Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 15th January 2013 Commons Chamber

[Mr Hunt]

It will be very easy to look at the number of lives saved. We will be able to see the impact of the fund, because it only started in 2010.

[Mr Philip Hollobone (Kettering) (Con)]

Kettering has the sixth fastest household growth rate in England, and accident and emergency admissions to Kettering general hospital are now at 12% year on year. Will the Secretary of State ensure that the NHS funding formula reflects the very latest population estimates?

[Mr Hunt]

NHS funds are independently decided by the NHS Commissioning Board, and I know that is a key concern of the board. I visited Kettering hospital, so I know that it is a very busy hospital coping well in difficult circumstances.

NHS Commissioning Board (Mandate)

Philip Hollobone Excerpts

Tuesday 13th November 2012 Commons Chamber

[Mr Hunt]

The mandate makes it clear that waiting times targets must be met. That is a very important part of the mandate. I continue to be extremely concerned by what the hon. Gentleman tells me about what is happening in his constituency, and I look to his local NHS to come up with a sustainable, rapid solution.

[Mr Philip Hollobone (Kettering) (Con)]

As the Secretary of State saw for himself when he visited Kettering general hospital recently, the NHS is very good at treating people but perhaps is not quite as good at preventing people from getting ill. Given that prevention is better than cure and often less expensive, what is there in this mandate that will encourage up-front health care before patients are admitted to hospital?

[Mr Hunt]

There is something critically important in the mandate that will do that, which is that by making the NHS operationally independent we are giving commissioning responsibilities to local GP-led groups for the first time, and GPs understand the importance not just of primary care but of prevention. So I think we will see much more innovation, along with the co-operation that the NHS has with local authorities and the new health and wellbeing boards, to make sure that there is a much bigger focus on prevention than there has been in the past.

Kettering General Hospital

Philip Hollobone Excerpts

Friday 9th November 2012 Commons Chamber

[Mr Philip Hollobone (Kettering) (Con)]

I thank Mr Speaker, through you, Mr Deputy Speaker, for granting me the privilege of holding this debate, and I welcome the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) to his place. May I also take this opportunity to thank, on behalf of local residents throughout the borough of Kettering, all those who work at Kettering general hospital, whether they be nurses, doctors, consultants or ancillary staff, for all the work they do on behalf of local people. It is hugely appreciated. Many people at Kettering general hospital have worked there for a very long time—20, 30 or, in some instances, 40 years. The hospital is very much embedded at the heart of the local community.

I thank Lorene Read, the chief executive, and Steve Hone, the chairman of the trust, for all the work that they have put into the hospital and for the time they have given me over recent weeks to talk about the hospital’s future. I also thank Councillor Russell Roberts, the leader of Kettering borough council, for his close involvement in trying to sort out the hospital’s future.

It is my privilege to have been elected to serve as the Member of Parliament for Kettering, to stand up and speak out on behalf of local people about issues important to them. There is probably nothing more important to local people than the future of our much loved and badly needed local hospital in Kettering.

The nub of the points that I want to make is that local people simply will not put up with any prospect whatsoever of any downgrade to the accident and emergency facilities or the maternity wing at Kettering general hospital. Those are two highly valued, much prized departments and whoever plans the future of the hospital simply must not downgrade those two vital facilities, because they do a fantastic job in very difficult circumstances.

Kettering is growing extremely rapidly. Over the past decade, the borough of Kettering was sixth out of 348 districts throughout the country in the rapidity of household growth, and 31st in population growth. Few other parts of the country are growing as fast as Kettering. We have always needed our hospital and we now need it more badly than ever.

On public sector transport, the connections between Kettering and the rest of Northamptonshire, let alone the rest of the country, especially to the other acute hospital sites in the south-east midlands, are not good. The road between Kettering and Northampton, the A43, is the most dangerous and most congested in Northamptonshire. The idea that facilities could simply be moved out of Kettering and down the road to Northampton does not work for the staff or patients at the hospital. I say to the Minister that because of the demographics, the increasing age of the population, the rate of population growth, the geography of Northamptonshire and the crucial need for, but lack of, available future capital investment, any rearrangement of acute service provision by the NHS in the south-east midlands must not involve any downgrading of the A and E and maternity departments at Kettering.

The Minister needs to be aware that Kettering general hospital is much loved and badly needed. It has been in existence for 115 years. Local people have been born there, have seen their relatives treated there and have died there. Everyone in Kettering has, at one point or another, been through that hospital. It is a hospital embedded in the local community like few others.

As of today, Kettering general hospital employs 3,100 staff. It has more than 600 in-patient and day-case beds, 17 operating theatres, seven intensive treatment unit beds and three high-dependency unit beds. The obstetric unit delivers about 3,800 babies a year and is where my two children were delivered some years ago. The midwifery department is growing at a rate of between 5% and 7% a year. It includes a neonatal intensive care unit for babies, which is a sort of special care baby unit-plus. There is also a new £30 million treatment centre with enhanced paediatric facilities, which is opening next year.

Kettering general hospital has a level 2 trauma unit in its 24/7 A and E department, which is consultant-led. It currently has five consultants and two locums. Consultants are on site until 11 o’clock in the evening and are on call until 8 o’clock in the morning. Some 3,200 orthopaedic patients—people with hip and knee problems—go through the hospital every year, as well as 2,137 trauma patients. The hospital has a leading endoscopy unit, which basically does bowel screening, and a state-of-the-art cardiac facility, which is now the primary angiogram centre for Northamptonshire and south Leicestershire.

It is true that Kettering general hospital cannot provide the required level of treatment for severe head injuries or severe burns. Such patients are transferred, often by helicopter, to University hospital Coventry down the road, which has a level 3 trauma facility. However, Kettering general hospital is where most trauma patients need to go. Its location, right next to the A14, which is one of the busiest arteries in the midlands, is ideal for the all-too-many road traffic accidents that occur.

Healthier Together is leading a review of acute hospital provision in the south-east midlands that involves the five hospitals in Northamptonshire, Bedfordshire, Milton Keynes and Luton: Kettering general hospital, Northampton general hospital, Bedford hospital, Milton Keynes hospital and Luton and Dunstable university hospital. Kettering general hospital is the most northerly of those. It is 16 miles from Northampton, 24 miles from Bedford, 34 miles from Milton Keynes and 47 miles from Luton and Dunstable. If we lose our A and E or if it is downgraded, it will simply be too far for people to go to those other facilities.

Healthier Together set up six clinical working groups led by consultants, which produced seven highly theoretical draft models for the way in which acute hospital services could be reconfigured. There are now two preferred models. The problem is that, in one way or another, both the preferred models involve effectively downgrading two of the five hospitals. At the moment, the five hospitals all have A and E, trauma, emergency surgery, complex and elective surgery, acute medicine, ITU, in-patient paediatrics, obstetrics, out-patient diagnostics and in-patient re-ablement services. Under the draft proposals, two of them would not have all those services, and my campaign is to ensure that Kettering is not one of those two. It would be an absolute tragedy for local people were we to lose our ITU, our acute medicine facility, our level 2 trauma unit or our emergency surgery unit, or if the much needed recent investment and next year’s investment in improved paediatrics were moved away from Kettering. Up with it local people simply will not put.

One of my big worries about Healthier Together is that, although a lot of well meaning clinicians are leading the review—I know the Minister is a clinician of some repute himself—they need to realise that they are dealing with patients who do not move around as much as clinicians might. Although it might in theory be very nice to have shiny, brand-new hospitals in ideal locations, people do not live like that. Patients and staff need to have straightforward, easy access to hospital facilities.

There is meant to be public engagement in the Healthier Together review process, led by the so-called patient and public advisory group. I am sure that the individuals on that group are doing their best, but I am afraid they are hardly representative of the population of the south-east midlands. I have been on the comprehensive Healthier Together website today and read through all the material, including the minutes of the patient and public advisory group’s recent meetings. The most recent one whose minutes have been published was in March, so the minutes of a lot of meetings have not yet been published. Of the 17 individuals present at that March meeting, one was from Kettering and five were from Milton Keynes. Reading through the material provided by Healthier Together makes it clear that the process is led and dominated by Milton Keynes. I have nothing against people in Milton Keynes, and I am sure they need health services like everyone else, but there are five acute hospitals in the south-east midlands, not one, and the patients of all five deserve fair representation throughout the process. I invite the Minister to look at the Healthier Together review and see whether he is satisfied that patients and clinicians from across the region are being fully engaged in the process. My contention is that patients, doctors, nurses and ancillary staff from Kettering are not fully involved, which they should be.

One of the key points that has been missing from the review so far is recognition of the importance of access to health care facilities. Healthier Together states in its papers that it has set up a travel and transport working group, which has started to investigate the possible effects on journey times if health services are reconfigured. It states:

“An early task included commissioning independent experts to analyse journey times to hospital by private car and emergency ambulance. That analysis focused on travel at peak rush hours—from 7-9 am and from 4-7 pm.”

We do not need an independent expert to tell us that it is almost impossible to drive from Kettering to Northampton down the A43 during peak time without becoming part of an elongated car park, or that if a nurse had to move to Northampton she would find it very difficult to get there in the morning by public transport. There is no rail link between the two towns, and the bus service is intermittent. We do not need an independent expert to tell us that Kettering residents who want to visit an elderly relative in hospital would find it very difficult, without public transport, to go to Northampton, Bedford, Luton or Milton Keynes.

Evidence—if we need more—of the pressure placed on Kettering hospital by the growth in local population was provided a few weeks ago by Monitor’s intervention in order that the hospital improve its A and E targets. Kettering hospital is treating 10% more A and E patients year in, year out; it is treating more A and E patients this year than last year, but it does not treat 95% within four hours and is in significant breach of statutory targets. Monitor has intervened, quite rightly, and told the hospital to sort that out, which I am confident it will sort out. That situation is indicative of the growth in the local population and the pressure that that is putting on local A and E facilities.

I am grateful for the chance to put the concerns of local people about our hospital directly to the Minister on the Floor of the House, and let me tell him, as plainly as I can, that the situation is completely unacceptable to everyone in Kettering, whatever political party they support or even if they support no political party. We will not put up with our accident and emergency service or maternity wings being downgraded.

Local staff at the hospital are doing their best in difficult circumstances against a background of one of the fastest population increases in the country. Healthier Together needs to get its act together because Kettering hospital is going to have a bright future, whatever clinicians in Milton Keynes might say.

Leeds Children’s Heart Surgery Unit

Philip Hollobone Excerpts

Tuesday 30th October 2012 Westminster Hall

[Several hon. Members]

rose—

[Mr Philip Hollobone (in the Chair)]

I am just checking that the seven Members standing match the seven names in front of me, and they do tally. We have 45 minutes until I call the Opposition Front-Bench spokesman, which gives you about six minutes each. I cannot enforce that, but I urge Members to stick to six minutes so that everyone can get in. To be helpful, I will read out the batting order: Nic Dakin, Greg Mulholland, George Mudie, Martin Vickers, Julian Sturdy, David Ward and Andrew Jones.

--- Later in debate ---

[Martin Vickers]

As usual, my hon. Friend and neighbour is correct. Because of the remoteness and so on, the assumption that all patients in northern Lincolnshire will transfer to Newcastle will simply not be borne out. They will choose alternatives and I suggest that most will gravitate south. Therefore the Newcastle target of 403 will not be achieved.

There are expert opinions on both sides of the argument. The significant point is that the parents and grandparents of the children who receive the treatment are not convinced about the alternatives, because they have seen surgeons and other experts in Leeds performing miracles on their children with modern medical technology. That is their doubt: they do not have confidence in the alternatives when they have seen the Leeds centre of excellence in action.

My hon. Friend the Member for Pudsey stole a line from me because I too was going to quote the point that my hon. and learned Friend the Member for Harborough (Sir Edward Garnier) made in last week’s debate. I will take another line from his speech:

“The Secretary of State has the levers of power in this question and he must pull them—he must exercise them”.—[Official Report, 22 October 2012; Vol. 551, c. 188WH.]

That is what we expect. We do not want the question shuffled off to a panel of experts, with automatic acceptance of what they say. Different experts come up with different decisions.

Time is pressing. In Leeds we have a centre of excellence. It deserves our support, and already has the support of those we represent. I am sure that the Minister and the Secretary of State would not want to be responsible for destroying it.

[Mr Philip Hollobone (in the Chair)]

If the final three hon. Members who want to speak in the debate take five minutes, they will all get in.

--- Later in debate ---

On resuming—

[Mr Philip Hollobone (in the Chair)]

Order. Mr Sturdy has about three minutes remaining.

[Julian Sturdy]

Thank you, Mr Hollobone. As I was saying, throughout this saga I have been reluctant to compare the Leeds unit directly with others, in particular Newcastle’s. My intention is not to criticise the Newcastle unit, which has also carried out great work, saving many young lives over a number of years. Rather, my belief continues to be that the Leeds unit has always had the strengths to merit its survival without such comparisons. Put simply, its own case is strong enough. That is my message to the Minister today, and it was also put eloquently by my hon. Friend the Member for Pudsey.

The single biggest failing in the consultation has been the flawed decision-making process of the Joint Committee of Primary Care Trusts, from the lack of weight given to transport and travel times, and the population that centres such as Leeds serve, to the true co-location of services. There has also been a lack of clarity over the terms of the review, and the failure of the JCPCT to release the information and evidence behind its decision is only adding to the controversy and suspicion. Without being able to break down the scores awarded to each children’s heart surgery unit by Professor Sir Ian Kennedy’s assessment panel, the decision-making process lacks basic transparency and scrutiny.

Throughout York there exists huge public interest in this ongoing and disruptive issue. I am particularly concerned for the families of affected children in York who now face the problem of having to travel to other areas for treatment—I stress “other areas”. The Minister must be under no illusion that the families and children displaced to Newcastle if Leeds closes will not automatically head north. They will disperse to centres throughout the country, and we must not lose sight of that.

In conclusion, the Save our Surgery campaign has suggested a balanced solution to the current dispute, as set out by my hon. Friend the Member for Pudsey. It suggests that the decision should be implemented in full throughout the country, but delayed in the north-east until April 2014. That window of opportunity could then be used to clarify the figures and findings of the JCPCT, allowing both affected units to demonstrate their capacity and capability on a level playing field.

I am delighted that since the election, the Government have worked to make health services more representative and more responsive to local people. I urge the Minister to continue that fine work by listening to the concerns of patients and residents in Yorkshire and taking on board and responding positively to the Save our Surgery campaign to save the children’s heart surgery unit in Leeds from an unjust and ill-informed closure.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Mr Hunt]

Let us look at some of the facts. The number of clinical staff in the NHS has gone up since the coalition came to power. The right hon. Gentleman talked about the cost of the reforms, which is about £1.6 billion. Thanks to those reforms, we will save £1.5 billion every single year from 2014 and the total savings in this Parliament will be £5.5 billion. Let me remind him that he left the NHS with £73 billion of private finance initiative debt, which costs the NHS £1.6 billion every single year. That money cannot be spent on patient care. He should be ashamed of that.

[Mr Philip Hollobone (Kettering) (Con)]

Will the Secretary of State confirm that NHS spending will increase in real terms during the lifetime of this Government, and that there are no plans from anyone to close the accident and emergency department and the maternity unit at Kettering general hospital? Will he condemn those who say that the Government want to close the hospital, when nobody is going to do that at all?

[Mr Hunt]

My hon. Friend is absolutely right: that is a mendacious scare story that is being put out on the ground. Real-terms spending on the NHS has increased across the country, which has not been possible across all Government Departments. Because of that, we are able to invest more in patient care, cancer drugs, doctors and facilities across the country, and indeed in Kettering.

Children’s Cardiac Surgery (Glenfield)

Philip Hollobone Excerpts

Monday 22nd October 2012 Westminster Hall

[Liz Kendall]

We have all met many children, some of whom are now adults, and families who have received excellent care and support. It is important that we put their views forward strongly and that the best peer-reviewed and validated clinical evidence is considered in the new review.

As many hon. Members have said, Dr Palmer wrote to the former Secretary of State saying that he sharply opposes the use of his name for the proposed transfer of services from Leicester to Birmingham. A similar view is taken by leading international ECMO experts from the Extracorporeal Life Support Organisation, which also wrote to the former Secretary of State:

“We are united in our dismay. We are united in our dismay at the proposed move of ECMO services from the Glenfield programme in Leicester to elsewhere…The Glenfield program is clearly and objectively recognised as one of the finest ECMO programs in the world. Movement of an established unit such as Glenfield in the manner described will have profound negative consequences on the outcomes of patients needing ECMO. This move…is one clearly likely to produce results that will have a human toll in increased deaths.”

That is why the specific evidence on ECMO must be fully considered, including by the new review.

An issue raised by my hon. Friend the Member for Leicester South (Jonathan Ashworth) and several other hon. Members must also be considered by the new Independent Reconfiguration Panel: whether the assumptions about the level of cases remain based on the best available evidence. The Safe and Sustainable review looked at surgical activity data from the central cardiac audit database for 2002 to 2006—the latest evidence available at the time—which suggest that the number of cases for heart surgery would remain roughly stable over the next 20 years. New validated data, however, are now available for three more years—to 2010—showing a consistent rise in activity, suggesting that adult and paediatric activity will each increase by approximately 75 cases per year.

We also have new evidence from the Office for National Statistics about population growth, which comes from data published in October last year and indicates that there will be substantial increases in the number of nought to four-year-olds, in particular in the east midlands, the east of England and London. That causes real concern about whether Birmingham will be able to cope with all the extra cases that it will receive.

Birmingham’s case load will also increase because of the closure of Northern Ireland’s children’s heart surgery services. The Safe and Sustainable review reports an all-Ireland framework, with Northern Ireland cases going to Dublin, but that will take several years to establish and, in the meantime, a significant and increasing number of babies will continue to travel to Birmingham.

The Birmingham children’s hospital itself is concerned about whether it has the capacity to cope with all the extra cases that it will receive from a closing Glenfield, from the likely increase in surgical activity, from the increase in population, in particular among the nought to fours, and from the increase in cases coming from Northern Ireland. The hospital, I understand, has analysed the case load and produced an internal paper concluding that it would have to perform 1,000 cases a year, which is at the very limit of what the Safe and Sustainable review panel reported as a safe number for cases to be treated. I urge the IRP—rather than the Minister, if she cannot do anything—to look at whether that paper has been written and to assess all such evidence in its review.

Finally, like the previous Government, this Government rightly want changes to children’s heart surgery services so that they provide not only safe standards of care, but excellent, high-quality standards for every child in every part of the country. Just as they want that for children’s heart surgery services, they must want that for children’s ECMO services. It is not good enough to say that it is possible to move a service; we want to know whether it is desirable to move a service to get the very best outcomes.

Glenfield survival rates are 50% higher than any other unit’s in this country and internationally. It will take at least five and probably up to 10 years to redevelop the same quality of service. No one would take the best service in the country for children’s heart surgery and close and move it, so no one should do that for ECMO either.

The issue is of concern to my constituents and those of hon. Members from throughout the east midlands, and to families everywhere in the country. Such people include Clare Johnson, a constituent of my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson). She contacted my right hon. Friend to tell him about the experience of her son, Michael. Michael was born in July last year with severe meconium aspiration, which means that his lungs fill with a substance that makes it very difficult to breathe. His lungs haemorrhaged and his heart failed. The paediatric mobile ECMO service from Leicester came to collect him and transferred him to Glenfield. He was on the ECMO machine 24 hours a day for four days; when he came off it, his heart and lungs were working for themselves. Ms Johnson said:

“As soon as the team arrived to prepare him for transfer, their evident skill and professionalism gave us that very first glimmer of hope…The care we received was second to none.”

Ms Johnson also said that:

“although I am not the best person to point out facts and figures, I cannot help but pore over the evidence available and the main thing that strikes me is the ECMO survival rate”,

which is so much better. She said:

“Glenfield is the only unit to offer Mobile ECMO”—

the very service to save her son—and concludes:

“I understand that I probably sound like a Mother who is just wanting to support the unit who saved her baby’s life”

but:

“My beautiful baby boy Michael Martin Johnson died at 10.40 pm, 8 days after his birth and 3 hours after being transferred back to Hull from Leicester. He had a reaction to some medication he was given and died very suddenly and unexpectedly of a severe gastric perforation. A successful result will not bring my son back. But it WILL prevent other mothers from losing their child, as that IS the ultimate and inevitable result that stopping ECMO at Glenfield will have.”

Clare Johnson makes the case far more eloquently than I ever could. I hope that the IRP looks properly at Glenfield’s ECMO service and at the real benefits that it brings. The Minister has rightly said it is up to the IRP to consider the evidence, but it was the new Secretary of State who decided not to include ECMO as part of the review—that is what he says in his letter today—and that is a mistake, because the two services need to be looked at together. I ask the Minister to explain why the Secretary of State has explicitly excluded ECMO from the new review. That is the wrong decision and I hope that it will be changed.

[Mr Philip Hollobone (in the Chair)]

After the Minister has spoken, I will call Sir Edward Garnier to wind up the debate.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 21st February 2012 Commons Chamber

[Mr Lansley]

As we have set out clearly, we want to promote clinical networks more widely, not just in relation to cancer and stroke, as has been the case in the past. I shall write to the hon. Lady about whether it would be appropriate for neuromuscular conditions and whether it is embraced in any plans that the NHS Commissioning Board and commissioning groups have in place already.

[Mr Philip Hollobone (Kettering) (Con)]

T7. Northamptonshire residents are rightly concerned that in the county in the last four months of 2011 the East Midlands ambulance service reached fewer than 69% of category A calls within eight minutes. The target is 75%. What hope can my right hon. Friend offer to local residents that this poor performance will rapidly improve?

[The Minister of State, Department of Health (Mr Simon Burns)]

I hope that I can give some reassurance to my hon. Friend by telling him that East Midlands ambulance service is working with commissioners, hospital trusts, community health services and social care services in taking measures to address its response time performance. NHS Milton Keynes and NHS Northamptonshire have received £1.7 million in additional funding, and NHS Midlands and East advices me that some of that has been used to fund further measures to help improve EMAS response times, including through the provision of additional ambulance crews and the deployment of hospital-ambulance liaison officers in each accident and emergency department to improve handover and turnaround times.

Stoma Care

Philip Hollobone Excerpts

Wednesday 25th January 2012 Westminster Hall

[Mr Philip Hollobone (in the Chair)]

Someone has asked me to explain the subject of this debate on sponsored nurses and off-script tendering in stoma care, but I do not know where to start, so thank goodness that the hon. Member for Cardiff North (Jonathan Evans) is here to reveal all and enlighten us.

--- Later in debate ---

[Jonathan Evans]

I am not going to propose the end of sponsorship, but we need more robust mechanisms of managing the potential conflicts of interest. I will develop that argument in the limited time available.

The Department of Health appears to take comfort in the professional code of nurses, which states:

“You must ensure that your professional judgement is not influenced by any commercial considerations.”

Surely, we can be sure that that code is being properly observed only if the Department undertakes, at least from time to time, some assessment of the commissioning decisions being made, but it has never done so.

In January 2001, The Guardian drew the practice to wider public attention, reporting that the NHS planned to crack down on these commercial sponsorship deals. The paper claimed that more than half of stoma nurses were funded by commercial deals that were worth— remember that this was a decade ago—up to £100,000 a year to each health trust. The RCN claimed that the manufacturers specified that a minimum percentage of patients had to be fitted with the commercial sponsor’s products.

The previous Government’s response to The Guardian’s revelations was to issue new guidance requiring NHS trusts to review all such arrangements in which suppliers met all or part of the cost of members of staff, discounts on drugs and equipment, or subsidised research and training as a condition of the contract. Nevertheless, Health Ministers maintained that they did not want to prevent collaborative partnerships between the NHS and private contractors—nor do I—but they also said that clinical decisions should always be based on evidence of what was best for the patient. I agree, but how do we know? Again, the Department did not undertake any assessment of its own to reassure itself that that was being done.

By 2003, sufficient concern was being expressed over these commercial deals that the then Government launched the first of what was to be a series of consultations on the arrangements for paying appliance contractors. By 23 January 2006, the Government issued a report on the consultation, noting:

“Specific and frequent mention was made of the issue of sponsored nursing posts in secondary care, with most parties”

—I stress, “most parties”—

“feeling that this practice was inappropriate, and that it should cease.”

The Department of Health’s response to that concern was to ignore it. It maintained its policy of resisting any assessment of impact of commercial sponsorship on commissioning decisions, and that strand of concern was, interestingly, subsequently eliminated from further consultation on these matters by Health Ministers.

In Scotland, the Scottish Executive took a completely different line. The Scottish Government decided that commercial sponsors could no longer directly subsidise specialist nurses in stoma care. The nurses were taken on and paid directly by the NHS. In fact, the British Healthcare Trades Association funded transitional support to the Scottish health boards for two years because of that dramatic financial change. The outcome was also dramatic. Free samples of stoma products were withdrawn from Scottish hospitals by the manufacturers that had always previously provided them, and it is estimated that, over the following five years, the number of specialist stoma nurses in Scotland fell by up to half.

In Scotland, therefore, the policy has been to ban commercial sponsorship—this addresses the concerns expressed by my hon. Friend the Member for Montgomeryshire and the hon. Member for Strangford (Jim Shannon)—with a consequential fall in both the quality and the availability of specialist stoma care to patients. By contrast, the policy of Health Ministers here has been to refuse to undertake any assessment whatsoever of the impact of commercial sponsorship on these arrangements within the rest of the UK.

As I hope I have made clear, I am not arguing for the Government to follow the Scottish policy. Patient groups have made it clear to me—this is endorsed by the words of my hon. Friend the Member for Montgomeryshire—that they recognise that the quality and the availability of stoma care in Scotland has fallen markedly. I want to make it clear that I am not questioning in any way the commitment or the concern of stoma nurses. Again, I can say that patient groups who have briefed me for this debate have made it clear that they deeply value the services that are provided by stoma nurses.

Nevertheless, as I indicated to the hon. Member for Strangford, there are real questions about conflict of interest, which successive Governments, sadly, have ignored. Let me draw an analogy with another sector that we debate a lot in the House: the financial services sector. Today, all financial services companies are required to satisfy the regulator that they have robust processes in place that are fully understood by all staff for managing conflicts of interest. Can we imagine a Minister standing at the Dispatch Box talking about concerns with financial services and saying that he is entirely satisfied there is no need for robust conflict of interest processes because he is satisfied that the professional code of those who work in financial services will always require them to act properly? That is a ludicrous proposition. There is a need for the management of conflicts to be subject to a similarly robust process in terms of stoma care.

In March 2011, Health Ministers were asked by parliamentary colleagues some basic questions to glean information on the number of stoma care nursing posts sponsored in the UK. No helpful response was provided, and the Department had no statistics to share with colleagues. So, for this debate, I have had to turn to the British Healthcare Trades Association for the figures. According to the association, stoma care manufacturers sponsor more than 200 of the 337 departments in England at a cost of £10 million a year. However, some of those manufacturers share the same concerns about commercial sponsorship that I am outlining. They only maintain their sponsorship for fear that other suppliers will otherwise corner the market. Those manufacturers have even expressed their concern to me that the current commercial arrangements might fall foul of the new Bribery Act 2010. Have Ministers undertaken any assessment of that?

On 15 October, I wrote to the Minister and received a response from him on 9 November confirming again that the Department had not made any assessment of the commissioning decisions of PCT employees sponsored by private enterprises. Again, he highlighted the fact that Ministers relied on the code of professional conduct, but he said in his letter that he was satisfied that that was a concern and that he had asked his officials to make further studies into the activity. I hope that the Minister can tell us the outcome of those studies.

The issues that I have raised relate to the maintenance of patient choice in the appliances that are prescribed for stoma care, and the concerns are shared by patients, charities and several manufacturers. Such concerns have been shown to be very well-founded by reports of recent discussions between major manufacturers of stoma care products and PCTs about what has come to be called off-script tendering, which you mentioned in the second part of your comment, Mr Hollobone. What is being proposed is that preferred or single supplier agreements are made between commissioners and manufacturers, in which the commissioning body would get a bulk discount for requiring all patients to take one manufacturer’s products. The arrangements would then bypass the operation of the drug tariff for the provision of such products, which is regularly reviewed on an annual basis by the Department.

Currently, a GP or suitably qualified nurse issues a patient with a prescription—an FP10—and the patient is free to take that to the manufacturer of their choice to have the product dispensed by a pharmacy contractor or an appliance contractor. The drug tariff industry forum considers the advantages of that system to be patient choice, cost and value for money, quality of products and a centralised system working on a local basis. The British Healthcare Trades Association has obtained legal advice that suggests the off-script arrangements being discussed by big manufacturers might be beyond the powers of health trusts. However, the question arises whether such arrangements could be taken forward as part of the Government’s health reform.

Those questions were raised by the Urology Trade Association, which is a body representing 95% of manufacturers, and by the Urology User Group Coalition on behalf of patients in evidence given last year to the Select Committee on Health. Unfortunately, follow-up questions by parliamentary colleagues confirmed the long-standing Department of Health response that no assessment of those issues had been undertaken either.

The thousands of patients who suffer bowel or bladder cancer and require ongoing stoma care deserve better. They should be assured that the Government will defend patient choice and maintain robust processes for managing real or perceived conflicts of interest in the commissioning of services. The Government should ensure the continued provision of specialist nursing advice and support and reassure us that it is in no way influenced by financial or commercial considerations.

[Mr Philip Hollobone (in the Chair)]

All has become clear. What are the Government going to do about it?

Breast Implants

Philip Hollobone Excerpts

Wednesday 11th January 2012 Commons Chamber

[Mr Lansley]

We have been very clear about the advice we have given to women, and I hope that, through the NHS, any woman in those circumstances would go and see their general practitioner, who will have full access, from the chief medical officer, to the expert advice we have disseminated. I know that the Harley Medical Group has not shared with others the view that it can match the NHS’s standard of care; but given that, the professions are suggesting to surgeons that they should honour requests for replacement surgery free of surgical charge. I hope that gives a basis on which more of the private providers will now meet their full obligation of a duty of care.

[Mr Philip Hollobone (Kettering) (Con)]

What is the Department of Health’s central estimate of the number of women who have had breast implants through private clinics who will seek their removal through the NHS?

[Mr Lansley]

I am sorry to disappoint my hon. Friend but I cannot offer him such an estimate. We know that some 37,000 women had PIP breast implants. Clearly, not all those will necessarily want removal, and on advice, it might be any proportion of those; I cannot tell him what that figure would be. As we see in France, recommending the removal of implants does not mean that all women will have them removed.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 10th January 2012 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend for her question. She rightly talks about this increasing number of older people in the community and rightly says that we want to support them to be independent and to improve their quality of life.

The whole system demonstrator programme was the largest trial of telehealth systems anywhere in the world. In the three pilot areas of Kent, Cornwall and Newham, it demonstrated a reduction in mortality among older people of 45%; a 21% reduction in emergency admissions; a 24% reduction in planned admissions to hospital; and a 15% reduction in emergency department visits. Those are dramatic benefits, which is why we are so determined to ensure, over the next five years, that we reach out to older people who are living at home with long-term conditions and improve their quality of life in this way.

[Mr Philip Hollobone (Kettering) (Con)]

9. If he will consider proposals to introduce a national screening programme to detect group B streptococcus in pregnant women.

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

The UK National Screening Committee is reviewing the evidence for screening for group B streptococcus carriage in pregnant women, and I am sure that my hon. Friend will be pleased to hear about that. The committee will review the international literature, and a public consultation on the results will open in spring 2012.

[Mr Hollobone]

Group B streptococcus is the UK’s most common cause of life-threatening infection for newborn babies. Will my hon. Friend agree to meet me and Group B Strep Support, the excellent campaign group, to see how calls for a national screening programme might best be advanced?

[Anne Milton]

I am certainly happy to meet my hon. Friend. I should point out that the Royal College of Obstetricians and Gynaecologists is updating its guidelines and that NICE is also developing guidance. The issue is complex, however, and even testing is not 100% effective. Women who produce a positive result during pregnancy might be negative during labour and, more importantly, those who are negative during pregnancy might be positive during labour. It is important that we get the most up-to-date evidence and ensure that we reduce the tragic consequences of this infection.

--- Later in debate ---

[Mr Lansley]

As the hon. Gentleman knows, following the independent reconfiguration panel report, which I accepted in full, the Barking, Havering and Redbridge Trust is looking to manage safely its maternity services, while improving the quality at Queen’s. It is doing that in close co-operation with NHS London and, indeed, with the advice of the Care Quality Commission, following the commission’s inspections. I will continue to be closely involved in that, and we will continue to support the Barking, Havering and Redbridge Trust in improving services for the hon. Gentleman’s constituents and others.

[Mr Philip Hollobone (Kettering) (Con)]

In north Northamptonshire in 2010-11, there were 6,164 alcohol-related hospital admissions. That is four times the number just eight years before. What more can be done to tackle this horrendous increase in booze drinking?

[Mr Lansley]

Time does not permit me to mention all the things that could be achieved, but let me just say that we are clear about the need, for example, to tackle below-cost selling of alcohol, and we are doing that; to stimulate more community alcohol partnerships, and we are doing that; and to accelerate public understanding of the consequences of alcohol abuse, and we are doing that, not least through Change4Life, additionally, during this year. There is more, but we will say much more in our alcohol strategy soon.