by listening to Labour Members, who have no interest in making the NHS better and who would have cut it, had they had the opportunity to do so in government.

Question put.

Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 8th March 2011 Commons Chamber

[Chris Leslie (Nottingham East) (Lab/Co-op)]

2. What steps he plans to take to reduce cancer mortality rates in deprived communities.

[The Minister of State, Department of Health (Paul Burstow)]

“Improving Outcomes: A Strategy for Cancer” sets out our plans to reduce mortality rates by tackling preventable incidence and improving survival rates for those diagnosed with cancer. As we make it clear in the strategy, we cannot deliver the reductions without a focus on poorer socio-economic groups.

[Chris Leslie]

I wonder whether the Minister has seen the statistic that 70% of people with cancer can lose half their income during the course of their disease. Obviously, those who are least well-off will be hit the most. Would it not be best therefore for the Government to heed the warning from Macmillan Cancer Support and others that the Welfare Reform Bill proposal to end abruptly the eligibility for employment support allowance after 12 months is both unfair and arbitrary, particularly for those who have the fewest resources, as they try to recover from cancer?

[Paul Burstow]

That sounds more like a Second Reading speech on the Welfare Reform Bill than a Health oral question; but of course, we listen carefully to what Macmillan says. We work closely with it on many aspects of our cancer strategy, but it is also important to bear in mind that we need to ensure that people who are suffering from cancer receive the benefits to which they are entitled in a timely fashion, and we are working on that with colleagues from the Department for Work and Pensions.

[Mr Peter Bone (Wellingborough) (Con)]

Mr Speaker, you might remember in the last Parliament that a young constituent of mine—a five-year-old boy—had neuroblastoma and that his likelihood of surviving that rare cancer was very small, but thanks to the intervention of Ann Keen in the last Parliament and working together, I am pleased to say that it has just been announced that that little boy is clear of cancer. Will the Minister comment on whether, as I hope, it will not be so difficult in this Parliament to get treatment for such cases?

[Paul Burstow]

I thank the hon. Gentleman for his question, and I share his satisfaction and pleasure at the successful treatment that his constituent’s son received. Certainly, on cancer survival rates and cancer outcomes, we need to make sure not just that we are delivering for the most typical cancers, but that we have good processes that ensure early diagnosis of all cancers.

[Mr Stephen Hepburn (Jarrow) (Lab)]

3. What recent representations he has received on his proposed reforms of the NHS.

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[Steve Baker (Wycombe) (Con)]

17. What steps he is taking to improve NHS cancer services.

[The Minister of State, Department of Health (Paul Burstow)]

We published our cancer strategy in January, which set out a range of actions to improve cancer outcomes and cancer services. We set out our plans to improve earlier diagnosis, access to screening, treatment and patient experience of care.

[Stephen Phillips]

I am grateful to my hon. Friend for that answer. He and my right hon. Friend the Secretary of State will be aware of the concerns expressed by a number of GPs across the country, including in my constituency of Sleaford and North Hykeham, about the pace of reform in the NHS. What assurances can he give the House that GP consortia will continue to have access to the expertise they need to commission effective cancer services?

[Paul Burstow]

I am grateful to my hon. and learned Friend for that question, because part of that pace is, of course, due to the fact that a substantial part of the country is now covered by pathfinder GP consortia, many of which are actively engaging with their colleagues in cancer networks and developing the expertise and experience that will be essential in taking forward their commissioning responsibilities. We have already made it clear that funding will be available in the coming year for the commissioning networks for cancer and that after that it will be a matter for the NHS commissioning board.

[Mr Stewart Jackson]

Cancer specialists at Peterborough City hospital tell me that they are prevented from prescribing drugs to needy patients, even after accreditation by the National Institute for Health and Clinical Excellence, as a result of the necessity for further approval by their local primary care trusts. Will the Minister undertake to tackle that bureaucratic delay, as it is having a significant impact on clinical outcomes in my constituency?

[Paul Burstow]

There are several aspects to my hon. Friend’s question. One is that we need to see much more commissioning for outcomes in cancer services. We must also ensure that full advantage is taken of the cancer drugs fund. I would be happy to look at any specific details of the case he has mentioned if he cares to write to me.

[Jessica Lee]

Does my hon. Friend agree that an important part of improving cancer care in this country is supporting the excellent palliative and respite care wards, such as Oakwell ward in Ilkeston community hospital in my constituency? It would be remiss of me, as the daughter of a nurse, not also to ask him to pay tribute to the nursing staff who work in that important area.

[Paul Burstow]

First, I will take the opportunity to pay that tribute to the excellent and hard work of clinicians in providing invaluable support to people affected by cancer. My hon. Friend is also right to refer to the importance of respite care for families. As part of the end-of-life strategy that the Government are taking forward, we are looking to improve palliative care services and inquiring into the possibility of a per-patient funding mechanism to cover the costs of these services.

[Rehman Chishti]

Given the Minister’s commitment to improving patient experience, and the significant learnings from the national cancer patient survey, will he ensure that from now on the survey will be conducted annually?

[Paul Burstow]

My hon. Friend is right to draw attention to that survey, which has produced invaluable data. More than 65,000 patients took part in the 2010 survey, and it is proving to be an invaluable tool in enabling trusts and commissioners to identify areas where there is scope for improvement locally. The cancer strategy that we published in January commits us to repeating such a patient experience survey, and we are exploring the options at the moment.

[Steve Baker]

What is the Government’s policy in relation to those charities that provide indispensable services to cancer patients and their families? I have in mind, in particular, Macmillan and Marie Curie.

[Paul Burstow]

My hon. Friend is absolutely right to describe the contribution of Macmillan, other cancer charities and, indeed, charities in the health sector more generally as indispensable. I recently had the pleasure of visiting Macmillan’s headquarters, where I did an online chat with a number of cancer sufferers and their families and saw the helplines and other support services that it provides. In our cancer strategy, we are very clear that such charities have an invaluable role to play.

[Alison Seabeck (Plymouth, Moor View) (Lab)]

Plymouth and neighbouring Cornwall, a former objective 1 area, suffer from enormous deprivation. Will the Minister therefore do all he can to ensure that those communities benefit from Plymouth Hospitals NHS Trust’s much hoped-for CyberKnife technology, and that its benefits for cancer patients are felt not just in London, but more widely in other regions?

[Paul Burstow]

I am very grateful to the hon. Lady for her question, and she is absolutely right: that technology is invaluable. We want to ensure that it is available to the patients, and the tariff structures need to ensure that it is properly supported. She is right also that issues of equality in the service are key, and that is why we have maintained this Government’s commitment to supporting the NHS constitution and its commitment to promote equality in the system.

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

What assessments has the Minister made of the work of academics, such as Robert Putnam, who claim that one of the biggest influences on health outcomes and recovery is social cohesion within a neighbourhood, friendship groups and families? If the Minister has made an assessment, is he putting forward any policies that will help to expand that area?

[Paul Burstow]

I thank the hon. Gentleman for that question. Indeed, the importance of family and social networks is a key component of the vision for social care, which we set out in November. Importantly, social care can support those networks through support for family carers.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

Queen Elizabeth hospital in my constituency provides excellent cancer care for the people not just of Birmingham, but of the west midlands. Following a freedom of information request by Unison, it has become clear that the hospital faces a 17%—or £22.5 million—cut in its funding from primary care trusts. How can the Minister say that cancer care will not be compromised if we have cuts on that scale?

[Paul Burstow]

First, there has been a 3% average increase in the funding that is available to PCTs, and, as my right hon. Friend the Secretary of State said in answer to an earlier question, we are currently in that process of negotiation between hospital trusts and PCTs. It remains to be seen where the final figures will settle, but the money is in the system: the Government are committed to putting £10.7 billion extra in the system—something that the Labour party actually opposed.

[Toby Perkins (Chesterfield) (Lab)]

As someone whose mother died of cancer, no one needs to tell me how important cancer is within the NHS, but it is noticeable that nine out of 13 questions asked by Conservative Members are about cancer; it seems to be the only part of the NHS which the Government are happy to talk about. But cancer cannot be taken in isolation from the rest of the NHS, when there is a massive reorganisation costing billions of pounds which only one in four GPs thinks will actually improve the service. How can that possibly involve doing the best for cancer patients?

[Paul Burstow]

Again, I suspect that the hon. Gentleman is trying to re-run the Second Reading of, in this case, the Health and Social Care Bill, but in fact this Government are committed to seeing improvements across the board. That is why in the NHS outcomes framework we do not just talk about cancer, we identify other areas as well. If hon. Members table the questions, I am certainly happy to answer them.

[Derek Twigg (Halton) (Lab)]

The Secretary of State is fond of making unfavourable comparisons between European and UK health outcomes, but recent research shows that we are doing much better than the picture he portrays. Independent research has borne that out. Concerns have also been raised about the impact of his NHS reorganisation on cancer networks. Sarah Woolnough of Cancer Research UK says:

“One of our concerns is to ensure that we do not lose the expertise that we have been developing.”––[Official Report, Health and Social Care Public Bill Committee, 10 February 2011; c. 116, Q227.]

Under this Government, however, patients are already waiting longer than six weeks for diagnostic tests, many of which are for cancer. In fact, the numbers have doubled, and that is according to the Department’s own figures. Can I ask the Minister why?

[Paul Burstow]

On the hon. Gentleman’s last point, the first thing to say is that average waiting times have gone down, but beyond that, he is right to identify the need to achieve earlier diagnosis. That is one of the reasons performance in this country on cancer survival has not been as good in comparison with other European countries. That is why, in the outcomes strategy that we published in January, we made it clear that we would put in an extra £450 million over the next four years to fund the additional diagnostic procedures directly available to GPs so that they can make those tests available to their patients.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

8. What assessment he has made of the adequacy of the number of care home beds available in the north-east over the comprehensive spending review period.

[The Minister of State, Department of Health (Paul Burstow)]

Local councils are responsible for ensuring that there is sufficient residential care provision to meet the needs of their populations. I understand from the Care Quality Commission that the number of care home places in the north-east has risen substantially and steadily in recent years.

[Chi Onwurah]

A recent report from Bupa predicts a shortfall of 100,000 in the provision of care home beds nationally because of the cuts and because of our ageing population. That will obviously impact on hospital beds. How will the Minister prevent that from impacting on health care in the north-east if he is not going to ring-fence the social care budget?

[Paul Burstow]

First, let me re-emphasise that we know, on the basis of independent assessments that have been carried out, that across England there is a surplus of 50,000 care home places. As regards the provision of care home places and the funding of social care, we have committed to an extra £2 billion going into the system by 2014, half through local government and half directly via the NHS, to ensure that social care services receive support; and just this year, an extra £162 million will go to local authorities to support them in their social care activities.

[Lorraine Fullbrook (South Ribble) (Con)]

12. What progress he is making in reducing mixed-sex accommodation in the NHS.

--- Later in debate ---

[Greg Hands (Chelsea and Fulham) (Con)]

18. What assessment he has made of the effect on survival rates of his Department’s cancer strategy.

[The Minister of State, Department of Health (Paul Burstow)]

We published “Improving Outcomes: A Strategy for Cancer” on 12 January. It sets out a range of actions to improve cancer outcomes, including diagnosing cancer earlier, helping people to live healthier lives to reduce preventable cancers, screening more people, introducing new screening programmes, and ensuring that all patients have access to the best possible treatment, care and support. Through those approaches, we aim to save at least an additional 5,000 lives every year by 2014-15. We will publish annual reports to measure progress on implementation of the strategy.

[Greg Hands]

Does my hon. Friend agree that the establishment of the cancer drugs fund will help the UK to raise its cancer survival rate from among the worst in Europe to potentially one of the very best? [Interruption.]

[Paul Burstow]

My hon. Friend is absolutely right to draw attention to that, and it is interesting that a number of Opposition Members are saying that they do not see it as making any contribution whatever to the quality and extension of life. Yes, the funds that the Government provided very early on will be available to ensure that people get access to drugs that have hitherto not been available to them.

[Mr Andrew Love (Edmonton) (Lab/Co-op)]

The Minister has indicated several times that diagnosing cancer earlier is the solution to the difficulties that we face. What is he going to do to bring that about?

[Paul Burstow]

Just a few weeks ago we started a pilot of a national advertising campaign on bowel cancer, with the key message being that people should never feel embarrassed about talking about their poos, so that they get the diagnosis that they need at the earliest opportunity. We are ensuring that such messages get across, even in the Chamber today. We are taking steps to raise awareness so that people get earlier diagnoses.

[Stephen Mosley (City of Chester) (Con)]

T1. If he will make a statement on his departmental responsibilities.

--- Later in debate ---

[Tristram Hunt (Stoke-on-Trent Central) (Lab)]

T4. What assessment has the Secretary of State made of epilepsy helplines in helping to save NHS costs? I have constituents who are able to live happy and fulfilled lives by talking with epilepsy specialist nurses on the phone rather than going into hospital, but unfortunately, it seems as if that service is under threat from the University hospital of North Staffordshire. What is Government policy, and will he look at the situation in north Staffordshire?

[The Minister of State, Department of Health (Paul Burstow)]

The hon. Gentleman is absolutely right to say that telephone services of the sort he describes play an invaluable role in giving people support. Again, we are at that point in the year when there are budget arguments between PCTs and hospitals, to which he refers. If he supplies me with further details on this case, I will happily write to him.

[Mark Lancaster (Milton Keynes North) (Con)]

T3. The Secretary of State has visited Milton Keynes, so he will be well aware of the historical problems at the maternity unit there and, following the intervention of his Department, of the positive outcomes that have been achieved with one-to-one supervision for all mothers. I am convinced that the increased training of midwives has contributed to those outcomes, but may I press him to reassure the House that that level of training will continue?

--- Later in debate ---

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

T7. Every 23 minutes, someone in the UK is diagnosed with a blood cancer disorder—that is 23,600 people per year, including many children. Survival often depends on a donor match. Today until 6 pm, the Anthony Nolan trust has a stand in Portcullis House, where people can get more information, and where those under 40 can register. Will the Minister join me in promoting the donor register and in encouraging MPs and staff to visit the stand?

[Paul Burstow]

I think that more than one of us wanted to do just that, because the Anthony Nolan trust does a fantastic job. The hon. Gentleman is right to raise awareness of it, and all hon. Members should take the opportunity to visit its stand today.

[Priti Patel (Witham) (Con)]

T8. Witham town council and my constituents are deeply concerned about the lack of local medical facilities serving our town. Will the Secretary of State reassure my constituents that under the new commissioning arrangements medical provision in our town will be able to expand?

--- Later in debate ---

[Jane Ellison (Battersea) (Con)]

I represent a constituency with a young and highly mobile population. Younger women are very much over-represented among those who do not respond to routine invitations to screenings. Will Ministers promote the increasing use of mobile communications in inviting women to routine screening services?

[Paul Burstow]

That is certainly one way in which we can improve access, and it is one of many that we outlined in the improving cancer outcomes strategy that we published in January.

[Mr Ben Bradshaw (Exeter) (Lab)]

Given that the Prime Minister has ordered his new communications director to order a shake-up of the health team because he is worried that they are losing the argument on the Government’s health upheaval, would it not save us all a lot of trouble if the Secretary of State admitted, not least to the Prime Minister, that it is not the public relations that is the problem, but the policy?

Learning Disabilities (Government Support)

Paul Burstow Excerpts

Friday 4th March 2011 Written Statements

[The Minister of State, Department of Health (Paul Burstow)]

I am today making a number of announcements confirming continued Government support to help improve the health and lives of people with learning disabilities.

The Department has today decided to extend its existing contract with the University of Bristol Norah Fry research centre (Norah Fry) for a further two years to March 2013 to carry out a time-limited confidential inquiry into premature and avoidable deaths of people with learning disabilities.

In parallel, I can confirm the Department has decided to continue to support for a further two years to March 2013 the provision of a time-limited public health observatory (PHO) service in relation to the health and health care needs of people with learning disabilities. This service is currently hosted by the North-East Public Health Observatory (NEPHO).

I am writing separately to the project teams at Norah Fry and NEPHO to confirm the extension of their work with the Department, and the funding arrangements going forward, so they can plan accordingly.

I can also confirm I wrote separately on Monday 21 February 2011 to the chairs of the National Forum of People with Learning Difficulties, and the National Valuing Families Forum, to confirm continued funding by the Department for their work in 2011-12.

In addition, I can advise that the Department published on 1 March 2011 an updated version of its handbook “Positive Practice Positive Outcomes: A Handbook for Professionals in the Criminal Justice System working with Learning Disabled Offenders”. The handbook originally dates from 2007 and now reflects recent developments in the field. The handbook has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

The Department is also preparing publication later this month of a suite of practical tools and materials that will help local authorities and other partners drive employment for people with learning disabilities.

All of this demonstrates the Government’s ongoing commitment to maintain momentum in delivering improved life outcomes for people with learning disabilities.

My announcements today on the inquiry and PHO service follow an open competitive procurement process in 2009-10 that resulted in contracts being awarded on 23 March 2010 to Norah Fry to run the inquiry; and NEPHO, leading a partnership involving the Centre for Disability Research at Lancaster University, and the National Development Team for Inclusion, to provide the PHO service.

Both these contracts were originally awarded for an initial period of 12 months, with the intention to extend them for a further two years until March 2013, subject to satisfactory evaluation of the work carried out in the first year and availability of funds. They took forward the Department’s commitment to implement the recommendations in the report of the independent inquiry headed by Sir Jonathan Michael into access to health care for people with learning disabilities “Healthcare for All” to establish a learning disabilities inquiry and PHO.

Offender Personality Disorder

Paul Burstow Excerpts

Thursday 17th February 2011 Written Statements

[The Minister of State, Department of Health (Paul Burstow)]

I am publishing today a joint Department of Health and Ministry of Justice consultation document on an “Offender personality disorder pathway implementation plan”.

This document sets out the Government’s plans to reshape services, interventions and treatments for offenders with severe personality disorders. These plans would be implemented within the existing resources devoted to this area across the national health service and National Offender Management Service. The proposals take account of the learning from the dangerous and severe personality disorder programme, introduced by the previous Administration, and are aimed to improve identification and assessment, increase treatment capacity, provide additional psychological support in prisons, and strengthen oversight for those released from custody.

This consultation is an important opportunity for professional bodies, service providers in health and criminal justice, patients and the public to comment on how best to ensure continuity of care through the development of effective service pathways across custodial settings and in the community, to improve care, protect the public and make the best use possible of the available resources. This consultation sets out the Government’s initial thoughts and invites views from interested persons or organisations.

The consultation document has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Services for Adults with Profound Intellectual and Multiple Disabilities

Paul Burstow Excerpts

Thursday 10th February 2011 Written Statements

[The Minister of State, Department of Health (Paul Burstow)]

I am today formally launching the Government’s response to last year’s report “Raising our sights: services for adults with profound intellectual and multiple disabilities” produced by Professor Jim Mansell of the Tizard Centre, Kent. This report is a very valuable contribution to the debate on how we can ensure that people with highly complex needs can be supported to live as independently as possible and as included and valued members of society.

The Government have made clear their commitment to improving the health and well-being of all people with learning disabilities, including those who have profound intellectual and multiple disabilities. That is why we support this report and have taken on board its central message that the major obstacles to improving outcomes for adults with profound intellectual and multiple disabilities are prejudice, discrimination and low expectations.

As our “Vision for Adult Social Care, Capable Communities and Active Citizens” made clear we were looking to empower service users and those who care for them and to enable a more personalised, preventative service focused on delivering the best outcomes for people who need support, enabling people to live as independently as possible.

The revised “Recognised, Valued and Supported: Next Steps for the Carers Strategy” outlines the priorities over the next four years to ensure carers get the support they need. “Equity and Excellence: Liberating the NHS” White Paper set out our long-term vision for the NHS which puts people at the heart of everything the NHS does focuses on continuously improving the outcome of their healthcare.

The response to “Raising our Sights” responds to the report’s 33 detailed recommendations. In addition. Professor Mansell set out five key conclusions:

adults with profound intellectual and multiple disabilities are a relatively small, easily identified group of people with undeniable needs for care and support. Despite these needs, they and their families have often not been provided with services to adequately meet them;

the “personalisation agenda” expressed in Government policy does appear to provide a better quality of life for adults with profound intellectual and multiple disabilities and their families. Continued progress in widening access to these kinds of services will enable more people to benefit;

there are a number of obstacles to wider implementation to which Government and other agencies should attend;

shortage of resources may influence the speed with which the recommendations of this report can be implemented but should not change the direction of policy and practice; and

learning disability partnership boards and voluntary bodies will have an even more important role in future in scrutinising services and giving voice to people with profound intellectual and multiple disabilities and their families. Government and regulatory bodies should take account of the likely effect of their work on the quality of life of adults with profound intellectual and multiple disabilities.

The Government accept and support these conclusions.

“Raising our sights: services for adults with profound intellectual and multiple disabilities” and the Government’s response have been placed in the Library. Copies of both documents are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Neuromuscular Care (North-West)

Paul Burstow Excerpts

Wednesday 9th February 2011 Westminster Hall

[The Minister of State, Department of Health (Paul Burstow)]

I congratulate the hon. Member for Weaver Vale (Graham Evans) on the passionate and powerful way in which he clearly set out the case. He has done a great service to the interests of those who suffer from muscular dystrophy and their families. I thank him for securing the debate. I also congratulate him on the work he has done in his role as a member of the all-party group on muscular dystrophy, not only for his region but in raising the issue more thoroughly around the country. I join him in paying tribute to the work of the Muscular Dystrophy Campaign and the North West Muscle Group. Both those organisations operate as powerful advocates for people affected by these lifelong and life-limiting conditions.

It is 18 months since the all-party group published the Walton report, which showed how far we had to go—as the hon. Gentleman has described only too clearly— to improve the care of those with muscular dystrophy and other neuromuscular conditions. There are historic weaknesses. The intervention of my hon. Friend the Member for Southport (John Pugh) just now underscored that point. There are weaknesses in the current system and in how we organise the things that have rightly been highlighted by today’s debate.

There is a real sense of urgency for change, not least because of the simple fact that we know about the huge personal and family costs of this condition and how it impacts upon people’s lives. Unless care is properly co-ordinated and well conducted, NHS resources will be wasted. They will be invested in the wrong places and will not deliver good outcomes. That cannot be acceptable in our modern health care system. Several colleagues alluded to the costs. The figure of £13.6 million was mentioned as the overall cost of unplanned hospital admissions for those with neuromuscular conditions in the north-west. If we analyse the journeys that people make through our health care system, that shows the actual cost.

Some hospital admissions are necessary and unavoidable. A person who contracts a respiratory infection is a good example of where there is an unavoidable need. However, if we consider the figures in greater detail, the number of people admitted for non-invasive, elective care, shows that there are many preventable costs in the system. That amounts to just under £5 million in the north-west alone. Those costs could be avoided and the money could be spent better. That has to be a key message. It is not just about spending more; it is also about spending better in our system. We need to ensure that we consider the economic case for investing wisely in services that can, in fact, provide a better quality of life. We must also ensure that we avoid unnecessary admissions in the first place.

Positive steps have been taken in the north-west. That progress has been hard fought, and it deserves to be recognised and applauded. Indeed, the strategic health authority has told me that £4.2 million has been spent on developing neuromuscular services over the past four years. As mentioned, a dedicated neuromuscular service at Alder Hey has been set up to provide excellent care for children. Out of that £4.2 million, £289,000 was invested as a commitment to the service provided and led by Dr Spinty. There appear to be some grounds for dispute over whether such services are funded or unfunded. However, we certainly need to keep ensuring that resources go in. There is a case to be made for ensuring that resources are well spent. Paediatric critical care services have improved with a dedicated paediatric intensive care transport team. There are additional beds at Alder Hey and the Royal Manchester for ventilation services, with similar investment in both invasive and non-invasive respiratory services for adults, too.

Although those developments are welcome, the local NHS accepts that many issues still have to be addressed, many of which have been aired today. The specialised commissioning group is responding to the Walton review by reviewing the region’s neuromuscular services. In essence, that review group—made up of clinicians, commissioners, patients and families—is aiming to address exactly the issues aired today: how to improve the poor support available to those diagnosed with neuromuscular conditions in adulthood; how to address the variability and patchiness in the availability of specialised neuro-rehab and wheelchair services; and how to improve transitional arrangements to help young people to move from paediatric to adult services. That is an absolutely key issue that comes up time and again in relation to rarer conditions when considering how well or how poorly the NHS manages those vital transitions from child and adolescent services to adult services.

The review group has updated the all-party group on muscular dystrophy on the review’s progress. On the kind invitation that has been extended to me to attend the meeting of the all-party group, I do not know whether I can attend on the specific date mentioned. However, I will certainly undertake to attend a meeting of the group as soon as I can and take questions from the group’s members.

I understand that the NHS North West specialised commissioning group will consider the review’s recommendations in March, and that the full report will be published shortly after. Clearly, I do not wish to pre-empt that report in any way but, based on the conversations I have been having in preparation for the debate, I think that the review team is asking some important and necessary questions. Those questions are on sharing best practice to ensure greater consistency, on work force planning, so that there is better co-ordination and leadership across care pathways, and on finding efficiencies across the system in line with the region’s quality, innovation, prevention and productivity plans.

The key to all of this is to have a much clearer split of responsibility—a sense of joined-up access across the care pathways to deliver a less fragmented and more person-centred approach to planning. I will say a bit more about the point that the hon. Member for Islington South and Finsbury (Emily Thornberry) raised on that in a moment. For me, the greatest challenge for the modern NHS is how to make sure that we have much more joined-up delivery. We have to accept that care and support for those with long-term conditions is a particular area where we do not get it right often enough, and it is unfinished business. There is too often a disconnect between what is commissioned at a regional level by specialised commissioning groups and what is available at a local level as commissioned by primary care trusts. It not only confuses patients and compromises both their care and quality of life; it also leads to inefficiency and duplication within the system.

Putting that right means thinking radically. It means putting greater emphasis on managing pain and helping people with multiple conditions. It means finally developing a personalised system to end the attachment to bricks and mortar institutions and to reinvent health care in a modern context—a health system that is much more about what can be delivered in the home and in the community than it is about clinics and consulting groups.

When it comes to long-term conditions such as muscular dystrophy, attention tends to fall on specialised commissioning groups, and that is what has been rightly talked about today—the response in terms of tertiary care. Tertiary care is clearly important. We can see, from the important work at Alder Hey and Royal Manchester children’s hospital, the difference that such specialist centres can make. However, there also needs to be an equal onus on community-based support—the ongoing day-to-day care that is so important to support quality of life and to keep people out of hospital in the first place.

Primary care trusts and in the future GP commissioning consortia and health and well-being boards, not the specialised commissioning teams, will be responsible for that. They will shape the services that clinicians and social care need to provide to meet the needs of patients, such as hydrotherapy, wheelchair services, speech and language therapy, respiratory support and help with swallowing. It is therefore essential to have better co-ordination, a better link-up between commissioning teams across health and social care and beyond, and, rather than individual bits, a person-centred approach to planning across the whole care pathway. That needs a whole life course approach, which is why I return to the point that we need a focus on transitions between childhood services and adult services. The review’s recommendations will help to bring that about in the north-west. I look forward, as I am sure the hon. Member for Weaver Vale does, to its publication and to it being put into effect.

To take the case of specialist physiotherapy, the SHA recognises that there is pressure on tertiary centres, which is something that the hon. Gentleman talked about. The challenge must be met by a whole system approach that makes full use of the available resources. NHS North West tells me that it is already mapping out in more detail what neurophysiotherapy services are available across the north-west. The current specialist physiotherapists are being encouraged to work with community physiotherapy to improve their skills and to help them to offer appropriate services at a local level. That outreach to upskill other parts of the work force will be a key way to improve delivery. I understand that Manchester PCT is also doing some exciting work in piloting a neuro-rehab service that treats people at home or in the community, rather than in a clinic. That brings into relief the potential benefits of integrating tertiary and community-based services—of how, by doing things differently, we can improve services for patients.

The hon. Gentleman talked about the NICE guidelines. He is absolutely correct, as are other hon. Members who have spoken in the debate: we need greater consistency, and being more consistent means being clear about what “good” looks like. I have already mentioned NHS North West’s neuromuscular services framework, which is a helpful starting point for bringing different organisations together. My hon. Friend the Member for Southport also raised the issue of the need for clinical networks, and I will say a bit more about that in a moment. The review group is also making the case for the clinical networks and clinical network managers to provide leadership, to share best practice, and to provide challenge to commissioners. Again, that would seem to be a sensible approach not just in the north-west, but around the country. I would expect the NHS commissioning board to help to take that forward when it takes up the reins of specialist commissioning.

Of course, another issue mentioned by hon. Members is the need for clear guidelines and quality standards from NICE to cover muscular dystrophy and various aspects of the delivery of care and treatment for people with the condition. I hope that Members understand that it is not for me to direct NICE. Its strength as an organisation rests on its independence from Government, and therefore I will not compromise that. What I will do, and which is important to do, is ensure that it is made aware of today’s debate, so that it can take it into account in its deliberations. The East of England specialised commissioning group is leading on quality standards work and service specifications, so there is work to help influence that going forward.

Another influence on NICE are the conversations with the leadership group of the Neurological Alliance on how it can develop stronger clinical advice for a range of rare neurological conditions. I strongly urge the Muscular Dystrophy Campaign to actively engage with that leadership group, so that it is also at the table with NICE. NICE is part of that forum, which presents an important opportunity to achieve faster progress and effective action. We are also, in the context of the work of health and well-being boards and GP commissioning consortia, looking at how to update the guidance for joint strategic needs assessments. I urge the Muscular Dystrophy Campaign to have an input, through the Neurological Alliance, on that work, too.

Equally, the National Quality Board is working on a broad library of quality standards to cover all areas of NHS care. Again, there will be opportunities for the Muscular Dystrophy Campaign and others to feed into that process. Input through the leadership group of the Neurological Alliance would be a very effective way of getting its voice heard.

Careers and training have been referred to in the debate. I suggest that, rather than a Minister trying to dare to dictate the curricula of the medical professions, it might be more prudent to ensure that they are also aware of this debate, with a covering letter from me to draw it to their attention so that they can take it into account as they reflect on future curricula.

On the issue of advice and support for patients, a strong case has been made for the case-management approach. It is important that we look outwards to patients and their families. At the moment, people with long-term conditions can feel disempowered and frustrated by the complexity of the system. It can be a fight, as the hon. Member for Weaver Vale has described, to understand what is available. As the hon. Member for Foyle (Mark Durkan) rightly said, it should not be the case that every time someone enters the system it feels like they are navigating it for the first time, as if no one else has ever gone through that before. That is a perfect way of describing how the system should not feel and how it must not feel as we go forward. The hon. Member for Weaver Vale described the example of Liam. That example makes a very strong case for increasing the number of neuromuscular care co-ordinators, who are known to be extremely helpful in improving patient care and outcomes. I understand that that is something that the review group is exploring and it will, through its contracting arrangements that go beyond that, help to drive that forward. I have no doubt in my mind that there is a strong economic case for the co-ordinators.

I am also pleased that the Manchester PCT is looking at how personal budgets can be used to help people with neuromuscular conditions to get the help they need. Personal budgets are more than a lever to give patients more control. They can be a catalyst for bringing services together around the needs of the individual—another way in which we can integrate at an individual level. In fact, a number of the pilots that are testing personal health budgets are actively involving people with neuromuscular conditions.

The final question, asked by both my hon. Friend the Member for Southport and the hon. Member for Islington South and Finsbury, is how do we maintain continuity during the transition period? The Health and Social Care Bill is clear that highly specialised services would, in future, be commissioned by the NHS commissioning board. I can confirm that this condition is included among them, as it is already designated as a specialist commissioning area. The board will decide how best to organise itself to deliver, on a case-by-case basis, different commissioning activities on different specialist conditions. It would be wrong, when the Government are saying in the Bill that we are giving autonomy to an NHS commissioning board, for the Minister to then specify, in an Adjournment debate, to the nth degree precisely how the NHS commissioning board should discharge that function.

The NHS commissioning board has that responsibility, and that comes with a responsibility on patient and public engagement as well. It is important that lessons from existing experience of specialised commissioning are drawn together to inform the way in which those responsibilities are discharged in the new system. I will undertake to ensure that this debate is drawn to the attention of those who are doing that work at the moment. Again, I think that the Specialised Healthcare Alliance provides the Muscular Dystrophy Campaign with a way in to influence and shape those opportunities. I note from comments to the Health Committee before the general election that there was a recognition that we could do much more by moving to a national commissioning board that can streamline, simplify and ensure greater consistency around contracting for these services.

That brings me to the other element of the new architecture, which is general practitioner commissioning consortia. Clearly, integrated planning between consortia and the NHS commissioning board will be essential, just as joint working between primary care trusts and specialised commissioning groups is at present. I am keen that strategic health authorities will encourage GP pathfinders, along with the early implementers of health and well-being boards, to work with the specialised commissioning groups to explore how the relationship can work best on the ground so that we develop the best case examples to inform the system as we move to the new arrangements.

As the hon. Member for Weaver Vale rightly highlighted, GP consortia will need advice and guidance as they take up the reins. There will be a great opportunity for patient groups to step in and provide support in that way, and I would certainly encourage that kind of active engagement. Also, health and well-being boards will have a key role as system integrators—they will have a major part to play in developing the more joined-up system. We will consider whether that is enough or whether we need to do more as we scrutinise the Health and Social Care Bill clause by clause in the coming weeks. The most effective way of operating will be through the regional networks that the Neurological Alliance is setting up. Again, I hope that the Muscular Dystrophy Campaign will be part of that.

Yes, we have to ensure that we get specialist commissioning right, but we also have to ensure that we get commissioning for long-term conditions in general right, and we have to do that at a local level.

I thank the hon. Gentleman for securing this debate and for setting out the issues so clearly, and I thank other hon. Members for their contributions. We know that there is much to do to improve the care of those with neuromuscular conditions, and that we are not doing enough yet. We know that the system that we inherited has not delivered uniform and consistent access to services—we must do more. We also know that financial pressures should not block progress because, all too often, action here saves money that can then be better spent on improving the quality of services.

I look forward to reading the final report of the north-west review group—and, indeed, the other reviews that are taking place—and I hope that it can be a catalyst for real improvements in the years ahead. The hon. Gentleman is right to say that we have to translate the intentions behind the review into tangible actions that transform the lives of his and many other hon. Members’ constituents up and down the land.

Care for the Elderly (Kent)

Paul Burstow Excerpts

Tuesday 8th February 2011 Westminster Hall

[The Minister of State, Department of Health (Paul Burstow)]

It is a pleasure to serve under your chairmanship, Mrs Brooke. I congratulate the hon. Member for Dover (Charlie Elphicke) on securing the debate. He, like the hon. Member for Dartford (Gareth Johnson), has used it to ensure that those responsible for making the decisions are properly held to account and the issues are fully aired and in the public domain. The summing up given by the hon. Member for Dartford underlines the important contribution that a debate in Parliament can make to illuminating an issue and ensuring that local decision makers account to their public for their decisions.

The hon. Member for Dover raised an issue that is causing a great deal of concern to his constituents, the hon. Member for Dartford and many other Kent residents. He talked specifically about Sampson Court and identified the commitment that he and his constituents feel towards that facility. It is a much loved, long-standing part of the community. Both hon. Gentlemen talked about the passion displayed by those campaigning on these issues.

The county council has already taken decisions on this and other home closures of the sort about which the hon. Member for Dartford spoke. Parliament has given the responsibility for taking final decisions on care home closures to councils not to Ministers. I know from my constituency work just how upsetting care home closures can be. Clearly, in the event of any care home closure—I will not prejudge where a subsequent challenge to the decisions in Kent would get to—our first thoughts have to be about the welfare of those who live in the homes and use the services, as has been clearly described by the hon. Member for Dover who talked about his father and about the representations received from constituents. I realise that for residents and families associated with the care homes, this is an unsettling time. Moving home when a person is elderly or frail can be hugely distressing and potentially damaging to their health. If badly handled, it can actually foreshorten life—I make no bones about that.

I have asked Kent county council for reassurance about its plans to reduce the disruption and harm to residents who will be transferred as a result of the decisions that it has made. As I understand, the council is currently assessing the needs and preferences of all residents and services, and it is doing everything in its power to accommodate people’s wishes. For example, it is ensuring that people are not moved to a place that is different from the place their friends from the home are moved to. If people want to stay together, they will have the opportunity to do so.

The council also told me that the families or advocates of those affected are being kept informed during the process. That is crucial, although some of what I have heard during the debate suggests that there are different opinions about that statement, and from some of the body language, I see that others share that feeling. The council hopes to support residents to move at a pace with which they are comfortable, and evidence from past closures demonstrates that that is crucial for minimising the effects of such a move. The sense that there is an arbitrary timetable can have a significant impact on the health and well-being of an individual.

I am told that all residents and service users will be found places in centres and homes of an equivalent or higher standard. I do note, however, the representation made by the hon. Member for Dover about the experiences of his constituents and the lack of assurance that they have received so far in their efforts to discover an appropriate home for their loved ones. The council has said that, within reason, service users will not lose out financially, and that an independent arbiter will deal with any disputes over costs associated with the move.

The hon. Gentleman was right to say that we must put this into a national context, and across the country all councils are having to grasp the nettle and take painful decisions to reshape social care around the changing needs of their population. We need a broad strategic shift towards preventing and postponing dependency, and promoting greater independence. That includes ensuring that the services available are the right services for a particular point in a person’s journey with a degenerative neurological condition, such as dementia, for example, which he mentioned. Earlier diagnosis is key to sensible planning and it is important to ensure that we deliver the right care at each stage of the journey taken by an individual and their family carers. That means that over time, councils need to spend less on care services where there is overcapacity, and free-up resources to invest in more personalised support.

This Government have no ideological opposition to residential care, although there is a sense that that was the case in the past under previous Administrations. There will always be a need for good-quality residential and nursing care in our communities, and anyone who has had a long-term engagement with the sector—as I have, and I am sure other hon. Members have—will know how much it has changed over the past 20 years. The level of need and dependency of residents has risen significantly, and the length of stay has shortened.

Currently there are approximately 50,000 vacancies in care and nursing homes across the country. According to the recent “Care of Elderly People UK Market Survey” by the independent health care analysts, Laing and Buisson, the level of spare capacity in the care home sector is currently 10% nationally. That carries a significant opportunity cost and locks a public resource that could be released and spent more effectively on early intervention and more personalised forms of care.

We should be clear that these closures are not—or should not be—a question of budget pressures forcing the council’s hands. The money for social care is there. The Government made a clear choice on decisions about funding critical services, and despite inheriting the largest peacetime deficit in our history and the largest structural deficit in Europe, and despite paying £120 million a day in interest repayments on the national debt, we have chosen to protect the care and dignity of older people. In the spending review, we made it clear that an extra £2 billion a year for adult social care would be available by the end of the spending review period. Furthermore, £1 billion of that would be added to the local government formula grant, which comes on top of the existing £1.3 billion social care grant. That means that total grant funding from the Department for social care will reach £2.4 billion by 2014-15. For those keeping up with the numbers, the other £1 billion will be transferred from the NHS and spent on social care measures that also support health.

That settlement is frontloaded, so that extra resources are put into the system at the beginning of the spending period. It means that considerable amounts of extra investment are available now. Kent county council has already received £1.4 million in November to improve re-ablement services, and £4.1 million in January as part of a national investment of £162 million to cope with winter pressures facing social care services. From April, it will get an additional injection of £16.2 million, which is its share of the £648 million that we are allocating via primary care trusts to support social care. That is on top of the extra funding for social care that we are putting into the local government finance settlement—a share of the £530 million extra available nationally next year, rising to the £1 billion I have just mentioned.

My understanding from briefings I have received is that Kent county council’s approach is not a sudden, hasty, knee-jerk response to tighter financial circumstances. The proposals are part of a long-term plan in Kent to improve care and meet the changing needs of the local population. The council published its “Later Life” plan in 2009, and it has been working over the last two years to restructure and transform services to put more emphasis on prevention and practical support.

Services need to be tailored to people’s circumstances and population need, and I emphasise that residential care is part of that mix and must be carefully thought through when services are designed. We need services that deliver value for money in a climate where we expect higher demand as the population ages, and we want good quality services—whether provided in the public or independent sector—that are well equipped to give people the choice, comfort, compassion and independence they deserve.

The council argues that the facilities at Sampson Court no longer meet the standards we should expect. The hon. Gentleman has rehearsed that argument and stated his concerns. The council also argues that the building would require extensive refurbishment to bring it up to scratch, and that the money could be better used in other ways. The council’s view—painful though it clearly is—is that closure is the right way forward. I understand that many people will disagree with that, and believe that alternatives have not been adequately considered—the hon. Gentleman referred to the petition collected by Councillor Julie Rook. The Government are keen to give communities the opportunity to run community facilities. That is what the Localism Bill currently making its way through the House attempts to put in place. That Bill also seeks to reduce the barriers that enable a variety of organisations, including community groups, to provide services.

The council’s view is that it has been through an extensive consultation process and considered the alternative options. The 11 care home changes have been debated in the council’s chambers, and the proposals have been the subject of the council’s overview and scrutiny committee. I know that there are great concerns among those who have led the campaign against the closures, and I am told that lawyers have been instructed to look at pursuing the matter through a judicial review. In that way, the process that the council has gone through can be tested, and if it is flawed, the decisions will be reopened and further options considered. However, that is not a matter for me as a Minister; it is about deciding whether the process has been properly followed, and a matter for judicial review. Parliament has not given Ministers that power, and the Government have made it clear that in the past, far too much rested on the desks of Ministers in Whitehall and other officials.

During conversations with Kent council over the past few days, the director of adult social services said that the council would be pleased to continue discussions with the hon. Gentleman and his colleagues, to see whether further points of concern can be addressed. In conclusion, I hope that we have covered some of the issues raised, but in the end, this matter must be resolved locally.

Hospice Care

Paul Burstow Excerpts

Wednesday 2nd February 2011 Commons Chamber

[The Minister of State, Department of Health (Paul Burstow)]

I congratulate my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) on securing this debate and on laying out the issues so clearly. We must draw attention regularly and repeatedly to the contribution that hospices make to our society. As he rightly said, they are in the vanguard of the big society. He was right to paint the picture of the factors that drive us to focus on the role of hospices, such as the demographic pressures that he described.

My hon. Friend talked with eloquence about the difference that St Elizabeth hospice makes to his constituency and his constituents. I join him in paying a warm tribute to that hospice and to the others that have been mentioned. Recently, I have had the privilege of visiting my local hospice, St Raphael’s, and St Ann’s hospice in Cheadle Hulme. I share his and other hon. Members’ admiration for the tremendous care and compassion that is provided by staff in those places.

We want to ensure that these institutions grow and flourish as part of a more personalised approach to end-of-life care. How can we do that? First, we need to get the funding right to ensure that hospices can plan for the future with confidence. Secondly, we need to be much clearer about the role that hospices can potentially play in end-of-life care, and have that role recognised in the commissioning and shaping of local services. Thirdly, we need to establish end-of-life care as a clear priority for improvement across the NHS, using levers such as the outcomes framework, the operating framework and the forthcoming quality standard.

I know that my hon. Friend the Member for Central Suffolk and North Ipswich and others have concerns about funding. He will know from his recent visit that St Elizabeth hospice has recently undertaken a refurbishment programme. It had to raise a lot of money to pay for that work, but I am pleased to be able to say that part of the cost was funded from a £40 million capital grant scheme that we are making available this financial year. One of the coalition Government’s first actions was to confirm that funding, as an early indication of our commitment to hospice care. Well over a hundred hospices, such as St Elizabeth, are receiving funding from that grant to help them improve their facilities.

My hon. Friend will know that that is part of a much larger sum that we have made available to support the end-of-life care strategy for adults. In the current financial year, £198 million was made available to help improve the quality and range of services for people in the final stages of life. That was an indicative amount set by the previous Government, and there have been doubts, expressed not least by the Public Accounts Committee, about whether the new money for the implementation of the strategy was being used for its intended purpose. The big question is how to ensure that the funding gets through.

Some argue, although the argument has not been advanced tonight, that ring-fencing is the answer. I actually believe that it would be likely to be a retrograde step. It would give the NHS less flexibility, less discretion and less scope to meet local people’s needs at precisely the time when we need the NHS to have a more personalised approach. Ring-fencing can act as a cap rather than a guarantee, putting an artificial ceiling on the amount that an area can spend on end-of-life care rather than encouraging that amount to be commensurate with need.

Ongoing and increasing funding for end-of-life care will be part of the baseline for primary care trusts, and for the GP consortia that replace them. However, the local NHS will get freedom and responsibility in choosing how it spends the taxpayers’ resources committed to health care. That is the key refreshing change that the Government’s reforms will bring about. In return, we expect much greater transparency and accountability for the decisions that are made.

By monitoring how the new end-of-life care funding has been spent, we are doing what we can to shed light on PCTs’ decisions and on the variations in spending that occur. Last year, for instance, just 20% of the money going to PCTs was allocated to hospices. We are repeating the monitoring process for this year and conducting a survey of total PCT expenditure on specialist palliative care, including that provided by hospices. Together, that will give a clearer picture than ever of how different parts of the NHS make use of local hospices in delivering care. That is an essential component of the picture that we need to build to ensure that good commissioning takes place.

End-of-life care will also be given greater visibility in performance structures in the NHS. We have already published the NHS operating framework for the coming year, 2011-12, which emphasises the need for greater choice in end-of-life care. That care also figures prominently in the outcomes framework for the NHS, which will ensure that commissioners and providers give the matter priority. In fact, last month we published a set of performance indicators to work alongside the outcomes framework. For end-of-life care, PCTs are currently planning against the indicator measuring the percentage of deaths that take place in someone’s usual place of residence—their own home or their care home. That will provide a real incentive, real traction and a real opportunity for hospices and other providers to work with commissioners to improve outcomes.

Finally, as I have mentioned, the quality standard that the National Institute for Health and Clinical Excellence is working on will give clinicians, hospices and health managers a clear and shared idea of what best practice looks like. NICE tells me that it expects the standard to be published by November this year.

[Mr Steve Brine (Winchester) (Con)]

Naomi House children’s hospice in my constituency is a fantastically run hospice that raises an enormous amount of money to continue its hospice-at-home service, which recently restarted. It receives about 12% of its direct care costs from the Department of Health, but was told a couple of years ago that that would come to an end this year, and it is not having much luck in securing ongoing funding from the primary care trust, NHS Hampshire. What advice would the Minister give to that hospice for the interim period before GP consortia in west Hampshire are up and running?

[Paul Burstow]

Hospices need to continue to work to demonstrate the huge benefits of their provision to commissioners. If the hon. Gentleman writes to me, I will pay close attention to what is happening in that regard.

My hon. Friend the Member for Central Suffolk and North Ipswich rightly mentioned the difference that GP consortia will make. GPs are the best people to bring together the provision that I have talked about, along with the new local health and wellbeing boards. The advent of GP consortia will change the relationship—quite fundamentally, and in the right way—between hospices and GPs. It will make it natural for doctors to talk to each other and solve problems together, and to draw on different sources of support to help patients get what they need. It is encouraging to note that three of the GP pathfinders—Westminster, Bristol and Somerset—are specifically looking at how they can improve end-of-life care under the new arrangements. That is a sign of GPs’ interest in such care, and the potential for GP-led commissioning to bring about change and to address that challenge.

There is a new opportunity for collaboration and innovation, but hospices must not sit back—they must actively engage. We need them to be proactive in understanding and engaging with the new systems and structures as they settle into place over the next two years. They need to be proactive in talking with their local GPs and building up the relationships and mutual connections that will be essential to how the system works, and proactive in working with local authorities, which will play an increasingly important role in shaping and integrating care through the health and wellbeing boards. Ensuring that health and social care are commissioned and planned together is critical in the delivery of good end-of-life care.

Hospices also need to be proactive in broadening their horizons and innovating to support a wider range of people. As my hon. Friend rightly said, hospices are not just about cancer. We want people to be able to die in their own homes, where they would choose to be, and we need a more flexible and dynamic approach from both the NHS and hospices in that regard.

As my hon. Friend rightly pointed out—this is a key point—contrary to popular perception, only a small number of people actually die in a hospice. A great many more people benefit from their work in other ways. People could, for instance, receive day therapy in a hospice, or, as is the case with the local hospice in my constituency, they can get help from hospice staff working in the community, which was referred to by a number of hon. Members. Children’s hospices, meanwhile, could get more involved in the long-term treatment of children rather than just end-of-life care.

We need to innovate in those partnerships. We need commissioners to make imaginative use of hospices as part of their end-of-life, palliative care plans. Hospices must also have the ambition to explore new ways of offering their skills and services to NHS commissioners. My hon. Friend is right that we need to reach out beyond cancer services—it is essential that services diversify. St Christopher’s in London, which he mentioned, is doing excellent work with people with dementia who need end-of-life care. We need to focus much more on that to deliver the national dementia strategy.

I want more hospices to play a role in supporting people with other degenerative conditions—not just dementia, but conditions of the sort my hon. Friend rightly highlighted. We make that point explicitly in the national dementia strategy, as I said, and we want to reinforce it through the end-of-life care strategy.

The levers and the incentives are in place to enable hospices to secure NHS funding in the years ahead. But in the longer term we know that a new funding model is needed. We made it clear in the coalition agreement that we want to introduce a per-patient funding system that is built around a much clearer understanding of what level of care should be available through the NHS and that is fairer and more sustainable for all providers, including hospices, because it moves us away from the vagaries of grants—we have just heard about the problems those cause to the children’s hospice in the constituency of my hon. Friend the Member for Winchester (Mr Brine)—and gives them certainty of a set level of funding per person.

The debate about this subject has been going on for some time and is well developed. I encourage hon. Members who have spoken to contribute to that work. In July, the Secretary of State for Health appointed Tom Hughes-Hallett, the chief executive of Marie Curie Cancer Care, to chair an independent review covering both adult and children’s services. That review will look at the issues raised in this debate to ensure that we have services that reach out beyond the confines of the hospice and address the wider cost issues in rural communities. An interim report was published at the end of last year, which sets out a definition of dedicated palliative care and provides initial thoughts on how a new national funding system could be built.

[Stuart Andrew]

Will the review take account of not only the similarities between children’s and adult’s hospices, but the differences? Respite care is a fundamental part of the care that children’s hospices provide.

[Paul Burstow]

I can give my hon. Friend that undertaking. Understanding of and sensitivity to those differences will be reflected in how the review is put together. I will also ensure that this debate is brought to the attention of those doing this work.

Hospices play a strong and distinguished part in our communities. We absolutely want them to have a bright future. Yes, there will be challenges, not least because the financial environment will affect hospices just as it will affect other parts of the health system, and I can understand the concern that that creates. But through the operating framework for the NHS, the funding review and the wider improvements that we are making in terms of GP-led commissioning, we are creating the right conditions for a vibrant hospice movement for the future. That will mean that institutions like the ones my hon. Friend the Member for Central Suffolk and North Ipswich mentioned can continue to make a significant and valued contribution in the years ahead.

Question put and agreed to.

Myalgic Encephalomyelitis

Paul Burstow Excerpts

Wednesday 2nd February 2011 Westminster Hall

[The Minister of State, Department of Health (Paul Burstow)]

It is a pleasure to serve under your chairmanship, Mr Hancock, with the coincidence of speaker and respondent in the debate.

I congratulate my hon. Friend the Member for Redcar (Ian Swales) on securing the debate, and thank him and other hon. Members for their contributions. This is not the first time the House has debated these issues. My hon. Friend the Member for Mid Dorset and North Poole (Annette Brooke) raised them—as have others, including me—when in opposition. My local ME support group has been encouraging, and what it has taught me has been an invaluable part of how an MP gets an insight into a condition they might not personally suffer.

I realise that this is a difficult and controversial subject, and I can understand why feelings run high. I appreciate the difficult and desperate struggles that people often face to achieve clinical recognition and relief from the condition, and a sense of hope that there is a direction of travel toward understanding the underlying causes, and eventually getting a cure.

I will ensure that the comments of my hon. Friend the Member for Redcar about benefits are passed on to ministerial colleagues at the Department for Work and Pensions. Although he made some important points in that regard, I will not address them as they are above my pay grade—or certainly outside it.

The basic challenge is that we do not know with any confidence what causes the distressing symptoms—indeed, the condition itself—that my hon. Friend so clearly described. That is why he is right, as is the hon. Member for Stockton South (James Wharton), to highlight the need for research. On my hon. Friend’s point about defining the condition, until we have a strong clinical evidence base, we have to keep an open mind about whether this is one condition or a number of conditions with similar symptoms but different causes. The Department does follow, and will continue to follow for the time being, the World Health Organisation convention in how we describe and refer to the condition—that is, to call it CFS/ME. That is the WHO definition; it is not a specific term that the Department of Health has alighted on and no one else uses. It is important that that be understood.

On present understanding, that definition best captures the spectrum of symptoms and effects that characterise the illness. As yet, there is no cure nor any consistently effective treatment for the condition. As my hon. Friend rightly said, we do not even have a standard diagnostic test to confirm the condition. Diagnosis is possible only through excluding other illnesses with similar symptoms. There is, however, strong international consensus that CFS/ME is a chronic and disabling neurological illness. I want to stress that it is a neurological illness; it is not a mental health problem. I know that that suggestion causes great concern—and, arguably, offence—for many sufferers who have campaigned vociferously against it. The strength of many people’s reaction to that label says a lot about the stigma that is still attached to mental illness, and about the attitudes of health professionals towards it. We seek to tackle those two problems in the mental health strategy that the Government have published today.

Although CFS/ME has no psychological foundation, that does not mean that we cannot gain lessons and insights from cognitive behavioural therapy, and that where appropriate, it should not be used as part of a treatment plan, just as it is for many other long-term health conditions. The NICE guidelines, to which my hon. Friend has referred, include counselling and graded exercise as possible treatment options. Let me emphasise the words “possible” and “guidelines.” Neither of those things is mandated, but they could form part of a conversation between the clinician and an individual about the appropriate, personalised approach to their situation.

The guidelines seek to help a person to manage their symptoms as much as possible. In lieu of any clinical cure, that is about social recovery and helping people to manage their symptoms, be clear about their goals and define their own recovery, rather than simply prescribing a clinical treatment. We know that the treatment in the guidelines helps some patients but, as my hon. Friend has said, for many people it does not help at all, and some people find it offensive. The obvious point—I will return to this in a moment—is that a doctor needs to work with the patient to find the most appropriate way forward. That is why personalisation is at the heart of our general approach to long-term conditions, which is critical in this debate.

With no cure, research is naturally a source of hope for those with the condition, and my hon. Friend has made a powerful and compelling case for further investment. However, it is not as simple as the Government saying, “We will the end but we are not clear about the means when it comes to research,” and it is not a case of allocating a research pot to a specific disease type. Down that road lies poor research, not discovery and real change.

We are protecting health research budgets overall. That decision was taken from the centre and made by the Chancellor in the spending review. However, decisions about how money is allocated remain—rightly—with the Medical Research Council and other funding bodies, not with a Minister behind a desk in Whitehall. That must be the case with other funding bodies.

The MRC has nominated CFS/ME as a strategic priority area for several years. Indeed, it has set up an expert group to focus specifically on the condition in a way that did not happen previously. The group comprises leading academics from across the country, as well as representatives from several organisations that have direct experience and interest in the condition. They are working together to improve the capacity and opportunities for research in the area.

My hon. Friend has acknowledged as good news the fact that the MRC is making up to £1.5 million available to support research into the causes of CFS/ME, which is welcome. Decisions on funding will continue to be made purely on the quality of research funding received. Critically, as in any area where we need more research, that sends a clear signal that the money is there and that there is a willingness to commit funds to research. The gauntlet has been thrown down to the research community to rise to the challenge and ensure that there are enough bids of sufficient quality to draw in that funding.

The funding call will focus on six priority areas identified by the expert group— autonomic dysfunction, cognitive symptoms, fatigue, immune problems, pain management and sleep disorders. I will ensure that the MRC and other research bodies look at this debate and see the additional points that have been made about biomedical research, so that that can be taken into account by the expert groups.

The call will also seek to build up research capacity, because one of the challenges has been attracting more researchers into the field. The expert group can only achieve so much on its own and, if I may be blunt, there has been a history of fractiousness and fragmentation between different groups with an interest in the area. Often, it is easy to agree on what we do not like, but harder to agree on the common ground and what the course of action should be to change things. I understand the heightened emotions that are often articulated by constituents who suffer from the condition, and I have spoken about that to people in my surgery. However, we will not achieve anything if organisations do not work together and engage with one another to find common ground and build alliances.

All patient groups need to look outwards and be positive about how they can work with the NHS, the Department, medical researchers and each other to influence change. One big challenge is to get more researchers interested in that area of work, but we are sometimes in danger of shooting ourselves in the foot by failing to show a united front.

Everyone with a stake in this area has an interest in ensuring that a constructive and supportive environment exists for research—that is key. Division and discord will not accelerate the pace of change, and I hope that the reconstituted all-party group on Myalgic Encephalomyelitis will play its part in facing that challenge and driving us forward.

My hon. Friend has mentioned the XMRV retrovirus, and I want to underline his point. It is an area in which research is not conclusive and where further research is being pursued to establish whether there is a link. At this time, however, there is no robust evidence to suggest such a link. Research can provide hope for the future, but we need to do more now to improve care for people with the condition.

The NHS does not always get it right for people with long-term conditions in general, let alone those with CFS/ME. The problems faced by people with CFS/ME are consistent with those caused by other conditions. Care is fragmented rather than integrated, and people struggle to be referred to a specialist in a timely and appropriate way. Most importantly, there is a sense that health professionals see the condition, rather than the person in front of them. Although this debate is about how we describe CFS/ME, it taps into some basic ideas. All too often, the label ends up mattering more than the person. Health professionals decide how people are treated and to which services they should be referred, but that should not be the most important determinate. We want the patient and doctor to work in partnership in the consulting room, meeting as two experts—one on the person, and one on the appropriate ways to support and treat them.

The greater use of personalisation and care planning can play a part, and that must be an explicit part of the Government’s plans for the NHS. However, it goes deeper than that, because it is really about patients being given the power of self-determination. The idea of, “No decision about me, without me,” should be a governing principle of the NHS. People should be asked to set their own personal goals and work together with professionals to achieve them. Everybody is different, and we must ensure that the care they receive reflects that.

My hon. Friend did not mention commissioning, but it is important to touch on that issue. To achieve these changes and get the right services and specialists, we must make sure that support is available. I know from my own constituency that excellent work is done in specialist CFS/ME clinics to integrate care for patients. Nevertheless, there is patchiness around the country that compromises the quality of treatment and reduces the options available. That is why we must improve commissioning, and GP consortia can help us involve patients much more in how local services are shaped.

I stress that the future of the NHS is local, not national. It is about local NHS and local GP consortia working with local patients’ groups and making decisions based on a clear understanding of their needs and local needs. To commission effectively, GPs must understand the needs of patients with long-term conditions.

I hope that the Neurological Alliance can play an important role in that. Nationally and regionally, it has support networks that can make a huge difference by levering change in the commissioning of neurological services. I urge groups with an interest in CFS/ME to engage with the Neurological Alliance, use it, work through it and form connections with it, as a way of shaping and changing services in the future.

In conclusion, there are real opportunities ahead, and a real chance to address some of the frustrations and misery experienced by people with this condition. My message, and that of the Department of Health, is that there is an open invitation for representative groups to get involved in shaping the future of the NHS. We want the Neurological Alliance to be a key source of advice and support for GP consortia and health and well-being boards at local level. I am sure that the new NHS commissioning board will be keen to build links with the alliance in forming national policy.

The urgency exists, and the additional commitment to drive long-term conditions to the top of the agenda is one of the Government’s ambitions. I thank my hon. Friend for raising these issues, and we will continue to work together to make sure that we improve the lot of his constituents and those of other hon. Members.

[Mr Mike Hancock (in the Chair)]

Thank you, Mr Burstow. I ask those hon. Members who are not involved in the next debate to leave the Chamber quietly and speedily.

Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 25th January 2011 Commons Chamber

[The Minister of State, Department of Health (Paul Burstow)]

We published “Improving Outcomes: A Strategy for Cancer” on 12 January, which sets out a range of actions to improve cancer outcomes, including diagnosing cancer earlier, helping people to live healthier lives to reduce preventable cancers, screening more people, introducing new screening programmes, and ensuring that all patients have access to the best possible treatment, care and support. Through those approaches, we aim to save at least an additional 5,000 lives every year by 2014-15.

[Charlie Elphicke]

May I raise the case of my constituent, Suzanne Lloyd, who was diagnosed with breast cancer a decade ago? She was told that she had two years to live, but has successfully battled cancer for the last decade. The problem is that she has also been battling health chiefs to give her the drugs that she needs to extend her life. Will the Minister tell the House about measures to increase longevity through greater drug access?

[Paul Burstow]

Just last year the national clinical director published a report on the extent and causes of international variations in drug usage, which revealed that the UK tends to lag behind other countries in its use of newer cancer drugs. That is one reason why we have introduced the interim cancer drugs fund of £50 million in this current year and will introduce the full fund of £200 million from this April. That will help my hon. Friend’s constituent.

[Graham Evans]

What steps is my hon. Friend taking to ensure that all GP consortia will have access to the expertise they need to commission cancer services effectively?

[Paul Burstow]

The national cancer director will work with pathfinder GP consortia on commissioning cancer services, and that work will be fed into a cancer commissioning support pack that will be developed to support GP commissioners in discharging their functions effectively. Cancer networks will also be well placed to support GP consortia in that activity.

[Mr David Blunkett (Sheffield, Brightside and Hillsborough) (Lab)]

We all agree that properly evaluated, appropriately prescribed drugs make a big difference to survival, which is why patients welcome what was described as the additional special fund, of which Ministers made mention this afternoon, of £200 million for the coming two years. Why is it, therefore, that the budget for Sheffield has been top-sliced for next year to the tune of £1.5 million to pay towards this £200 million, which was supposed to be additional—to add to and not subtract from—what was available through GP commissioning?

[Paul Burstow]

The NHS has real-terms increases in its resources, and those resources are going into the programme that we outlined in our outcome strategy. Three quarters of a billion pounds will be going into that programme to deliver improvements in cancer services and the £200 million, being extra, will go into improving cancer services. That is the commitment that the Government have made and that is the investment that we will make.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Is the Minister listening when Macmillan warns that the proposed changes to the NHS risk us losing expertise in the cancer networks? If that happens, Macmillan says that

“cancer treatment will get worse…some treatments could even collapse in parts of the country…more patients could die earlier”.

As the Minister in charge of cancer services, should not he be on the side of cancer patients, not backing his boss’s reckless reforms?

[Paul Burstow]

The last comment was pretty cheap, and no Government Member has suggested that the future of the cancer networks is in doubt. Indeed, in the coming financial year, the funding is secure. As we move to the new arrangements, it will be for the NHS commissioning board to decide the appropriate arrangements for commissioning in the future. We are clear that the expertise of those groups could, should and will continue to be used to support commissioning in the future.

[Annette Brooke (Mid Dorset and North Poole) (LD)]

4. What steps he is taking to improve co-ordination of social care and health care for the benefit of patients.

[The Minister of State, Department of Health (Paul Burstow)]

We have set out in the White Paper “Equity and Excellence: Liberating the NHS” and the Health and Social Care Bill how we will deliver the coalition programme for Government commitment to promote greater integrated working. This includes local authorities taking the lead role in the future in joining up local NHS services, social care and health improvement via council-led health and well-being boards.

[Annette Brooke]

Can my hon. Friend assure me that there will be a joined-up approach when addressing patients’ interests and complaints when they straddle social care? Perhaps a single point of contact for a complaint would be a good step forward from what we have now.

[Paul Burstow]

My hon. Friend is right to draw attention to the need to integrate not only the way in which we deliver and plan services, but the way in which we manage complaints. That is why the Government have included in the Bill our proposals for the establishment of local healthwatch and healthwatch England. Local healthwatch will have the ability to deal with complaints and also have the capacity to refer concerns about services to the Care Quality Commission so that it can take the necessary steps to investigate. In that way, we will deliver a more integrated system for dealing with such complaints.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Is the Minister aware that most of us are in favour of much better co-ordination of these services, but we worry about the backdrop of the reforms? In Yorkshire, some doctors are saying, “Come on, guys, this is a bonanza and we will all be California-style millionaires under these reforms.” What sort of a backdrop is that for health care reforms and better co-ordination of services?

[Paul Burstow]

The backdrop that the hon. Gentleman has just painted is a rather thin one. In fact, it does not exist at all. The Government set out in the Bill we published last week that there will be clear responsibilities on GP commissioning consortia, working in partnership with their colleagues in local government, to commission services in ways that will improve quality of life for people in his constituency, my constituency and the constituencies of all hon. Members.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my hon. Friend agree that improved co-ordination between health and social care is fundamental to the delivery of the efficiency challenge faced by the health service and social services? Does he further agree that the £1 billion provided by the health service to reinforce that relationship is an important step taken by the Government to reinforce that interface? Can he assure the House that, as we move into the new world, the existing arrangements for good practice across that interface will be preserved?

[Mr Speaker]

Order. I know that three questions will attract one answer from the Minister.

[Paul Burstow]

The answer to all those questions is yes. The right hon. Gentleman is right to draw attention to the additional money going into social care via the NHS. It is intended to kick-start the collaborative working that was often so absent under the previous Administration.

[Dame Anne Begg (Aberdeen South) (Lab)]

The care that someone gets can be defined as either “social care” or “health care”, and that can determine the benefits to which an individual is entitled. With that in mind, what conversations has the Minister had with the Minister with responsibility for disabled people about the Government’s proposal to withdraw mobility disability living allowance from those staying in residential care?

[Paul Burstow]

I and the Minister responsible for disability issues in the Department for Work and Pensions meet regularly. In fact, a further meeting on this and other matters is coming up shortly.

[Fiona Bruce (Congleton) (Con)]

5. What recent steps he has taken to reduce levels of alcohol misuse among young people.

--- Later in debate ---

[Philip Davies (Shipley) (Con)]

9. What assessment he has made of the effectiveness of video link medical consultations in prisons.

[The Minister of State, Department of Health (Paul Burstow)]

The Department has made no assessment. PCTs and prison partnerships may consider using telemedicine as an alternative to hospital appointments for offenders, after considering any security issues and the benefits for improved health care. Decisions about treatments for offenders, including video link consultations, are made by local commissioners.

[Philip Davies]

Red Embedded Design, an SME technology company in my constituency, is working in partnership with Airedale NHS Foundation Trust to enable video link medical consultations to take place in prisons. May I suggest that the Minister look closely at this scheme, which has been rolled out in a number of prisons? He will see the cost benefits and the lack of risk of absconding involved. Will he encourage other PCTs around the country to introduce the system in their prisons?

[Paul Burstow]

As part of a wider programme, a demonstrator project looking at telemedicine and telecare, we are looking at a possible roll-out of such approaches. In regard to the specific case of the Airedale NHS Foundation Trust, I would be only too happy to look further at the details and the benefits that have arisen.

[Mr Denis MacShane (Rotherham) (Lab)]

Telemedicine is obviously a help, but nothing beats talking to a real human being about our medical problems. Would the ministerial team consider copying the Conservative-Liberal Government in Sweden, who have banned from all public agencies, including health agencies, automatic answering machines—the kind that tell us to “Press 1”, “Press 2” or “Press 3”? Instead, people calling those agencies have to speak to a real live Swede in Sweden. Would not that be a good step forward for our health service?

[Paul Burstow]

The right hon. Gentleman has found a cunning way of getting in a point that does not directly relate to the question. He makes a very fair point, however. It is important that people should feel confident that, when they pick up the phone and make a call, they can speak to a person. Telemedicine can provide that route as well, through allowing people to get a diagnosis and treatment, as well as access to the appropriate support at the right time.

[Nic Dakin (Scunthorpe) (Lab)]

12. If he will take steps to increase the availability of the BCG vaccine for children.

--- Later in debate ---

[Margot James (Stourbridge) (Con)]

T2. Some care homes that have received critical reports from the Care Quality Commission are reopening under the same management but with different names. The CQC’s practice is to remove earlier poor reports from its website, leaving potential customers in the dark about the poor record of those homes. Will the Minister remind the CQC of its responsibility to highlight poor practice in care homes, and request that it change its practice?

[The Minister of State, Department of Health (Paul Burstow)]

I will certainly ensure that the CQC understands that that is a matter of concern. When it discharges home owners and deregisters them, after receiving an application for a fresh registration, it conducts a thorough appraisal and assessment of their fitness to provide the service. The new owner of a home may well have done a great deal of work in improving the quality of training given to staff, but I agree that it ought to be possible for people to look at the CQC’s website and see reports on the quality of the previous provider so that they can assess that as well.

[Paul Blomfield (Sheffield Central) (Lab)]

T5. A year ago, writing in The Sun, the Prime Minister made a firm and passionate pledge to increase the number of midwives by 3,000. Last week, the chief executive of the NHS told the Public Accounts Committee that the NHS is now short by 4,500 midwives. Will the Secretary of State tell the House when he intends to implement plans to honour the Prime Minister’s pledge—or can we take it that it is just another Conservative broken promise on the NHS?

--- Later in debate ---

[Mr Steve Brine (Winchester) (Con)]

T10. What does the Minister think is the likelihood of the pathfinder consortia examining commissioning arrangements for neurological conditions? This is particularly important, because conditions such as Parkinson’s are not familiar to many general practitioners, and commissioning arrangements for these complex conditions are tricky, so they need specialist knowledge. They need to be getting expert support and advice, including from patients and third sector groups.

[Paul Burstow]

The hon. Gentleman makes some important points about how the new system provides the opportunity to access a range of new resources to develop the way in which commissioning is provided for people with neurological conditions. Not the least of these are the way in which the Neurological Alliance is working to provide a new structure for its way of operating at the local level to offer commissioning support and, from the Department, how the neurological commissioning support group will be able to work with early implementers of the health and well-being boards and pathfinder GP consortia to provide them with the necessary support to develop their capability in this area.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

The Minister of State referred earlier to Labour Members cherry-picking quotes, but I do not believe that Laurence Buckman, chair of the British Medical Association’s GP committee, was mincing his words when today he described the Government’s reorganisation plans as “fatally flawed”, warning that they

“would see the poor, elderly, infirm and terminally ill in large parts of the country losing out”.

Why does the Secretary of State believe that he knows better than Dr Buckman?