Written Ministerial Statement (Correction)
Simon Burns Excerpts(13 years ago)
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The Minister of State, Department of Health (Mr Simon Burns)
I regret there was an error in my written statement issued on 4 March, Official Report, columns 49-50WS.
The cost of a full bespoke human hair wig was given as £239.65. The correct cost is £239.45.
Private Finance Initiative Hospitals
Simon Burns Excerpts(13 years ago)
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Mr Dave Watts (St Helens North) (Lab)
It is a pleasure to have the opportunity to debate this subject under your chairmanship, Mr Meale.
Before I set out my concerns, I put on record my appreciation and that of my colleagues for the work of the excellent St Helens and Knowsley Teaching Hospitals NHS Trust. I pay tribute to its doctors, nurses, technicians, cleaners and all its support workers, who provide an excellent service to my community and to the communities of my colleagues.
I am pleased to have the opportunity to debate this important subject. St Helens and Knowsley is a five-star hospital trust, benefiting from excellent staff and management and delivering well run hospital services that are clean and safe. The trust now provides state-of-the-art treatment to the people of our communities. I asked for the debate in an attempt to discover the details of the secret discussions currently taking place between the trust, the strategic health authority and the Department of Health.
The trust provides services mainly for St Helens, Halton and Knowsley, but for the wider north-west community as well. Its burns and plastic surgery department provides treatments for patients over a wide area, including the Isle of Man, Cheshire and north Wales, altogether serving a total population of more than 4 million. The trust operates on two sites, St Helens and Whiston. The new hospital opened in 2010 and, as is the norm for the trust, did so on time and on budget. There was new hospital investment of £350 million, so the trust now boasts world-class services at the St Helens site as well as the newer Whiston site.
The trust has a strong performance record: three stars, a “double excellent” rating and performing above average in all key indicators. It is one of the few trusts to have achieved the maximum overall score in the auditor’s local evaluation. The hospital trust is well run and well managed, and the financial problems it faces are not of its making. It has managed to achieve high standards over the past five years despite having a low level of funding and extremely high levels of demand—its accident and emergency units have some of the highest levels of use in the whole country—and serving a community with poor health indicators. The trust used to operate from two run-down main buildings, one of which was a workhouse before being turned into a hospital, and from 40 separate sites in total. Imagine the difficulty of providing health care to a community when operating from so many different sites, with the related management problems.
The trust’s current problems stem from it having to become a foundation trust hospital by 2014; that is something the Government are insisting on, not something the trust is attempting. To achieve that aim, the trust must make efficiency savings. Every hospital, as we know, is having to struggle to make the efficiency savings expected by the Government. On top of the efficiency savings to meet the Government’s financial requirements for FT status, the trust must save a further £20 million a year to pay for the PFI estate. That is impossible and will not happen.
The trust commissioned its own report, I think by Coopers & Lybrand, on the feasibility of those savings. Coopers & Lybrand came back and made it absolutely clear that such levels of efficiency savings are not possible. Efficiency savings are already being made, but the requirement to save a further £20 million a year is impossible to meet. At the same time, the trust must run a state-of-the-art hospital on virtually the same budget as when it had three worn-out hospital buildings in St Helens.
The Government need to act, and to do so transparently, but the discussions so far have been held behind closed doors. The local MPs believe that such important discussions taking place in private is totally unacceptable. The community, health professionals, local MPs, councillors and the House need to have the information in the public domain, so that we know exactly what is going on behind closed doors and what options the Government are considering. Despite written questions, letters to the Minister and an oral question last week, that information has still not been put into the public domain. That is not acceptable. We wonder what is happening not only in our trust but in others. Are the same sort of secret discussions taking place throughout the country? If so, why are they taking place behind closed doors, instead of openly and transparently?
In case some people wonder whether a new hospital was required, as I said earlier, the trust was previously working out of 40 buildings, including two old hospitals, one a former workhouse. Clearly, new hospital buildings were needed. Furthermore, the health problems of St Helens, Knowsley and Halton are extremely well known: we have poor health indicators, high levels of deprivation and had poor medical services for many years. Before the new hospitals were built, we had poor health services provided in poor buildings.
One of the health indicators is that St Helens, Knowsley and Halton males are likely to live 10 years less than the national average, and women seven years less. The poor health indicators are partly owed to the poor lifestyles of many of our constituents: smoking, obesity and drinking levels are all higher than the national average. The local partnership is addressing some of the issues successfully, but not all our problems are related to lifestyle; we also have an industrial past to deal with and high levels of poverty. In my constituency of St Helens, the traditional industries of coal, chemicals and glass left a legacy of poor health. My colleagues in Knowsley and Halton would say the same.
Not everyone is in favour of PFI schemes; they have their critics. Frankly, I would welcome a change in the rules, which are controlled by the Treasury, because they are inefficient and ineffective. I want my hon. Friend the Member for Halton (Derek Twigg) and his Front-Bench colleagues to consider whether there is a better way than PFI to provide the capital required for public services. At present, however, no political party—not the Liberal Democrats, nor the Conservatives, nor the Labour Opposition—is proposing to change the Treasury rules. I understand that the Conservatives are looking at a new vehicle, resembling PFI mark 2, which the Government claim would cost the Treasury and the public purse less and provide better value for money, but all Governments say that when introducing new schemes, and few succeed in achieving those aims. I wish them well with delivery, but I suspect that they will have similar problems to those the Labour Government had when introducing our PFI schemes.
The private finance initiative has achieved a great deal. It has created Britain’s biggest hospital building. The previous Labour Government delivered 118 new hospitals—88 PFI schemes and 30 with public capital, amounting to a £10 billion investment in our hospitals. In its last report in 2003-08, the National Audit Office confirmed that PFI schemes provided guaranteed price certainty. Much hospital building before the PFIs—under the old Health Department schemes—came in well over budget, and delivery was delayed. Even before PFI schemes, hospital building programmes often came in at a much higher budget than expected when they were first approved.
The second issue, which was often raised by the then Opposition, is that health investment was simply unaffordable. That is not true. Most of the investment in our health and public services was made at a time when the national debt was lower than in most European countries. On top of that, under the Labour Administration we had long-term economic growth, unlike what we are seeing now under the new coalition Government. However, when the world financial crisis came, it hit countries such as the UK, which had large financial sector industries: the USA, Britain, Ireland and Iceland all had large financial institutions and were hit harder when the financial crisis came. It is worth remembering that in 1997, 50% of our hospitals had been built before 1948. Now, only 20% of hospitals remain to be modernised. It was a substantial achievement by a Labour Government to turn around the hospital-building programme as we did.
I do not accept the point, which I am sure that the Minister will make, that in the past the coalition and its friends called for greater regulation of the banking industry—I am moving a little away from PFI schemes—and one reason given was that it was unaffordable. Banking regulation rules were weak, and I accept that they needed to be changed, but I will take no lessons from the Conservatives, who claimed for many years that we had too much regulation and that we needed to loosen our grip on the financial institutions.
Why was such major investment required? The Government would have us believe that before 1997, Britain was a success story. That is simply not true. It had run up massive public debt not to invest in Britain’s public services and future, but to pay for mass unemployment and economic failure. It had failed to invest in our schools, hospitals, roads and railways. Many of my colleagues have been involved in local government and we remember the state of our public buildings before 1997. I remember schools and hospitals with holes in the roof; I remember the shortage of nurses and doctors; I remember people waiting six or seven years for operations. The investment the Labour Government need to put in to deal with the problems caused by the preceding Tory Government was clear for anyone to see.
Returning to the main point of the debate, I want the Minister to be open and transparent. I want him to set out his own views on the options open to the hospital trust in my constituency. I want him to agree today to publish all the documents on discussions between the Department and the trust, which he has failed to do so far. I have one here, but we have not seen the other documents. There is only one option. The Government should invest in and reflect the cost of running the PFI scheme at St Helens and Whiston hospitals by increasing the budget in proportion to the increased PFI cost.
On 26 April, during Health questions, the Minister stated that the Government are not and will not seek to privatise my trust or any other trust. Will he explain why his Department produced a document containing three options, of which the first is a national solution; the second is a merger with another trust, although no one knows where that would take place, and the Minister and the Department seem unwilling to discuss it; and the third option, which requires a proper explanation, is a joint venture with a private provider? I am not sure what that means, but most people I have spoken to in the health industry in St Helens, and my political colleagues believe that that is an element of privatisation. I would welcome the Minister setting out what the comment in the document about a joint venture with a private provider means. I have here a copy of that document, and the Minister should explain why it was produced and what the implications are, and provide the assurances that we seek today.
The Minister of State, Department of Health (Mr Simon Burns)
I am somewhat confused. At the beginning of his speech, the hon. Gentleman made an important comment: that one problem is that no documents are available for people, including MPs, to see. As he is now quoting one of those documents, surely it must be in the public domain. He has produced it at this debate, and I know that it has been written about in the Liverpool Echo. Is there not a contradiction in what he is saying?
Mr Watts
It seems that the Minister is the only person who has had difficulty getting hold of a copy. Mine is a leaked copy, but it is clear that it is from the Department of Health. When I raised the matter with him, he seemed to have great difficulty in finding it. He should get a grip on his Department, and find out what documents are being produced and why he is unable to obtain a copy when he needs one.
Mr Watts
I understand why the Minister asked for more detail, because another document was also produced. I do not have a copy of that, but I hope that when he returns to his Department he will publish the second document. I understand—the Minister will clarify whether this is the case—that when the document was produced, and the option for private sector involvement partnership was suggested, my local trust refused to endorse that option. I am told that it endorsed it only on the back of the fact that a sentence would be included stating that it was at the direction of the Department of Health—not only was the Department involved in the discussions, but it was driving them. I understand that when the document went back to the Department, it refused to accept the amendment to the original document. That leads me to believe that the Government are trying to influence the trust to go down a path that it does not want to go down, but that they are unwilling to do so publicly.
The only way to clarify the matter is for the Minister to guarantee that he will produce the original document, a copy of which I have, and the second draft, so that we can see what is going on between the Department and the trust. Discussions are being held behind closed doors for obvious political reasons, and my colleagues and I suspect that they are being kept quiet until the outcome of the local elections. Frankly, I think the Minister knows that my constituents and voters who support his party in St Helens, Halton and Knowsley would not support the proposal that is being pushed forward by the Department.
Mr Watts
I do not normally believe in conspiracy theories, but I have seen a document that everyone claims does not exist. I passed that document to the national media, and an article was written for The Sunday Mirror by an excellent journalist, Vincent Moss. Apparently, when he contacted the Department of Health the officials asked whether the document existed and whether he had a copy and he replied that he did. They asked to see the document but he said that they could not. The Department then refused to comment on the matter.
The reason behind the conspiracy theories is clear: the Department is acting in an underhand way. Those discussions should take place not behind closed doors but in an open and transparent way so that the community, local health care providers, MPs and the House can understand what is driving Government policy and where it is going. My view is that the Government intend to try to privatise hospitals. Unless the Minister publishes the documents in question and clarifies some of the points raised, people will be left to come to their own conclusions.
I do not believe this is an isolated case. My hon. Friend the Member for Blackley and Broughton (Graham Stringer) and other hon. Friends with new PFI hospitals in their constituencies will experience similar problems to those faced by the trust in my constituency. Unless the Minister can clarify how the costs of running those estates will be paid for in the future, the uncertainty will remain and many people will believe that he intends to do exactly what he claims not to be doing.
I hope the Minister will provide some reassurance today. I am looking for one particular assurance. The only way to resolve the outstanding problem is if the Minister gets to his feet and says that he will provide the £20 million a year extra funding required to run state-of-the-art hospitals at Whiston and Knowsley, rather than the old workhouses we had before. If the Minister can do that, I will gladly congratulate him. Most of my constituents and the trust itself would welcome such a decision.
Mr George Howarth (Knowsley) (Lab)
May I repeat what my hon. Friend the Member for St Helens North (Mr Watts) said about it being a pleasure to serve under your chairmanship, Mr Meale? I congratulate him on being fortunate enough to secure this debate on a matter that is of great concern to our constituents, and on the manner in which he presented his case.
It is right and proper to begin by repeating something mentioned by my hon. Friend, which is that the hospital staff, whether medical, support or care staff, are highly regarded by the local community. The St Helens and Knowsley primary care trust is highly thought of, and has been prominent in ensuring that we get the health service we deserve. The new hospital facilities at Whiston and St Helens are considered to be at the cutting edge in technology, the use of space and the way that services are conducted, and we appreciate the service that we currently receive. I know from recent personal and family experiences that those who make use of the hospital facilities on both sites have every reason to be grateful that they are available.
The communities served by the two sites have particular, and in some ways difficult, health needs. Some of those health needs are related to former and current occupations, and some to the prevalence of poverty and consequent lifestyle choices. In parts of my constituency, for example, we have abnormally high rates of cancer. That is partly a result of high levels of smoking, but in some cases it is the result of former occupations. My hon. Friend mentioned the mining industry and the legacy left by that in St Helens. Some of the chemical processes that have taken place over the years in and around that area have also taken their toll on people’s health, and we therefore need a very good hospital service. We also need a good primary care trust that can provide a lot of the treatment people need, but hospital services are an important part of that mix.
As my hon. Friend rightly said, the difficulties we seem to have arrived at are due to the deficit carried by the hospital. We could have a long discussion about how that deficit was created, but that would not necessarily be fruitful. The deficit appears to stand in the way of the hospital achieving foundation trust status, and that seems to have been the impetus behind the three options referred to by my hon. Friend and mentioned in the tripartite document of which he has a copy.
I do not for one minute underestimate the seriousness of the deficit. Any responsible Administration or Government should take a deficit of that size seriously, and I understand that is the case. The difficulty arises, however, because the three options under discussion leave people concerned about what might be going on. I will talk about what has and has not been published, because the Minister tried to cast some doubt on that a few moments ago.
Mr Howarth
Had the Minister been listening, he would know that I said that a little later in my speech, I will try to cast some light on what has and has not been published. He cast some doubt on whether there is in fact material that we should have seen but have not, and I will return to that issue in a moment.
My hon. Friend referred to the three options that have been suggested. The document refers to a national solution, and even if it is not spelled out in clear terms, I take that to mean that it is intended—presumably by Department officials—for some means of closing the deficit to be found nationally, in order to get rid of the £20 million deficit that is creating the problem. I am not in a position to say whether that is a likely solution; hopefully, the Minister will be better able to explain that. To me, however, that solution is the most preferable of the three options.
The second option would involve some kind of amalgamation or merger with other existing NHS facilities, although that seems fraught with inevitable difficulties. If an existing facility already carries some sort of deficit, presumably it will not be keen to add to that by amalgamating or merging with another institution that might bring even more of a deficit to the table. Furthermore, I do not see any of the synergy that would need to exist between the St Helens and Knowsley trust and other nearby hospital trusts for such a move to be thought of as a likely solution.
We are therefore left with the third option, which is some kind of merger or joint venture with the private sector. I was interested to see that when my hon. Friend the Member for St Helens North referred to that option, the Minister, from a sedentary position, seemed to indicate that it was not an option. [Interruption.] Well, I am glad that he clarified that. When my hon. Friend mentioned that option—I think that he used the word “privatisation”—the Minister said no.
Mr Howarth
But presumably the Minister is not ruling out now the possibility that something could happen that would involve the private sector in the long-term future of these hospital sites. No doubt he will enlighten us on that when he replies to the debate.
Mr Howarth
I have to warn the Minister that I am not someone who believes that everything should be owned by the state. There are occasions when I can understand that some co-operation with the private sector is required. In fact, the PFI in itself is in many ways an exemplar of that. On occasion, such an approach is appropriate, but any wholesale transfer of these hospital facilities would meet strong opposition from the public in St Helens, Knowsley and Halton, and it would certainly include my hon. Friends and me, because we do not see that as a viable way forward for these hospital sites. The body language coming from the Minister is encouraging. I just hope that the words that follow are equally encouraging.
Before I conclude, I want to clear up one point, which is what we know and do not know and what we hope the Minister can enlighten us on. I am sure that he is aware that my right hon. Friend the Member for St Helens South and Whiston (Mr Woodward) wrote to the Secretary of State about this matter several weeks ago, seeking clarification; my hon. Friend the Member for St Helens North tabled written parliamentary questions about the subject; and I wrote under the terms of the Freedom of Information Act to the regional health body, the Department and the hospital trust, asking not only for the tripartite document that my hon. Friend has a copy of, but for any advice and other, associated documentation that would throw any light on it. It is because we do not have all the information that there is a great deal of suspicion on the part of local people.
The Minister is a reasonable man whom I know will want to be as open and frank as possible in the debate. I hope he will be able to dispel those fears and leave people with the belief that no conspiracy is going on, that the Government are not trying to manoeuvre our hospitals into some kind of private sector solution and that a solution will be found that is within the NHS and is acceptable to all concerned. If he can do that, the debate that my hon. Friend the Member for St Helens North has promoted today will have been a worthwhile exercise.
Mr Simon Burns
I want to deal with this in detail when I come to my contribution. The hon. Gentleman said, “What man in his right mind would consider the private sector being used in the NHS for the management of an NHS hospital?”
Mr Burns
I am talking about the generality. I can answer the generality and will come to the specifics in my speech. The gentleman concerned, who accepted the principle in a generality, was the right hon. Member for Leigh (Andy Burnham), who was Secretary of State for Health before the election.
Derek Twigg
I am not sure that that is worthy of a reply. I am being specific. The Minister may remember—and the hon. Member for Broxtowe (Anna Soubry) sitting behind him will—that when the Health and Social Care Public Bill Committee discussed foundation trusts and insolvency, I made the point that it does not always follow that a hospital that gets into financial difficulties is badly run. That is the issue that the proposals in the Bill do not take into account. What was the logic behind the proposal for this specific hospital to have a private provider brought in to help manage it? That is a different point from the one that the Minister took.
I also want to make the point that the Government are placing NHS trusts under intense pressure through the policy of forcing foundation status within three years, coupled with the costs of reorganisation and the efficiency savings that trusts have been asked to find. That is leaving many NHS trusts in peril as they struggle to meet foundation trust status, or become foundation trusts with financial difficulties from day one. The Minister knows a number of hospitals are in financial difficulty. I do not know whether he has yet decided to put that list in the public domain.
The dangers are clear. St George’s hospital in Tooting, London, recently decided that it was too risky to push ahead with the Government’s preferred timetable for NHS trusts to become foundation trusts. Speaking after announcing a two-year delay to the plan to become a foundation trust, the board of the hospital said:
“The board recognises that if we put the organisation under pressure to become an FT during 2011-12 then this could impact on the quality and safety of the patient care that we provide.”
I wonder whether parallels can be drawn with the St Helens and Knowsley trust, as the board is not prepared to take the risk. Put simply, existing pressures on NHS trusts are too great to risk a massive reorganisation. Hospitals realise that, and so should the Government. It is important to understand that the pressures are great, and what is being asked behind the scenes at particular foundation trusts is important.
Now more than ever, the dangers of an FT or NHS trust experiencing financial difficulties are growing. Under the Tory-led Government’s plans for the NHS, a struggling FT will be faced with two options. One is insolvency in line with commercial insolvency procedures, and the other is the sort of takeover dictated by clause 113 of the Health and Social Care Bill, which the Committee discussed in some detail, or a takeover on unknown terms. The Minister refused to be drawn on giving an example of what hospitals might be in difficulty and what sort of takeover might be considered. I do not know whether he has changed his mind since then, because an example would help us with the detail of our deliberations.
Although the debate on PFIs and their appropriate use will continue, it is important to be clear on one issue. During our time in government, we supported the NHS. We undertook no step that would have endangered its position as a world class public health care system. In comparison, this Government’s policy on health care has been in turmoil from the very beginning. It is hated by the public and despised by the professionals, and we believe that that is dangerous for the NHS.
We need to know what plans the Government, the Secretary of State and the Prime Minister have for capital investment in the NHS. What will hospitals and NHS facilities have to do if they require large capital investment? Is it the case, as reported in the Financial Times last year, that the Secretary of State has ruled that they should no longer have access to public sector cash for big capital projects? Is that the Government’s current policy? Alternatively, will the Minister confirm that future investment in NHS capital projects will be determined solely by the market, as part of the Government’s plans to place the market at the centre of the NHS?
The Minister will expect me to remind him that he was forthright—it is not what the Secretary of State would have wished—in identifying the extent to which EU competition law will increasingly apply to the NHS. Just as importantly, we need to understand where the Government are going on PFI. Much has been said about what they are considering, but when will they publish their plans?
I remind the Minister that he is now in government. Whatever matters he raises this afternoon, he must realise that he needs to supply the answers to these difficult questions. There is great uncertainty within the NHS, which is not helped by the lack of policy detail on which course the Government intend to pursue. It is a crucial question for NHS services, and the answers need to be heard.
The Government should make no mistake about it that their massive reorganisation proposals are putting the future of the NHS as we know it in peril. They are causing massive uncertainty and distracting the professionals, and, as the Health and Social Care Bill impact assessment shows, it could have an impact on the safety and care of patients. The fact remains that opposition to the Health and Social Care Bill, which has been led by the Labour party, and the increasing rejection of the Government’s plans by medical professionals, health experts and patients groups alike have forced the Government to take this humiliating pause. If it is to be more than a simple political ruse to get through the local elections tomorrow, real and significant changes will need to be made to the Bill, including the crucial deletion of part 3, which has severe implications on the issues that we have been discussing today.
Labour left the NHS with record levels of public satisfaction, record low waiting lists and world class hospitals such as those at St Helens and Whiston. It is becoming increasingly clear that the NHS is moving backwards because of this Government’s cuts and broken promises. I have no doubt that that will inform the choice that people will make tomorrow at the ballot box.
The Minister of State, Department of Health (Mr Simon Burns)
Thank you for that, Mr Meale. It is a pleasure to serve under your chairmanship.
I congratulate the hon. Member for St Helens North (Mr Watts) on securing this important debate. I take the opportunity to pay tribute to the many who work so hard to deliver high-quality NHS services and health care for the benefit of his constituents and the constituents of the right hon. Member for Knowsley (Mr Howarth) and the hon. Member for Blackley and Broughton (Graham Stringer). I pay particular tribute to the St Helens and Knowsley Teaching Hospitals NHS Trust’s approximately 4,500 staff and its many trainee specialty doctors, who bring a consistently high level of care to patients throughout Merseyside and Cheshire.
The trust has a track record of first-rate clinical performance. As we heard, it achieved three stars and consecutive double excellent ratings from the Care Quality Commission, a feat that was maintained in 2010. It also achieved the highest score nationally for cleanliness in the recent national in-patient survey. The people of St Helens and Knowlsey can be very proud of what has been achieved. The hospital’s staff do a tremendous job, and the Government will support and empower them and all front-line staff in continuing to improve services free from the interference of meddling politicians in Westminster—and free at the point of use for all who are entitled to use the national health service.
The fact has been underlined that in 2010-11 we increased PCT allocations for the area to just under £600 million, a cash increase of £17.2 million or 3%. I know that the House will share with me the pleasure of knowing that, in the last two years for which figures are available, there was an increase in the number of nurses, consultants and doctors who serve the local community.
The hon. Member for St Helens North raised the important issue of PFI contracts. I shall deal with this topic in two parts. First, I shall outline the coalition Government’s approach to the private finance initiative generally. Secondly, I shall examine the situation at St Helens and Knowlsey.
The Government confirmed at the end of last year that we remain committed to public-private partnerships, including those delivered via PFI, if they can be clearly shown to represent good value for money. Such arrangements will continue to play an important role in delivering NHS infrastructure. However, we believe not only that too many PFI schemes have been undertaken but that some were too ambitious in their scope, a point made in an intervention by the hon. Member for Blackley and Broughton.
Mr Watts
Will the Minister say which PFI schemes should not have gone ahead? Frankly, we had a legacy of neglect under the previous Conservative Government, and most people believe that we should increase the hospital building programme, not decrease it. Will the Minister itemise those schemes?
Mr Burns
I do not share the hon. Gentleman’s blinkered view of what went on in the health service prior to May 1997. I am probably of a more generous spirit, in that I am prepared to pay tribute to the achievements of the last Labour Government, although it would be more difficult to discover those of the Wilson-Callaghan Government and before that the Wilson Government because of the chronic economic situation.
Unfortunately, the hon. Gentleman is not as generous of spirit; he seems to think that everything changed in May 1979 and did not improve again until May 1997, despite the fact that for every year between those dates we saw a real-terms increase in health spending. Indeed, health spending went up from just under £9 billion a year in 1979 to more than £39 billion in 1996-97, which at the time was an incredibly large sum, although due to inflation and other factors, it now seems far more modest. However, I am prepared to be more open-spirited and to acknowledge achievement when justified, but also to criticise when justified.
Derek Twigg
No one suggested that everything was renewed and changed under the previous Labour Government, but there was record investment and an unprecedented hospital building programme. How many hospitals did the Thatcher and Major Governments build?
Mr Burns
This is the point. Perhaps the hon. Gentleman is taking a punt on something with which he is not very familiar, but if he had been in the House in the mid-1990s, he would know beyond doubt that there were record levels of investment in the NHS. Even he said, looking at the report in front of him, that the Major Government used PFI, and there was considerable investment in infrastructure. He would probably argue—with some justification because one can always argue this—that there should have been more investment, but there was more. I shall give one example, but—
Mr Burns
I will. There are so many examples of old and dilapidated buildings or buildings that were past their sell-by dates that the Thatcher and the Major Governments knocked down and replaced through new investment. One example was the moving of the European-renowned burns and plastic surgery facility on a Billericay site in Essex, which wanted to expand to maintain its position at the forefront of providing highly specialist services and was moved to Broomfield. I remember a particularly happy day in February 1997 when, as a junior Health Minister, I accompanied the then Prime Minister to open it.
May I now get back to the point I was making to the hon. Member for St Helens North? However reasonable the hon. Member for Halton is trying to be, his hon. Friend was not quite so generous, suggesting that everything was appalling prior to 1997 and everything was magnificent after it. The hon. Member for Blackley and Broughton rather unfortunately brought the speech of the hon. Member for Halton to a bit of a halt by highlighting some of the perceived criticisms of the PFI system under the Blair and Brown Governments, but the hon. Member for Halton very neatly sidestepped the issue. He did not want his story of good news on investment in hospital buildings to be punctured, and neatly avoided it.
Mr Watts
The Minister must understand that St Helens was served by three Victorian workhouses. After the Labour Government were elected in 1997, three brand-new, state-of-the-art hospitals were built and we had a walk-in centre, new GP services and more doctors and nurses. He should understand that my experience is that after 1997 there was massive investment, and before 1997 there was very little.
Mr Burns
To pick up the point made by the hon. Member for Blackley and Broughton, until October last year, I, too, for the 13 years of the previous Labour Government had a hospital in my constituency that was an old, Victorian workhouse, with ancillary wards that were improved Nissen huts. We could go round the country and find many buildings that needed improvement.
I am sure that Labour Members will accept that even the NHS is restricted in that it cannot have unlimited funding, there will be priorities for improvements and reinvestment, and not everything will be done all the time. The process is ongoing. To answer another point before I focus on St Helens, the hon. Member for Halton asked about what is happening to the capital spending settlement and programme. As I am sure he is aware, as an outcome of the spending review, the Government have a capital spending settlement up to 2014-15, and capital will continue to be used to provide investment for NHS development, as well as PFI.
Mr Burns
The hon. Gentleman wants me to list some more new hospitals. There is the Chelsea and Westminster hospital on Fulham road, which was a flagship hospital for the centre of London initiated by Baroness Bottomley, I believe. I could continue round the country, but I will not because my time is limited. I think that the hon. Member for St Helens North would prefer it if I spent more time discussing his local PFI project, because there is a lot to be said to clear his mind and reassure him, if only he has the open ears to listen; an open mind would help as well.
As the Government confirmed at the end of last year, where they can be clearly shown to represent good value for money, we remain committed to public-private partnerships, including those delivered via PFI. Such arrangements will continue to play an important role in delivering future NHS infrastructure. However, the Government also believe that not only have too many PFI schemes been undertaken, but some were too ambitious in their scope. The Treasury has now reviewed the value for money guidance for new schemes and looked at how operational schemes can be run more efficiently. We are clear that the focus should now be on releasing efficiencies at the many existing PFI schemes.
In January, the Treasury published new draft guidance, “Making Savings in Operational PFI Contracts”, which will help Departments and local authorities to identify opportunities to reduce the cost of operational PFI contracts. As part of that initiative, my noble Friend Lord Sassoon, the commercial secretary, launched four pilot projects to test the ideas raised in the Treasury’s draft guidance. The focus of the pilots is to find efficiency gains and savings within the PFI contract itself, allowing the quality of care for patients to remain the priority. The pilots should end by the end of this month. The lessons learned will be used to finalise the Treasury guidance and to improve other relevant PFI contracts, including the one at Whiston hospital. One essential element is that all NHS trusts will retain any savings made to reinvest in improving patient care.
The other important aspect of operational PFI schemes and their cost to local health economies is their effect on NHS trusts seeking NHS foundation trust status. The coalition Government have set a clear commitment for all remaining NHS trusts to achieve foundation trust status by April 2014. That policy will finally realise the ambition of the previous Labour Government. It is about ensuring high quality and sustainable NHS services by giving trusts the freedom to serve their patients to the very best of their ability, unhindered by top-down bureaucratic control.
An issue facing some NHS trusts in their move towards attaining FT status is the affordability of their PFI schemes, as hon. Members are aware from examples in their constituencies. We are tendering for an independent review to establish where PFI schemes may, in some organisations, be the root cause of problems that prevent them from becoming foundation trusts. St Helen’s and Knowsley NHS Trust is one such organisation, and will be considered as part of the scheme. In addition to the independent assessment, the Department and the NHS are developing solutions in a systematic and comprehensive way to manage the PFI schemes in the very small number of trusts where a local or regional solution cannot be found.
When the current management of St Helens and Knowsley NHS Trust signed their PFI agreement in 2006, with the agreement of the then Secretary of State for Health, Patricia Hewitt, and other Ministers, local PCTs agreed to make up the shortfall between the revenue generated by the hospital through the national tariff and other means and the cost of the unitary payment—the annual PFI charge, which was some £20.3 million. Unfortunately, that decision built a deep lack of sustainability into the trust’s finances—a lack of sustainability that the trust, the strategic health authority and the Department are now working extremely hard to rectify. To that end, the trust’s board and the strategic health authority, NHS North West, are developing a tripartite formal agreement, or TFA, to be agreed with the Department of Health, which will support the work to achieve foundation trust status.
Every trust is required to produce a TFA, setting out how it plans to progress to FT status by 2014, the challenges that it faces and how it plans to overcome them. In the case of the St Helens and Knowsley trust, the TFA is still in draft form and is very much a work in progress. Beyond what was leaked to the Liverpool Echo and to the hon. Member for St Helens North, I have not seen the draft and while discussions are ongoing it would be inappropriate for me to do so and I will not see it. Therefore, it would also be inappropriate at this stage to publish the documents.
Mr Watts
Minister, the local community and the local MPs will believe that that is a totally unacceptable stance to take. It is clear that there are grave doubts about the future financial viability of the trust—the St Helens and Knowsley Teaching Hospitals NHS Trust, including the Whiston hospital—and that a number of options are being considered in the current discussions about the trust. For the Minister to hide behind the fact that he does not want to see that report removes the accountability that we would expect him to have. Will he reconsider that decision and will he look at that document? Also, will he rule out some of the options, including the private provider option? If he does not do those things, people will continue to suspect that his Department is being driven by the fact that it wants to privatise our hospitals, but he and other people in the Department do not want to see the documents that are being discussed now. I can see no reason why he should not see that draft document and why we should not see it.
Mr Burns
First, of course, the hon. Gentleman has seen the first draft document—it was leaked to him and I think that he held it up during his remarks this afternoon—so it is slightly stretching the point to say that local MPs have not seen it. I have no doubt that he has shown it to his hon. Friend the shadow Minister for Health, the hon. Member for Halton, and I would be rather surprised if the right hon. Member for Knowsley has not seen it too.
Mr Burns
Because it was a first draft document, drawn up between officials in the Department of Health, the SHA and the trust, and I do not think that at that stage it was appropriate for me to see it. Also, I suppose that if one is being totally candid, which often gets me into trouble when the hon. Member for Halton or particularly the hon. Member for Leicester West (Liz Kendall) are around, it does make it slightly easier for me because I can say, “In all honesty, I have not seen it.”
I will now make some progress, because I think that what I am about to say may answer some of the questions put by the hon. Member for St Helens North and it may well help the right hon. Member for Knowsley, too. If it does not and I have time to do so, I will give way then.
The TFA process should be completed soon, with the final approved version hopefully being published some time in June or July. I can confirm—if the hon. Member for St Helens North would like to listen to me, because I think that he will find what I am about to say particularly interesting, as he has expressed a degree of confusion about the issue—is that one of the options under review is not, I repeat not, to somehow “privatise” the NHS. As I said to the hon. Gentleman during Health questions last week, this Government will never privatise the NHS and we have no intention of doing so at the St Helens and Knowsley trust.
Perhaps it would be a help if I took a moment to explain the process through which the trust, like all trusts in a similar position, is progressing towards becoming an FT. First, the trust, along with local health authorities, will attempt to find a local solution to whatever financial issues there may be. If a simple local solution cannot be found from within its own resources, then a more radical solution may be necessary, such as merging with another trust and examining whether services need to be reconfigured. On that point, it may be of some consolation to Opposition Members that the benefits of a merger with another trust are that it reduces the percentage of the unitary payment of the PFI in relation to income, which helps with the financial situation, and for other FTs in a merger it increases the income base and economies of scale become possible, which again potentially helps with the finances of a trust.
If the problems cannot be resolved in that way, we would work to a national solution, which is being developed by the Department and which will be agreed with the Treasury. If there is no foreseeable solution, a final option would be to consider tendering the management of the trust. Under that option, management teams from within the NHS, from a social enterprise or from the private sector would put forward their ideas on how to find a way forward for the trust.
Mr Burns
May I just continue, because this is rather important?
While that option is a very long way down the line of potential solutions, it is only what is currently being done at Hinchingbrooke hospital in Huntingdon, in the constituency of the Under-Secretary of State for Justice, my hon. Friend the Member for Huntingdon (Mr Djanogly). The decision on that hospital was taken by the previous Labour Government, when the right hon. Member for Leigh (Andy Burnham) was the Secretary of State for Health. So it is not a new option dreamt up by the present Government since coming into office. We are simply taking an option that is already on the table and that was there when we came into power, which the previous Secretary of State for Health—a Labour Secretary of State for Health—was prepared to accept.
Mr Burns
Just one minute. I must say that at the time, during the discussions about what should happen to Hinchingbrooke hospital and about the use of the option that the right hon. Member for Leigh agreed to, nobody said that that was privatising the hospital, because it was not. If—and it is a big if—that solution were to be considered the right way to solve the problems at the St Helens and Knowsley trust, that would not be privatisation either.
Derek Twigg
With respect to the right hon. Gentleman, we are not comparing like with like.
Derek Twigg
We have a double-excellent hospital at St Helens and Knowsley; it has excellent financial management and excellent services. It meets all the standards. I put the question back to the Minister. On that basis, why is the Department—whether we call it the SHA or not, it is part of the Department and it has responsibility to the Secretary of State—
Derek Twigg
Well, I understand the SHA discussed this as an option with the hospital. I want the Minister to ask my question. Did the hospital voluntarily reject the third option of a private sector provider coming in to manage or run the hospital? Did it refuse that option and also say that it would not accept the cuts being asked of it by the SHA as that would put patient safety at risk? Is that correct or not? If he does not know, will he find out?
Mr Burns
That the trust rejected consideration, or the possible consideration, of that option, because—[Interruption.] What I want to do is to put it in context. As I said in my comments earlier, that is very much a last possible solution if the other solutions are not able to be worked out.
Derek Twigg
I understand that the SHA, not the hospital trust, suggested as a third option having the private provider, on the basis that the hospital—I understand that it was approved by the board—would not accept what was on offer because of the cuts that it would have to make and it was concerned about patient safety. It therefore would not accept voluntarily an option to have a private sector provider come in. The question is whether that option was proposed by the SHA and whether the trust, because of concerns about patient safety, rejected it on that basis, on a voluntary basis. I make that point very clearly.
Mr Burns
If—I will pursue the matter after the debate—there is anything in that that is incorrect, I will come back to the hon. Gentleman as quickly as possible, but my firm understanding and the advice that I have been given is that the answer is no.
May I reassert what I said earlier about the processes of the options, because it seems to be getting lost in the telling? I have said that it is important to find a local solution to whatever financial issues there may be. That is what the trust and the local health authorities are working to try to secure. If a simple local solution cannot be found from within the trust’s own resources, a more radical solution may be necessary, such as merging with another trust and considering whether services need to be reconfigured.
I think that it was the hon. Member for Halton but it may have been the hon. Member for St Helens North who said, “But nobody has ever said what other trust there might be.” I may be able to help the hon. Gentleman who asked that question. One of the options is the North Cheshire trust.
Mr Watts
I am extremely grateful to the Minister for giving way, because this goes to the heart of the matter. The lack of accountability comes from the fact that he has not seen the documents and therefore does not know what is in them. If he published the reports, he would see that there is a first draft and a second draft, and that the idea of the privatisation of the management comes from his Department. I do not want to see the Minister embarrassed. The best way for him to resolve the problem is to publish the two documents, and everyone will then be able to see that the third option was not wanted by the trust but is being driven by the Minister’s Department.
Mr Burns
May I return to the intervention made by the hon. Member for Halton? I said that as soon as I heard anything I would get back to him. He asked whether it was the trust that said it would not accept the option, and about the patient safety and quality of care recommendation. My answer should have been “I do not know,” not “No.” The advice I have been given is that I do not know, and we do not know.
As time is running out, may I reiterate the process? I do not want any confusion. I have said that if a simple solution cannot be found from within the trust’s own resources, more will be done to find a radical solution, perhaps involving a merger with another trust and examining whether services should be reconfigured. Although that option is a very long way down the line of potential solutions, it is similar to the one at Hinchingbrooke hospital that was embraced by the previous Labour Government and accepted, in principle, by the former Labour Secretary of State for Health, the right hon. Member for Leigh, as the way forward in a particular hospital with a particular problem. However, even if that were, in any circumstance, to become an outcome for a hospital, to suggest that it somehow equates to hospital privatisation is nonsense, for a number of reasons.
First, the hospital will remain a wholly owned NHS hospital, with NHS assets and NHS staff remaining entirely within the public sector. Secondly, I remind the hon. Gentlemen that the hospital has achieved its record of sustained excellence in part due to the significant involvement of private sector companies, a policy that was actively encouraged under the previous Labour Government. All the Labour Members present for this debate were proud members of that Government at some point during the Administration’s 13 years. Examples of that policy in operation in the hospital are that radiology imaging equipment has been supplied through a managed equipment service provided by GE Medical Systems since 2006, when Patricia Hewitt was Labour Secretary of State for Health. Facilities management services, which the hon. Member for Halton rightly praised and which have been vital to delivering high levels of cleanliness throughout the trust, have been provided by two companies—Vinci FM and Medirest—also since 2006. The use of the private sector does not mean privatisation, nor does it lead to a poorer quality of patient service, and I hope that hon. Members will acknowledge that the hospital trust’s excellent clinical reputation is evidence of that.
This Government want all NHS trusts to become foundation trusts because they will provide better patient care. Foundation trusts will be free to respond to the needs and wishes of local people and will be far stronger, both clinically and financially. To become a foundation trust hospital, an NHS trust must prove that it has passed strict tests on clinical care—the care that patients deserve. It also must prove that it is financially sustainable in its own right, which is what all taxpayers deserve.
Hospitals that are built on sand will sink, and this Government will not stand idly by and allow that to happen—the people of St Helens North deserve no less. I am sure that in due course, when the proper procedures have been adopted and the strategic health authority, the primary care trust, the hospital trust and the Department of Health have reached conclusions, documents will be published and decisions will flow.
This is not a conspiracy; it is a sensible and coherent way to move forward and discover a viable, practical and proper decision to help what is, in many ways—as all speeches in the debate have shown—a very good hospital that has a problem because of its PFI scheme. I gently remind Members that the PFI was approved by the trust and the Department of Health under the Labour Government, not the coalition Government. That is what has caused the problem, and it is why a viable solution is important. I wish everyone well in seeking a solution that is relevant and meaningful to the future success of the trust.
For a variety of reasons, it is always nice to have a conspiracy theory tucked in one’s back pocket to cause concern, but this is not a conspiracy. Just as I said earlier, Americans did land on the moon in 1969, John F. Kennedy was sadly shot in 1963 and, contrary to some people’s views, Barack Obama was not born in a manger.
Variant Creutzfeldt-Jakob Disease
Simon Burns Excerpts(13 years ago)
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The Minister of State, Department of Health (Mr Simon Burns)
I congratulate my hon. Friend the Member for Mole Valley (Sir Paul Beresford) on securing this important debate and on his thoughtful and well-informed comments on a matter of public concern and genuine importance. I also pay tribute to his ongoing commitment to keeping the issue of variant CJD in the public consciousness, not least through his various debates on the Floor of the House and his questioning of Ministers.
My hon. Friend asked about the Government’s response to vCJD, and I am happy to have this opportunity to update the House. Thankfully, the incidence of cases of clinical vCJD in the UK remains at a very low level, with a total of 175 cases recorded. Since a peak of 29 onsets in 1999 and 28 deaths—sadly—in 2000, the trend has fortunately been continuously downward. In 2010, there was only one new case. There have been no cases presumed to be associated with surgical or dental procedures and no known transmissions presumed to be associated with blood since 1999. The reality contrasts with some predictions that surrounded early discussion of vCJD in the late 1990s. Some people forecast large numbers of infections and deaths far in excess of what has come to pass. However, this is perhaps understandable given the uncertainties that still remain around the disease.
Although we can be pleased that the worst-case scenario has not materialised, we must remain vigilant and continue to do all we can to reduce risks to patients through potential transmissions via blood or surgical procedures. Many aspects of this condition remain unknown, and because of the unusual nature of the presumed infectious agent—the prion—are likely to remain so, as my hon. Friend alluded to. Existing measures have been put in place to reduce the risk of secondary vCJD infection passed from person to person, and it is vital that these are maintained unless evidence becomes available to indicate that they are no longer necessary or are otherwise ineffective.
Some measures put in place to protect against the transmission of vCJD also provide additional benefits to patients. One example is the continual improvement of decontamination practices across all of health care. This is vital to ensure that care is delivered safely with low levels of infection risk from all manner of infections, including vCJD, bacterial, protozoal and viral risks. The maintenance and improvement of existing, and the development of new, decontamination systems are essential for maintaining patient safety.
The Government take high-quality decontamination very seriously, and I can announce today that the Department of Health is commissioning a new programme of decontamination-related research. The Department will make available £2.4 million over the next four years to fund this research, which will include support for the development of cold plasma decontamination technologies, specifically for use in narrow channelled instruments such as endoscopes. Another study will aim to optimise the effectiveness of automated washer disinfectors used to wash and sterilise surgical instruments. Other projects will address new methods for detection of residual protein contamination on instruments following routine washing and disinfection.
In addition to decontamination, another vCJD risk-reduction measure that provides additional health benefits is the removal of white blood cells from all blood for transfusion. The removal of white blood cells not only reduces the risk of vCJD transmission, but reduces the risk of cytomegalovirus transmission, transfusion-associated lung injury and transfusion-related fever, and has other benefits. The provision of synthetic clotting factors for the treatment of all patients with bleeding disorders such as haemophilia is another measure associated with both reducing the risk of vCJD transmission and improved patient care.
Sir Paul Beresford
I thank my hon. Friend for his announcements and I note his repetition of some of the points that I have already made. Does he accept that there are already three commercially available materials that can be used for cold sterilisation—but which are not being used and to which the Government have given only semi-recognition—and could also be introduced extremely quickly? Secondly, I note his point about white cell depletion, but a filter has been available since 2006 that would take red blood cells out as well, greatly improving the restriction of the prion.
Mr Burns
I am grateful to my hon. Friend for that intervention. If he bears with me, I will come to both those points. I want to outline what the Government have been doing, but towards the end of my speech I have a number of comments to make in response to some of the valid points that he raised in his speech.
As I was saying, the provision of synthetic clotting factors for the treatment of all patients with bleeding disorders such as haemophilia is another measure associated with both reducing the risk of variant CJD transmission and improved patient care. Those products, although not suitable for all patients, eliminate all variant CJD and other blood-borne infection risks to those patients.
All the health care actions taken to reduce the risks of person-to-person transmission of variant CJD have costs. Estimates of the annual cost of blood-related protection measures alone amount to approximately £40 million. However, many costs that are badged as variant CJD risk-reduction measures would be incurred even without that specific risk. Without a variant CJD risk, many of the blood-related measures, including leucoreduction and the use of synthetic clotting factors, would continue because of the wider safety and other benefits that they confer. The Government also continue to support payments to those affected by clinical variant CJD through the Variant CJD Trust. The trust has paid out approximately £39 million to patients and their families over the last 10 years.
In the latter part of his speech my hon. Friend talked about the risk of contamination via dentistry, which I would like to address now. There have been no known, or indeed suspected, cases of variant CJD transmission arising from dental procedures. However, there are still considerable scientific uncertainties that prevent us from quantifying the specific potential risk. The Department of Health has focused on improving standards of dental decontamination over the last decade, as the risk from blood-borne viruses—especially hepatitis B and C, and HIV—is a recognised risk in dental practices. Approximately 500,000 people in this country are infected with those viruses, and there are more than 1.5 million patient contacts every week in NHS dental practices. It is essential that the quality of local decontamination in practices must be of the highest standard.
The available equipment for and knowledge about decontamination is constantly changing, as my hon. Friend is aware. We update our policies to keep pace with those technical and scientific developments. An essential feature of the British Dental Association guidance, published in 2004, was the importance of both the sterilization and pre-sterilization cleaning components of the decontamination process. Indeed, the essential quality requirements in the Department’s guidance, as set out in “Health Technical Memorandum 01-05”, were similar to those in the British Dental Association’s original A12 document.
Guidance from the Department of Health states that all dentists should use automated washer disinfectors as part of best practice. There are three reasons for this. First, they provide a consistent and reliable cleaning and disinfection process. Secondly, they contain the washing and disinfection process within a sealed unit, which helps to minimise the risk of spreading microbiological and chemical hazards. Thirdly, there is strong evidence that automated washer disinfectors are effective in removing the worst of the contamination from dental instruments and that they deliver a much greater degree of consistency in cleaning. This will reduce the worst-case risks to subsequent patients.
Also, following the recently commissioned research on optimising the efficacy of washer disinfectors, we expect their performance to improve significantly in the coming years. Initial research indicates that the use of automated washer disinfectors can reduce general protein contamination on instruments by a factor of up to 10,000. The reduction in hydrophobic proteins, similar to prion proteins, is roughly a factor of 100. Automated washer disinfectors are therefore very useful in improving the quality of instrument cleaning and reducing risk.
Sir Paul Beresford
I was not picking on dentistry specifically, because washer disinfectors are also used in hospitals. They are an excellent idea. They are very expensive, but we are going down the right road. The problem is, however, that the prion sticks to certain stainless steel instruments used in dentistry and elsewhere in hospital services, and the washer disinfector will not remove it. However, if the Rely+On, or one of the other two products, were utilised either in the soak beforehand or in the washer disinfector, that would make the process much more effective as far as the prion is concerned.
Mr Burns
Again, if my hon. Friend will bear with me, I will come to these points when I deal with a number of the issues that he raised in his speech.
The guidance encourages the purchase of automated washer disinfectors. However, no time frame has been stipulated and they were not part of the essential quality requirements that all practices had to meet by the end of 2010. A 2009-10 national survey on policy, equipment and procedures used by local dental practices in the decontamination of their instruments showed that more than 70% were at or above the standard required by Department of Health guidance. That figure is likely to improve further, as many other dental practices are close to the required performance level.
The British Dental Association was fully involved in the development of the guidance, and is supportive of the principles underpinning it. The guidance is also consistent with the BDA’s advice sheet A12, “Infection Control in Dentistry”, published in 2004, which states:
“CJD and related conditions raise new infection control questions because ‘prions’, the infectious agents that cause them, are much more difficult to destroy than conventional micro-organisms, so optimal decontamination standards need to be observed. As a universal precaution, all instruments should be thoroughly cleaned before autoclaving, in order to remove as much matter as possible.”
During 2006-07 and 2007-08, the Department of Health made £100 million of capital funding available through PCTs for use in primary dental care. One of the areas identified as suitable for that money was the improvement of standards of decontamination in primary dental care. Many PCTs have provided grants to practices to support the roll-out of automated washer disinfectors in primary dental care.
These and other variant CJD risk reduction measures will remain in place and we will continue to consider all other options where there is evidence of their overall efficacy, safety and cost benefit. For example, we closely follow the development by commercial and academic organisations of potential blood screening tests. While recent progress—as exemplified by the recent publication in The Lancet of the Government-funded prion unit’s development of a prototype diagnostic test—is promising, there remains no test suitable for screening blood donations.
Another possible technology is, as my hon. Friend mentioned, prion filtration, which aims to remove the presumed variant CJD infective agent from blood. In early 2012 on completion of a clinical trial, Ministers will consider the possible use of prion filtration in addition to leucoreduction to reduce further the potential risk of infection from red blood cells. I trust that that helps to answer one of my hon. Friend’s points.
Sir Paul Beresford
I thank my right hon. Friend again for giving way, and for his tolerance. His statement is interesting, although under the previous Government there was a demand by the Department to provide an impact assessment on the P-Capt filter, which should have been ready for Ministers in October 2009. Will he inquire whether that is available, and if so have a look at it? It would speed up the decision making.
Mr Burns
I can answer my hon. Friend instantly on that. I said just before his intervention that we expect the trial results in 2012, and the impact assessment will be completed only when the trial is completed. The impact assessment, then, will not be available until 2012 when the trials have been completed. I hope that that explains it, and satisfies my hon. Friend.
I would like to enter a note of caution that, as with all new technologies, it is important to consider all the potential costs and benefits to ensure that, as far as possible, the benefits they offer and the costs they incur—both financial and clinical— are fully understood. One example was when single-use tonsillectomy instruments were introduced in 2001 to reduce the risk of variant CJD infection. The instruments were withdrawn within a year, after the death of a number of patients. This clearly shows that no matter how good the intentions, there can, sadly, sometimes be unintended consequences with the introduction of thoroughly assessed new technologies.
My hon. Friend raised a number of issues, which I would like to go through methodically. He talked knowledgeably about prion filtration and effectively asked what was the Government’s position on its use to reduce the risk of variant CJD. I can advise him that the independent Advisory Committee on the Safety of Blood, Tissues and Organs considers that there is evidence that a particular filter is able to reduce potential infectivity in a unit of red blood cells and has recommended—subject to satisfactory completion of the clinical trial—the introduction of filtered blood to those born since 1 January 1996. The Government are undertaking an evaluation of the costs, benefits and impacts to inform a decision on whether to implement that recommendation. As I said to my hon. Friend a few moments ago, that is expected to be completed in 2012, when we will also have an impact assessment, which could be studied.
My hon. Friend raised the issue of funding. The current funding by the Department is for studies led by Professor Collinge. Between 1996 and 2012 the Department of Health will have provided more than £18.2 million for studies led by Professor Collinge, which is in addition to his funding by the Medical Research Council. Through the RDD policy research programme, the Department currently funds two studies that underpin and are integrated with the MRC Neuropathogenesis Unit funding. The National Prion Monitoring Cohort funding is worth £3.04 million between 1 April 2008 and 31 March 2012. Secondly, the development of an effective treatment for prion infection by humans is funded to the value of £7.2 million from 1 February 2006 to 30 June 2012, in partnership with GlaxoSmithKline.
Sir Paul Beresford
First, I am astonished that the PRISM trials have taken so long. They were supposed to finish in 2009, and they have dragged on for a further three years. We really should be worried about the potential development of infection in the intervening period.
Secondly, the Minister has delighted us with the research figures, but they pale into insignificance in comparison with the volume of expenditure by the national health service on imports of blood products and blood serum from the United States in particular. Collinge’s team have produced the test and one of the three soaks, so he has achieved positive results. It would be a mistake to stop now, rather than investing a little more funding to support the next stages of the test so that the tree that was planted initially can bear fruit.
Mr Burns
I always welcome any justified lobbying for extra funding, especially if it is for research. I do not think it appropriate for me to promise my hon. Friend the earth from the Dispatch Box this afternoon, but I will promise him that I will ensure that his request and his justification for the provision of further funds are drawn to the attention of the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton). No doubt she will consider what he has said and write to him in due course.
Sir Paul Beresford
I thank the Minister sincerely, because it is unusual for Ministers to give way with such regularity. Perhaps it is also unusual for them to receive requests.
I understand that the Under-Secretary of State has considered the matter, and is looking to the private sector to fund the advances and further testing. The private sector is unlikely to do that because it has no incentive, but, as a Minister in the Department of Health looking after the nation’s health, my right hon. Friend has every incentive, as has the Under-Secretary of State.
Mr Burns
I admire my hon. Friend’s persistence and congratulate him on it, but I fear that it will not push me any further at this moment. I hear what he says about the meeting between my hon. Friend the Under-Secretary of State and Professor Collinge. I cannot comment on that, but I reiterate yet again that I will draw my hon. Friend’s comments to the attention of my hon. Friend the Under-Secretary of State so that she can reflect on them. No doubt she will be in touch with him once she has had time to do so.
My hon. Friend mentioned the three decontamination products. They have not yet been proven suitable for use in the standard decontamination cycle in health care, and we must therefore await the conclusion of the research. Once we have seen the results of that research and, in one case, the impact assessment, we shall be able to seek to make positive progress.
Let me reassure my hon. Friend that the Government take the risks of variant CJD very seriously indeed. Because of the uncertainty surrounding it, we cannot be satisfied that we can stop looking for ways of improving and enhancing the protection of members of the public, and minimising the development and spread of this particularly horrendous medical condition. Successive Governments have introduced a wide range of precautionary measures focused on reducing risk to protect public health. I assure my hon. Friend that we will maintain them and keep them under review as new evidence emerges, and that we will ensure that any new measures under consideration are effective, safe and appropriate.
Question put and agreed to.
Oral Answers to Questions
Simon Burns Excerpts(13 years ago)
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Kate Green (Stretford and Urmston) (Lab)
2. What steps he is taking to ensure the provision of acute services in Trafford district.
The Minister of State, Department of Health (Mr Simon Burns)
This is a matter for the local NHS. Every NHS trust has a duty to provide the best quality care for its patients. The Government believe that the delivery of health services should be led locally, with clinicians working with GPs and patients to ensure that their needs are met.
Kate Green
I am grateful for that answer and for the Minister’s letter to me last week, but, having already lost paediatric and maternity services recently, and with the decision not to provide trauma services in Trafford, local people are understandably anxious about further services being lost. Is the Minister confident that sufficient independent oversight is in place to ensure that the needs and wishes of local people are adequately met?
Mr Burns
I hope that I can reassure the hon. Lady, because if there were to be any reconfigurations in the future—I put that in the conditional tense because the relevant trust is confident that there will not need to be any—quite clearly the four tests that my right hon. Friend the Secretary of State introduced last May would have to apply. There would have to be full consultation with local people and with clinicians, GPs and others in the health economy.
Simon Hughes (Bermondsey and Old Southwark) (LD)
3. What processes he has put in place to allow lay members of the public and elected public representatives to contribute to discussions on the reform of the NHS.
Mr Jim Cunningham (Coventry South) (Lab)
5. How much his Department allocated to the provision of out-of-hours surgeries in the last 12 months for which figures are available; and if he will make a statement.
The Minister of State, Department of Health (Mr Simon Burns)
The Government do not allocate centrally how much money is spent by local NHS providers on out-of-hours services. However, in 2009-10, the last year for which figures are available, £403.8 million was spent on out-of-hours GP services in England and £1.6 million was spent on out-of-hours services in Coventry. We plan to give GPs and other health professionals greater powers to commission out-of-hours care to achieve high quality, integrated services that are focused on the needs of patients.
Mr Cunningham
Given that waiting times in emergency units are increasing, what will the Minister do to protect out-of-hours clinics?
Mr Burns
It was, of course, the hon. Gentleman’s Government who did so much to undermine the provision of out-of-hours services. We propose not only to review the existing framework, but to ensure that there are the real improvements that benefit patient care, which are so badly needed.
Sir Peter Bottomley (Worthing West) (Con)
Will my right hon. Friend ensure that there are no artificial constraints so that GPs, even though they may be commissioners, can ensure that they provide out-of-hours services in combination with clinics and ambulance services?
Mr David Hanson (Delyn) (Lab)
6. What discussions he has had with Ministers in the Welsh Assembly Government on the cross-border implications of the Health and Social Care Bill.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
12. What arrangements he has made for continuity of provision of existing hospital services under his proposed reforms of the NHS; and if he will make a statement.
The Minister of State, Department of Health (Mr Simon Burns)
Commissioners would remain responsible for securing continued provision of NHS services to meet the needs of their local populations. We are proposing to support commissioners in this by introducing a comprehensive system of regulation at national level and additional regulation for designated services.
Luciana Berger
The Minister told the Bill Committee that some accident and emergency services might be undercut by private providers, which could force them to close. Will the Government bring forward amendments to the Bill to safeguard existing A and E services in all areas, including Merseyside?
Mr Burns
I know that the hon. Lady does not want to mislead the House, but she is totally, factually incorrect in how she paraphrased what I said in the Health and Social Care Bill Committee. As any hon. Member who was there will know, I tried to be helpful to the hon. Member for Leicester West (Liz Kendall)—it is the last time I will—and gave her an illustrative example of how designated services would work. However, I did not say what the hon. Member for Liverpool, Wavertree (Luciana Berger) attributed to me.
Mr David Ruffley (Bury St Edmunds) (Con)
Clinicians at the West Suffolk hospital in Bury St Edmunds are concerned that they will get the same tariff for an operation as a private sector provider, even though the NHS has to carry the cost of training whereas, on the whole, the private sector does not. What steps will the Minister take to address this perceived unfairness?
Mr Burns
I should like to reassure my hon. Friend. As he will know, we do not propose to introduce price competition into the NHS; rather, we propose to introduce competition based on quality. His clinicians are correct that the price will be the same. However, they must remember that we are going to stop the practice of the last Government, who, with independent sector treatment centres, paid the private sector over 11% more per operation than they were prepared to pay the national health service.
Helen Goodman (Bishop Auckland) (Lab)
15. Whether he has made an assessment of the effectiveness of the 111 non-emergency number; and if he will make a statement.
The Minister of State, Department of Health (Mr Simon Burns)
NHS 111 is currently being piloted in County Durham and Darlington, Nottingham city, Lincolnshire and Luton, and a full independent evaluation of these pilots will be available in spring 2012.
Helen Goodman
In Durham, 111 calls are being answered by telephone receptionists without any medical training. They run through a list of pre-scripted questions and frequently divert ambulance paramedics away from 999 calls. Clearly that is risky. Will the Minister look into that before the number goes nationwide?
Mr Burns
I am sorry, but the hon. Lady is a little bit confused. She says, rather dismissively, that the calls are being answered by telephonists. These are non-medically trained people who have nurses and GPs available to give them help and advice as and when the callers demand it, because of the complaint or problem that they are raising. The beauty of the 111 service is that people do not have to wait to be called back, as they do with NHS Direct. Instead, the people trained to help callers will point them towards the appropriate care—which in some cases will be the emergency services—and they are right to do so when this has been clinically determined.
Andrew Bridgen (North West Leicestershire) (Con)
Can my right hon. Friend assure the House that 111 telephone operators will be trained to the same level as 999 telephone operators?
Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)
16. What amendments he plans to table to the Health and Social Care Bill.
Mr David Evennett (Bexleyheath and Crayford) (Con)
22. What steps he is taking to extend the choice that patients have over the treatment they receive from the NHS.
The Minister of State, Department of Health (Mr Simon Burns)
The Government have consulted on proposals to give patients greater choice and control over their care and treatment. We have deferred publication of our response to take into account the results of the listening exercise.
Mr Evennett
I thank my right hon. Friend for that answer and refer him to the King’s Fund paper, “Patient choice”, which was published in March 2010. Does he agree that people value being able to choose and that the exercise of choice raises standards and encourages NHS providers to design services around patients and their needs?
Mr Burns
My hon. Friend is absolutely right. I am certainly aware of the King’s Fund publication. The report was cited as a key source of evidence in the consultation document, “Liberating the NHS”. The Department of Health welcomes this significant contribution to the evidence base, which will inform how we implement the choice commitments set out in the White Paper, “Equity and excellence: Liberating the NHS”.
Fiona Mactaggart (Slough) (Lab)
When I was first elected, I regularly received letters from constituents who were concerned about how long they had to wait for treatment. During the years of the Labour Government, those letters went away, but they are coming back again. What I know from my constituents is that their main choice is not to have to wait. Is that a choice that this Government are going to offer them or will waiting times increase?
James Morris (Halesowen and Rowley Regis) (Con)
T1. If he will make a statement on his departmental responsibilities.
David Morris (Morecambe and Lunesdale) (Con)
T3. According to recent press reports, hospitals have used money earmarked for front-line NHS services to pay salaries to trade union officials. Does my right hon. Friend consider it acceptable to spend taxpayers’ money on paying union hatchet people, and will he order an investigation?
The Minister of State, Department of Health (Mr Simon Burns)
The Government consider it right for NHS staff to have access to trade union representatives at work, but that should not be abused. Arrangements for reimbursing staff for trade union activities should be agreed locally between trusts and unions. There are no current plans to review union facility time.
Diana Johnson (Kingston upon Hull North) (Lab)
T6. Given that, according to the King’s Fund, waiting times are increasing as a result of the reorganisation, does the Minister expect things to improve now that the financial squeeze is starting to bite?
Mr Dave Watts (St Helens North) (Lab)
Given that Department of Health officials are actively discussing the privatisation of my local trust behind closed doors and are signing secret documents, will the Minister publish all those documents and will he make a statement in the House about the Government’s plans to privatise some of our NHS hospitals?
Mr Burns
I am afraid that I do not accept the premise of the question. May I tell the hon. Gentleman that this Government are not seeking and will not ever seek to privatise either the whole of the NHS or an individual trust? St Helens and Knowsley Teaching Hospitals NHS Trust is, like all other health trusts, currently agreeing plans to achieve foundation trust status by April 2014. That involves ongoing discussions with the North West strategic health authority and the Department of Health to determine the issues the trust faces and the actions needed to address them.
Stuart Andrew (Pudsey) (Con)
May I join my hon. Friends the Members for Leeds North West (Greg Mulholland) and for Shipley (Philip Davies) in supporting the children’s heart unit in Leeds? If the review fails to take full account of, and reflect on, the issues raised, what steps will the Secretary of State take to ensure that that is done so that we can fully understand the problems that would face families in Yorkshire?
NHS (Public Satisfaction)
Simon Burns Excerpts(13 years, 1 month ago)
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John Cryer
I agree with my hon. Friend. I have had exactly the same experience. We were both elected in 1997, and when I became an MP, I regularly had people come to see me with orthopaedic problems who had been waiting for operations for two to two and a half years. Some of them were in serious pain and unable to work. In the past few years, the complaints I have been hearing are that people have not had an operation for four or six months. It is a completely different world.
The Minister of State, Department of Health (Mr Simon Burns)
May I put the hon. Gentleman out of his misery before we start the debate on a false premise? He is absolutely right: the previous Government did not publish the 2008, 2009 and 2010 surveys, to which he refers. It may be of interest to him to know that the 2010 report was published following a written answer by the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow) in December 2010, and placed in the Library.
John Cryer
If the Minister will calm down a bit, I will come to that. After the Secretary of State appeared before the Health Committee, it emerged that data until 2010 had been placed in the Library, and the results until December 2009 are on the Ipsos MORI website. I was granted this debate on 24 March and the data were released the following day, Friday 25 March, on the Department of Health website. Previously, the data had not been on the Department’s website. It might be a coincidence, but it struck me that that was a fairly good time to bury good news: it was the day before 500,000 people tramped through central London on the TUC march in opposition to the cuts. The fact that the data were not initially released is unsurprising, given that polling showed a 72% satisfaction rating. Ipsos MORI concluded in the report:
“This level of satisfaction has now been recorded for over a year…suggesting that there has been a…positive shift in the public’s perceptions of the NHS. Pride in the NHS also continues to climb and is at its highest recorded level”.
Pride in the NHS is at its highest ever recorded level—an interesting statistic. We might hear a comment from the Minister about that.
The Minister of State, Department of Health (Mr Simon Burns)
As others have said today, Mr Bayley, it is a pleasure to serve under your chairmanship.
We have had an interesting debate. Some speeches were a continuation of what has been said in the Health and Social Care Bill Committee, and they bordered on fantasy. Other speeches were extremely informative. The speech of my hon. Friend the Member for Banbury (Tony Baldry) was in the latter category, and my hon. Friend the Member for Southport (John Pugh) made a reflective and interesting speech. I listened with extreme interest, as I always do, to the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke), who made a typically thoughtful speech about an area of health and social care on which he is an acknowledged expert. I listened to the hon. Member for Easington (Grahame M. Morris), as I often do these days, and to the hon. Members for Birmingham, Erdington (Jack Dromey) and for Blaydon (Mr Anderson). It was rather like a curate’s egg—parts of it, depending on which hon. Member was speaking, were all right, and other parts slightly broached on to fantasy island.
I congratulate the hon. Member for Leyton and Wanstead (John Cryer) on securing this important debate. He may be surprised to hear that I am in considerable agreement with him on certain areas. I wish to clear up a number of his questions about the surveys. In an intervention on the hon. Gentleman, I alluded to the Ipsos MORI survey. There is something slightly ironic about claiming that we refused to publish it because of its content, given that the previous Government failed to publish similar surveys in 2007, 2008, 2009 and 2010. To say that they did not publish it because the Opposition did not table parliamentary questions asking for it to be published shows breathtaking gall.
The fact is that we published the March 2010 survey following a written answer in December from the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), who is responsible for social care. It was placed in the Library, but it was not placed on the Department of Health website, for which I offer an apology. Some Members referred to the comments of my right hon. Friend the Secretary of State. Those statements were made in good faith but he was given the wrong advice. That is unfortunate, but he made that statement some three months after the results of the survey had been published.
The hon. Member for Leyton and Wanstead asked whether we will continue with the survey. I can tell him that a further survey has been done. It has not been completed, in so far as it has not yet been given to the Department, but that will happen in due course. What happens in future remains to be seen, as no decision has been taken on future exercises. The hon. Gentleman also mentioned the general life-style survey. Again, no decision has been taken. In light of that information, it is incorrect to say that we will not allow it to proceed.
On the question of the British social attitudes survey, things are a little more complex. The hon. Gentleman will be aware that the Department of Health is not the only Department involved; it is a cross-Government survey, and the Department of Health has some interest in it, but not exclusively so. Again, that is being considered, so I cannot give a definitive answer as to what will happen.
Many hon. Members, including the hon. Member for Leyton and Wanstead, pointed out that the last survey published by Ipsos MORI said that public satisfaction with the NHS was relatively high. That is self-evident, and I suspect that all hon. Members, as constituency MPs, will be aware of that from their constituents, their correspondence and just talking to people. As we heard, the most recent research puts overall satisfaction rates at 72%.
If we were discussing the future of any other public service, perhaps the debate would end there. However, we are not here today to discuss other public services, such as local bus services or rubbish collections, vital as they are. We are here to discuss the national health service, which for the public is literally a matter of life and death, and they have a high regard for it. People expect the NHS to be there when they are at their most vulnerable, or when their family members are in greatest need.
One cannot quantify what the NHS means to the people of this country with a smattering of national statistics, however comforting they might seem. The public have never been over-inclined to set great store by the pronouncements of politicians about the brilliance of the NHS, however familiar such pronouncements might be. However, people do not live their lives through the monochrome of MORI’s painstaking statistical analyses. They do not judge the NHS on the numbers. They judge the NHS on their experience of it; it is the NHS staff that they meet, and what they say and do, that ultimately informs their opinion.
The fact that satisfaction rates are relatively high is without doubt a tribute to the fact that those staff treat thousands of patients every day. I am sure that Members on both sides of the Chamber are united in their admiration for the work of staff across the board, and we should congratulate them on doing it day in, day out, when looking after our constituents, ourselves and our families. They do a fantastic job. We should never forget that we owe them a debt of honour and gratitude.
Mr Burns
No. If the hon. Gentleman will forgive me, I do not have much time.
We should not kid ourselves that that is the whole story. Although some may be only too content with the fact that three quarters of people are happy with the NHS, I am not. High levels of public satisfaction are a genuine compliment to the work of NHS staff, but they do not undermine the case for modernisation or imply that the NHS is perfect or should never change. There is plenty of room for improvement, building on the high satisfaction rates that we already enjoy, as shown by the various surveys mentioned today.
The House will know that although the money going into the NHS has dramatically increased over the last decade, which I welcome, productivity has not. In fact, it has fallen by 0.2% every year since 1997. In hospitals, it has fallen further—by 1.4% a year between 1997 and 2008. However, such statistics can sound quite abstract. We should think about what they actually mean for patients.
Some of the targets and incentives in the current system are simply perverse; far from promoting good-quality care, they encourage poor care. Take maternity services. With antenatal care, the more visits or scans providers can record, the more they are paid. It is in the financial interests of the hospital to provide care on a purely reactive basis, dealing with problems as they arise, rather than preventing them from happening.
The result is poorer health outcomes for the mother and child and a bigger bill for the taxpayer. No midwife or doctor would ever organise the system in such a way. No doctor or nurse working in acute care would design a system in which a hospital would be paid for a mistake rather than be penalised for it. For example, would they pay if a patient were discharged from hospital only to be bounced back into A and E a week or so later because they were not properly treated? No health professional would choose to work in an environment in which they and their colleagues are rewarded not for how well they treat patients, but for how well they process them through the health system.
Hon. Members claim that there is no rationale for our reforms, but they are wrong. I do not claim that the NHS is failing; there is much that is good about it, and much of what it does is internationally acclaimed. None the less, if hon. Members were honest they would accept that there is room for improvement, as was shown by the Ipsos MORI poll.
I do not think that it is right that pensioners over the age of 75 in the primary care trust that serves the constituency of the hon. Member for Leyton and Wanstead are almost twice as likely to be admitted to hospital in an emergency than those over the age of 75 in Devon or Cornwall. I do not think that it is right that, in some parts of the country, people are more than five times more likely to die of heart disease.
In its current form, the NHS cannot hope to cope with the rising demand from our ageing population and the relentless rise in the cost of drugs and treatment. Our health system is no longer battling with infectious disease. The typical patient is not a young man with TB or polio, as it might have been in the 1940s, but someone who is over 75 with probably two, if not more, long-term conditions and social care needs, too. It is a very different problem that requires a very different kind of health service.
Even more importantly, as a nation, we should be aspiring to be as healthy and to live as long as our European neighbours. A recent OECD report found that, if the NHS were to perform as well as the best-performing health systems, we could increase life expectancy by three years. The argument for change could not be clearer.
The ultimate objective of modernisation is to ensure that the quality of care that people receive is on a par with the best available anywhere in the world. To do that, we need to make fundamental changes to the NHS. For example, we need to ensure that it is the GP and not a manager or civil servant in Whitehall who determines the needs and requirements of their patients. A radical extension of patient choice would allow patients to choose not only where they are treated, but which consultant-led team will treat them. Patients could choose their GP and even, where appropriate, their treatment.
There should be greater accountability and transparency in the NHS to give patients the information that they need to make choices and to drive up quality. As the Society for Cardiothoracic Surgery said only last week, publicly reporting on the performance of hospitals and surgeons treating patients with heart disease can improve mortality rates by 50%.
There should also be more independence and freedom for clinicians, so that if local health and social care professionals think that they can deliver better services to support stroke patients, they can set up a social enterprise that will do that. We will give genuine freedom to foundation trusts, so that they can strive to provide the best possible outcomes for patients.
In conclusion, there have been a lot of disingenuous statements about privatisation of the health service and the quality of care. If hon. Members are prepared to listen, I will assure them that we have no intention of privatising the health service. We just want to improve patient care.
Cheshunt Urgent Care Centre
Simon Burns Excerpts(13 years, 1 month ago)
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The Minister of State, Department of Health (Mr Simon Burns)
I begin by congratulating my hon. Friend the Member for Broxbourne (Mr Walker) on securing what is a very important debate for him and his constituents. I commend him for the commitment that he has shown, as illustrated during his high-powered speech, in campaigning on health issues for his constituents to ensure that they get first-class, quality care. I also take this opportunity to recognise the hard work and dedication shown by NHS staff in his constituency. Their dedication, expertise and drive do so much to improve the health and well-being of his and other hon. Members’ constituents on a daily basis. This Government will support and empower them to provide his constituents with health outcomes that are consistently among the very best in the world.
As part of the Government’s commitment to the NHS, we are consistently increasing the amount of money we provide to local organisations. Total revenue investment in the NHS in 2011-12 will grow to more than £102 billion. The allocations announced on 15 December will provide primary care trusts with £89 billion to spend on the local front-line services that matter most. That is an overall increase of £2.6 billion, or 3%. Of that, Hertfordshire PCT will receive £1.7 billion—a cash increase of £47.7 million, or 2.9%.
Before turning to the specific issue of the Cheshunt urgent care centre, I will set out the context of our plans to modernise the NHS and bring considerable improvements to the health care experienced by my hon. Friend’s constituents. We believe that local NHS services should be centred around the patient, led by local clinicians and free from political interference, either from this House or from the various levels of NHS bureaucracy. To this purpose, we have set out our proposals to liberate the NHS from central control. We will set front-line professionals free to innovate and to make decisions based on their clinical judgment and the needs of their patients, with the sole aim of improving the quality of care given and the outcomes achieved.
Responsibility for budgets and commissioning care will transfer from managers within the PCTs to clinicians in general practice-led consortia. Patients will receive health care that is tailored to their community and their personal circumstances. Our plans will radically simplify the NHS. Two layers of management—strategic health authorities and PCTs—will no longer be necessary. We anticipate a one-third reduction in administration costs, saving the NHS £5 billion by the next election and £1.7 billion in every year after that. Every single penny of those billions of pounds will be reinvested in front-line services.
There are now 177 pathfinder consortia across England, covering 35 million people—more than two thirds of the population. Those consortia are taking a lead in rejuvenating local services, cutting out waste and putting the needs of patients before the needs of the system. There are now three pathfinder consortia in Hertfordshire. The East and North Hertfordshire GP commissioning consortium covers part of my hon. Friend’s constituency.
Clinical leadership will go hand in hand with greater local democratic accountability. Under “any willing provider”, an increasing number of independent sector and social enterprise organisations will deliver NHS services. Unlike now, local authorities will have the power to scrutinise all providers of NHS-funded services. Local authorities will be able to require the provider to present information and to appear at scrutiny meetings to hold them to account.
Already, 143 local authorities—almost 90% of those in England—have signed up to be health and wellbeing board early implementers, including Hertfordshire county council. The make-up of health and wellbeing boards will be left to their own discretion, but will include representatives of GP consortia, directors of public health, adult and children’s services, representatives of HealthWatch, representatives of the NHS commissioning board and locally elected councillors. As well as preparing a joint strategic needs assessment, they will have to draw up a strategy to deliver the requirements set out in that assessment. In short, health and wellbeing boards will promote integrated working across the NHS, public health and social care, and will hold NHS services to account. That will lead to better, more accountable services for local people.
The Government are clear that in a patient-led NHS, any changes to services must begin and end with what patients and local communities want and need. Until the new system is in place, we expect PCTs to follow best practice in ensuring that local communities are fully engaged in such decisions. When it comes to urgent care, it is vital that local services are coherent and easily accessible around the clock. However, we have again been clear that decisions on the form that they should take are best made locally, in the light of local needs.
In the Broxbourne area, there are 12 GP surgeries, four of which are in Cheshunt. The area also has an out-of-hours GP service provided by Herts Urgent Care, based at the Cheshunt community hospital. The community hospital also provides out-patient clinics and a range of community services. There are 22 pharmacies in the borough, nine of which are in Cheshunt and one of which opens for extended hours.
On the specific matters that my hon. Friend raised regarding the Cheshunt urgent care centre, I understand that in 2007, the former two Hertfordshire PCTs, in partnership with the two Hertfordshire acute trusts, held public consultations on a health strategy, “Delivering quality healthcare for Hertfordshire”. The strategy was intended to improve access to urgent care services in Hertfordshire, so that people with urgent but not life-threatening conditions could be redirected from hospital accident and emergency departments to receive more appropriate treatment more quickly and closer to home.
In response to the public consultation, the PCTs agreed to piloting urgent care centres at both Cheshunt and Hertford, on the basis that they would be evaluated before longer-term decisions were made about their future. It is crucial to remember that they were pilot schemes, and it was always understood that after a period of time had passed, so that experience could be gained, they would be evaluated before those longer-term decisions were taken.
The urgent care centres were established as part of a 12-month pilot project between January and December 2010, with the specific objective of relieving pressure on local accident and emergency services. The primary purpose and objective was to reduce the number of patients seen at A and E by 20,000 a year, by providing local people with direct access to urgent care centres. The purpose of those centres is to see and treat people with urgent, but not life-threatening, illnesses such as sprains, strains, broken bones, and minor burns and scalds in a local community setting, allowing A and E departments to concentrate on life-threatening emergencies.
Hertfordshire PCT commissioned an independent research organisation, Opinion Research Services, to evaluate the success of the pilot centres at Cheshunt and Hertford, the latter in the constituency of my hon. Friend the Member for Hertford and Stortford (Mr Prisk). I understand that during the evaluation process, the views of the general public, NHS staff and local GPs were taken into account. Evidence was then submitted to an evaluation panel consisting of local GPs, local councillors, staff from local authorities and representatives of the PCT.
When the evaluation panel met on 17 January this year, it came to the unanimous view that urgent care centres were not achieving their aim of diverting significant numbers of patients from A and E. I remind the House that that, of course, was the primary purpose of the pilot scheme when it was started at the beginning of January 2010. Instead, considerable numbers of those using the urgent care service were seeking advice and treatment usually provided by GPs, for conditions such as raised temperatures, sore throats and headaches. It was never the intention that the urgent care centres would have a primary care focus. They were established to relieve pressure on local A and E services and to treat people with urgent but not life-threatening illnesses.
The evaluation panel recommended that the pilot centres should not continue in their current format. Instead, it recommended that the PCT should consider recommissioning activity through one or two minor injuries units. It also recommended that the PCT consider how it could improve access to high-quality primary care, to compensate for the loss of the urgent care centre.
As my hon. Friend the Member for Broxbourne is aware, Hertfordshire PCT published its board papers on the issue on 18 March. I understand that the PCT met earlier today to consider the recommendations and has decided to uphold them and not recommission the urgent care centres in their current form. Instead, it will consider recommissioning a minor injuries unit at Cheshunt.
I accept, as my hon. Friend made clear, that the Cheshunt urgent care centre is well regarded by local people. However, the provision of services is a matter for the local NHS. As he understands, it is not for Ministers to interfere and micromanage the day-to-day business of the NHS.
My hon. Friend mentioned access to general practitioners in the Cheshunt area. To reiterate what he said, the evaluation panel recommends that the PCT considers how it can improve access to high-quality primary care to compensate for the loss of the Cheshunt urgent care centre. The PCT has upheld that recommendation. I understand that the PCT has a programme of measures to improve access to general practice, to which he referred. I am sure he will agree that it is important to pursue and achieve that.
Mr Burns
My hon. Friend makes an extremely valid point. It is sad that only in the last few months have this Government been able to come to grips with some of the previous Government’s failings in making the local health service more accountable to the needs, wishes and requirements of local people. He and I will be totally in agreement on that. That is why I believe that the core of our health service modernisation programme— putting patients at the heart of the delivery of care—is so important. I am sure that he and I agree that that is an appealing principle from which to work.
As my hon. Friend said, the PCT has established a funding initiative for GP practices to support the Improving Access programme, which includes funding for new telephone systems, improved appointments and check-in systems, and medical equipment. The programme continues to be a key area of work for PCT staff, who will work closely with GPs to ensure that it is implemented, and that local people see improvements.
I have been advised—I hope this reassures my hon. Friend—that the latest GP patient survey results show that four GP surgeries in his constituency scored 91% or above in terms of satisfaction with care. Two of those practices—the Cromwell medical centre, which achieved a 92% rating, and the Warden Lodge medical practice, which achieved 93%—are in the Cheshunt area.
I am assured that the PCT will hold discussions with East and North Hertfordshire GP consortium and involve it fully as it conducts that further investigation. I am also assured that the PCT will have conversations with the public and other stakeholders, including my hon. Friend if he wishes, to gain further understanding of the needs of the local population, and to explain to potential users of the services what a minor injuries unit can provide. In addition, I am advised that the PCT will strengthen its performance management of GP practices to address the problems that some local people have experienced. I fully understand my hon. Friend’s concerns, but the board has decided that the PCT needs to explore further the possibilities of setting up a minor injuries unit. I understand that the PCT will test the feasibility of the new unit with providers.
Question put and agreed to.
Oral Answers to Questions
Simon Burns Excerpts(13 years, 2 months ago)
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Tony Lloyd (Manchester Central) (Lab)
11. What recent representations he has received on his proposed reforms of the NHS.
The Minister of State, Department of Health (Mr Simon Burns)
The Government received more than 6,000 responses to the White Paper consultations. As a result, we have significantly strengthened both our approach to implementation and our proposals in the Health and Social Care Bill. We continue to engage widely across the health sector on our modernisation plans.
Mr Hepburn
Is not it only a Tory Government who can bring a system into the NHS whereby doctors get paid more for giving less treatment to their patients? What does the Minister have to say to the chairman of the BMA’s GP committee, who described the plans for the quality premium as “appallingly unethical”?
Tony Lloyd
The Minister will know that a concern about the Government’s health policies is the increased role for the private sector. He will also be aware that at the Christie hospital in Manchester 150 jobs have been transferred from the NHS to the private contractor on that site. Will he give the people of the north-west an absolute guarantee that we will not have twin-track cancer treatment at Christie’s and that there will not be a fast track for the private patient and a slow track for those on the national health?
Mr Burns
I can categorically give that assurance to the hon. Gentleman, because there is no two-track system. Where the private sector may provide care, it is to help to raise standards. I imagine he would agree with that, because he fought the general election on this manifesto commitment:
“Patients requiring elective care will have the right…to choose from any provider who meets NHS standards of quality at”
the NHS level.
Mr Stephen Dorrell (Charnwood) (Con)
Will my right hon. Friend tell the House how many representations the Government have received arguing the case in favour of the PCTs in the structure that we inherited at last year’s general election? If, as I suspect, the answer to that question is not very many, is that not because there was a shared commitment between this Government and the previous Government to introduce genuine clinical engagement to the commissioning process?
Mr Burns
I am grateful to my right hon. Friend for that question. I can go a little further and say that, to the best of my knowledge, we received no representations to keep the PCTs. He is right when he talks about what the previous Government were seeking to do, and we want commissioning to go to the local level—to GP commissioners, who have the best knowledge of the needs of their patients. The fact that we have so many pathfinders shows that GPs are signing up voluntarily, with enthusiasm, to take part in the scheme.
Jason McCartney (Colne Valley) (Con)
A consultation is under way on the reconfiguration of children’s heart surgery units. Last week, a number of colleagues from both sides of the House met a number of parents who are campaigning to keep the unit at Leeds general infirmary. Will my right hon. Friend confirm when he will announce his preferred option and what processes will be gone through to reach that decision?
Mr Burns
I am grateful to my hon. Friend, who was present at last Thursday’s Adjournment debate. He will know that the proposals, the options put together and the consultation, which we have just begun, have been organised at arm’s length from Ministers by the joint committee of PCTs. As I said on Thursday, I trust that he will forgive me if I say that it would be totally inappropriate for me to comment, because that might be seen as trying to influence or prejudge the ultimate outcome.
Liz Kendall (Leicester West) (Lab)
Before the election, the Secretary of State went up and down the country promising that his NHS reforms would save local A and E and maternity services, but on 1 March, during consideration in Committee of the Health and Social Care Bill, when I asked the Minister whether London’s A and E departments would be on the safe list of designated services that will not close, he said that
“I suspect the answer is that no…it will not be a designated service…there is a significant number of A and E services in London. There would not be a need to designate them”.––[Official Report, Health and Social Care Public Bill Committee, 1 March 2011; c. 349.]
Will the Minister now give the House a clear and simple answer to a simple question: will every London A and E remain open under this Government—yes or no?
Mr Burns
Mr Speaker, if you had had the opportunity to read the exchange in Committee, you would understand that the hon. Lady’s question is not factually correct. She asked me figuratively what would happen in an urban area as compared with a rural area, and as I explained three times during further interventions from her, my answer was illustrative, not definitive, because that would have been premature. She is trying to scaremonger—causing fear with something that she knows is inherently not true.
Andrew Rosindell (Romford) (Con)
4. What recent steps his Department has taken to reduce the incidence of MRSA and clostridium difficile in hospitals.
The Minister of State, Department of Health (Mr Simon Burns)
This Government have made it clear that the NHS must adopt a zero-tolerance approach to health care-associated infections. We reinforced this in the “NHS Operating Framework 2011-12”, requiring the NHS to prioritise delivery of the MRSA and the new C. difficile objectives. In 2009-10 C. difficile infections decreased by 29% and MRSA decreased by 35% on the previous year.
Andrew Rosindell
I thank the Minister for his reply, but will he tell me specifically what action the Government are taking to deal with MRSA and C. diff, particularly in the Queen’s hospital in Romford and throughout the Barking, Havering and Redbridge NHS Trust? Will he assure the House that any such case will be made public by the hospital trust and not kept quiet?
Mr Burns
I can assure my hon. Friend that the performance at his trust on health care-associated infections is unacceptable. We have set demanding objectives for reducing both those infections. In 2011-12, his trust’s MRSA objective requires a reduction of 58%, one of the highest reductions in the country. Its C. difficile objective requires it to deliver a 24% reduction. The consequence of non-achievement is an option to withhold part of the contract payments, and I can categorically assure my hon. Friend that there is no question of keeping this information or developments secret. We require weekly publication of figures.
Mr Jamie Reed (Copeland) (Lab)
As the Secretary of State knows, the north Cumbrian health economy is in crisis. GP commissioning is providing £30 million less for acute hospital services in north Cumbria this year than it did last year. This has resulted in the trust being unable to seek foundation trust status, and it is seeking a merger which minutes leaked to me by consultants say could lead to the closure of the West Cumberland hospital. Will the Secretary of State meet me as a matter of urgency so that we can collectively find how we can get the hospital out of that hole? Will he also consider a delay to foundation trust status to give the hospital trust more time to get back on its feet?
Mr Speaker
I am grateful to the Minister of State. My sense is that the hon. Member for Copeland (Mr Reed) is seeking a meeting. The Minister is perfectly at liberty to say more if he wishes, or if he does not think it is worth it, he does not have to do so.
Mr Speaker
Wise owl is the kindest description that the hon. Gentleman has ever offered of me. I shall take it that he means it. It’s the best I’ll get.
Alex Cunningham (Stockton North) (Lab)
16. What estimate he has made of the average amount of time per week GPs will allocate to the administration of commissioning consortia under his proposals for NHS reform.
The Minister of State, Department of Health (Mr Simon Burns)
We anticipate that GPs will focus on the aspects of commissioning that will benefit most from their clinical expertise and understanding of patients’ needs. Only a minority of clinicians will play a hands-on, executive role in consortia. Moreover, they will be able to secure support services to assist with their administrative and commissioning duties.
Alex Cunningham
At present, GPs are able to spend only about eight or nine minutes on average with each patient. How can the Secretary of State expect GPs to be meaningfully engaged in commissioning when, unlike him, they are putting patients first?
Mr Burns
Unlike the hon. Gentleman, my right hon. Friend the Secretary of State actually understands the situation. It is not true that doctors see patients for only eight minutes; GPs see their patients for the length of time that they feel they should see them. The concept that GPs will have their time taken away from looking after patients to do commissioning is not right, because GPs will employ commissioners with expertise to work with them and do the commissioning for them, so that they can get on with looking after their patients.
Andrew George (St Ives) (LD)
With regard to the admin load of GPs, the Government correctly want to have better integration of health and social care. Why, therefore, are they creating GP consortia that are less coterminous with local authority boundaries than the existing primary care trusts? How will that help to deliver a better integrated health and social care system?
John Mann (Bassetlaw) (Lab)
When, oh when, will the Minister listen to the country, get his sticky mitts off the health service and stop meddling with our hospitals and doctors?
Greg Hands (Chelsea and Fulham) (Con)
18. What assessment he has made of the effect on survival rates of his Department’s cancer strategy.
John Robertson (Glasgow North West) (Lab)
T6. Following on from the question asked by my right hon. Friend the Member for Wentworth and Dearne (John Healey) on the £2 billion that the Secretary of State is using for his top-down reorganisation, does the Minister feel that that kind of money, which was not mentioned in the Conservative manifesto, would be better spent on health care and on building new hospitals?
The Minister of State, Department of Health (Mr Simon Burns)
May I tell the hon. Gentleman that his figures are wrong? The cost of the modernisation of the NHS is £1.4 billion by 2012-13. That will be recouped in savings that by the end of this Parliament will be £1.7 billion a year, every year till the end of the decade, of which every single penny will be reinvested in front-line services and for patients.
Ian Swales (Redcar) (LD)
T5. A new primary care hospital opened in Redcar at the end of 2009. So far, the endoscopy unit and the two operating theatres are completely unused, and a state-of-the-art hydrotherapy pool has hardly been used. Will the Minister meet me to discuss that commissioning failure and to see how we can bring those facilities into use for the local community?
Mr Burns
I understand that the PCT will continue to work with health care providers to develop existing and future services at Redcar primary care hospital, and to promote the availability of services, but I would be more than delighted to meet the hon. Gentleman to discuss that issue.
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?
National Health Service Charges
Simon Burns Excerpts(13 years, 2 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Minister of State, Department of Health (Mr Simon Burns)
Regulations have been laid before Parliament to increase certain national health service charges in England from 1 April 2011.
There will be an increase in the prescription charge of 20p from £7.20 to £7.40 for each quantity of a drug or appliance dispensed.
The cost of a prescription prepayment certificate (PPC) will rise to £29.10 for a three-month certificate. The cost of the annual certificate will remain at £104. PPCs offer savings for those needing four or more items in three months or more than 14 items in one year.
Regulations have also been laid to increase NHS dental charges from 1 April 2011. The dental charge payable for a band 1 course of treatment will increase by 50p from £16.50 to £17. The dental charge for a band 2 course of treatment will increase by £1.40 from £45.60 to £47. The charge for a band 3 course of treatment will increase by £6 from £198 to £204.
Dental charges represent an important contribution to the overall cost of dental services. The exact amount raised will be dependent upon the level and type of primary dental care services commissioned by primary care trusts and the proportion of charge-paying patients who attend dentists and the level of treatment they require.
Charges for elastic stockings and tights, wigs and fabric supports supplied by hospitals will be also be increased.
The range of NHS optical vouchers available to children, people on low incomes and individuals with complex sight problems to help with the purchase of glasses remains unchanged in 2011-12.
Details of the revised charges are as follows:
New Charge (£) | |
|---|---|
Prescription charges | |
Single item | 7.40 |
3-month PPC | 29.10 |
12-month PPC | 104.00 |
Wigs and Fabric Supports | |
Surgical brassiere | 25.10 |
Abdominal or spinal support | 37.90 |
Stock modacrylic wig | 61.85 |
Partial human hair wig | 163.80 |
Full bespoke human hair wig | 239.65 |
Dental Charges | |
Band 1 course of treatment | 17.00 |
Band 2 course of treatment | 47.00 |
Band 3 course of treatment | 204.00 |
Voucher values continue at the rates effective since 1 April 2009, which are:
Type of optical appliance | Value |
|---|---|
A. Glasses with single vision lenses: spherical power of ≤ 6 dioptres, cylindrical power of ≤ 2 dioptres. | £36.20 |
B. Glasses with single vision lenses: spherical power of > 6 dioptres but < 10 dioptres, cylindrical power of ≤ 6 dioptres; spherical power of < 10 dioptres, cylindrical power of > 2 dioptres but ≤ 6 dioptres. | £55.10 |
C. Glasses with single vision lenses: spherical power of ≥ 10 dioptres but ≤ 14 dioptres, cylindrical power of ≤ 6 dioptres. | £80.60 |
D. Glasses with single vision lenses: spherical power of > 14 dioptres with any cylindrical power; cylindrical power of > 6 dioptres with any spherical power. | £182.00 |
E. Glasses with bifocal lenses: spherical power of ≤ 6 dioptres, cylindrical power of ≤ 2 dioptres. | £62.70 |
F. Glasses with bifocal lenses: spherical power of > 6 dioptres but < 10 dioptres, cylindrical power of < 6 dioptres; spherical power of < 10 dioptres, cylindrical power of > 2 dioptres but ≤ 6 dioptres. | £79.70 |
G. Glasses with bifocal lenses: spherical power of ≥ 10 dioptres but ≤ 14 dioptres, cylindrical power of ≤ 6 dioptres. | £103.30 |
H. Glasses with prism-controlled bifocal lenses of any power or with bifocal lenses: spherical power of > 14 dioptres with any cylindrical power; cylindrical power of > 6 dioptres with any spherical power. | £200.10 |
I. (HES) Glasses not falling within any of paragraphs A to H above for which a prescription is given in consequence of a testing of sight by an NHS Trust. | £186.40 |
Children's Heart Surgery (Leeds)
Simon Burns Excerpts(13 years, 2 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Minister of State, Department of Health (Mr Simon Burns)
I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on securing this important debate. It is a strong reflection of hon. Members’ commitment not only to their local health service but to the Leeds hospital and its facilities and services that so many are present. I am particularly pleased to see my hon. Friends the Members for Harrogate and Knaresborough (Andrew Jones), for Elmet and Rothwell (Alec Shelbrooke), for Skipton and Ripon (Julian Smith), for York Outer (Julian Sturdy) and for Calder Valley (Craig Whittaker). I am also pleased to have heard from the right hon. Member for Leeds Central (Hilary Benn) and to see the hon. Member for Scunthorpe (Nic Dakin) here. Their presence reinforces their commitment to their local health service and the facilities in the local hospital.
Let me take this opportunity to pay tribute to the dedicated NHS staff who work in children’s heart services in Leeds and across the country. They do a fantastic job for which we are all incredibly grateful.
As I know my hon. Friends and Opposition Members will appreciate, this is a complex and, understandably, highly emotive area, but it is worth reminding ourselves of the genesis of this review. For years, experts in the field, including professionals and national children’s charities, have urged the NHS to review services for children with congenital heart disease.
Although there has been no specific problem, concerns have been raised about the risks posed by the unsustainable and sub-optimal nature of smaller surgical centres. Experts agree that, with small centres, there are issues with the recruitment and retention of surgeons and that there is a risk that those who are recruited find themselves working in isolation in units that are not up to date with modern techniques and clinical practice. Smaller centres struggle to train and mentor junior surgeons, making such units less attractive to the surgeons of tomorrow.
The provision of children’s heart surgery has been a cause of concern since the Bristol inquiry in the late 1980s. Understandably, there has been considerable pressure from national parent groups to ensure that children receive the best treatment. The Monro report in 2003 set out standards of care and pointed to the need for reconfiguration to concentrate expertise. That need has become ever-more pressing with the increasing complexity of treatment.
In the light of clinical concern in June 2006, Roger Boyle, the national clinical director for heart disease and stroke, and Sheila Shribman, the national clinical director for children, young people and maternity, chaired a consensus workshop of service providers, specialised service commissioners and relevant parent groups. The unanimous view was that there should be fewer, larger centres of excellence. The workshop concluded that the current service configuration was not sustainable and that a long-term national view of how services might be reorganised should be developed.
In 2008, the NHS medical director, Sir Bruce Keogh —a heart surgeon—asked the national specialised commissioning group to explore how the reconfiguration of children’s heart surgery services in England could improve the sustainability of the current service and lead to better clinical outcomes for children. The national review, known as “Safe and Sustainable”, aims to ensure that children’s heart services deliver the highest standard of care regardless of where patients live or which hospital provides the care.
I must emphasise that the review is clinically-led and that both it and the case for change are supported by parent and patient groups and by clinicians working in the service and their professional associations, including the Children’s Heart Federation, the British Heart Foundation, the Royal College of Surgeons, the Royal College of Paediatrics and Child Health, the Royal College of Nursing, the British Congenital Cardiac Association and the Society for Cardiothoracic Surgery in Great Britain.
Julian Smith
Does the Minister agree that, as well as the importance of the clinical need, distance is vital and that the points made in the debate for this most rural and sparsely populated area of our country must be taken into account in the decision?
Mr Burns
Distance is one of a number of factors that, of course, will be considered by those people who are involved in the consultation process, although I advise my hon. Friend that some of the organisations involved in such medicine have certainly told me—I have met some of them personally—that many parents think not so much about the distance that must be travelled as about getting the best treatment for their children. They are prepared to travel further to secure that fine treatment for their children than we may think from what our constituents who want to have district general hospital treatments tell us. The question of distance must be put into perspective, and it is not an overriding factor that secures any decision one way or another solely on that basis.
Nic Dakin (Scunthorpe) (Lab)
I recognise what the Minister says about distance. Parents want good outcomes for their children—that is why parents in Scunthorpe travel to Leeds—but distance can have an impact on clinical outcomes. Certainly, when the weather was terribly bad around Christmas time, the distance to travel to get good clinical outcomes made a difference. Distance and clinical outcomes are related.
Mr Burns
I am grateful to the hon. Gentleman for his intervention, which in many ways reflects that made by my hon. Friend the Member for Skipton and Ripon. I was making a simple, factual point about the view of many parents at present. As a Minister, it is certainly not for me to interpret and give a view on that, because, as will become apparent later in my remarks, the consultation is being done by others. It would be totally inappropriate for me, as a Minister, to seek to interfere, prejudge or prejudice any outcome of the consultation process. I hope that both my hon. Friend and the hon. Gentleman will appreciate the position that I am in in, that respect.
The review wants to ensure that as much non-surgical care is delivered as close to the child’s home as possible through the development of local congenital heart networks. The joint committee of primary care trusts agreed the shortlist of four options for the future of children’s heart surgery on 16 February 2011. The committee was set up as the formal consulting body for the review and to take decisions on the issues arising from it. My hon. Friend the Member for Pudsey will know that Leeds general infirmary is included in one of the shortlisted options that went out to consultation on 1 March, and the consultation will continue right through until 1 July. There are also public events taking place during the four-month consultation, and there is one in Leeds on 10 May at the Royal Armouries museum. I urge all hon. Members and as many individuals, not only in the local community, but those interested in the services that Leeds provides for patients, to attend.
I want to pick up on the point that my hon. Friend made about inaccuracies in Sir Ian Kennedy’s report. In response to the safe and sustainable interim report last summer, the report’s team received correspondence from the trust about concerns on inaccuracies. The team thought that they had addressed those in the final report in December, and I can only assume that that information is correct, because the trust has made no further approach to the team on the concerns about the information in the final report. I hope that that clears up the problems identified between the interim report and the final report in December.
I also want to emphasise that no decision has been made on which centres should continue to undertake surgery. That will be decided only after the responses to the consultation have been properly and fully considered. I give that assurance to hon. Members today. It is also important to recognise that the safe and sustainable review is only one element of a larger NHS review of congenital cardiac services in England. The NHS is also reviewing the provision of services for adults with congenital heart disease, and I understand that the designation process to determine where the adult services will take place will start later this year.
There are powerful clinical reasons driving the review. The trend in children’s heart care is towards increasingly complex surgery on ever smaller babies. This requires working in surgical teams large enough to provide sufficient exposure to complex cases so that surgeons and their teams can maintain and develop their specialised skills. Larger teams also provide the capacity to train and mentor the next generation of surgeons and other staff.
Hilary Benn
Does that not strengthen the argument for looking at centres where there is co-location of services, because, as the Minister will recognise, a sick child with a cardiac condition might have a bowel obstruction, for example, and the ability to call on a skilled surgical colleague straight away to deal with that on the same site is a powerful argument for retaining the unit at Leeds, where co-location of services is found?
Mr Burns
I am very grateful to the right hon. Gentleman for making that point. He puts me in a slightly difficult position, because I genuinely do not want to be unhelpful. A consultation is ongoing through the joint committee of primary care trusts, however, and it would be totally inappropriate to start debating the rights and wrongs, the pluses and the minuses, of any one individual hospital or centre. It would be inappropriate—it might be construed as trying to influence, pre-judge or prejudice the consultation process—and I am sure that the right hon. Gentleman agrees wholeheartedly that it would be totally unacceptable for Ministers to start getting involved in that way. I hope he will accept that, for the best of intentions, it would be inappropriate for me to start debating that issue with him, however right or wrong he might be. I can tell him, none the less, that he has ample opportunity during the consultation process to make those very points to the JCPCT.
Stuart Andrew
I understand that, before the consultation document came out, one member of the steering committee gave her personal view of which unit should stay open. Does the Minister not agree that that might give some cause for concern?
Mr Burns
My hon. Friend is pushing me and tempting me, but I shall be up front and straightforward: I am unaware of that situation, and it would be unwise of me to start commenting on something that I do not know the background to or—if the conversation was had or the statement made—the circumstances of it. I hope he will forgive me if I do not go down that path.
Andrew Jones (Harrogate and Knaresborough) (Con)
I thank the Minister for giving way, because I know that he wants to make progress.
As part of the process, may I ask that the support facilities for families will be considered, because, at a time when one is dealing with sick children, families are under very great pressure? There is a new facility at LGI, Eckersley house, which has been in existence for a while, but it has moved to a new location and opened only last year. It provides 22 rooms for families to stay in while visiting sick children, it is a key part of the broader provision of support that is necessary and I know that it will be a very welcome development for families.
Mr Burns
I am very grateful to my hon. Friend for mentioning that facility, which I have no doubt is not only welcome but extremely helpful to families, particularly at a very difficult time in their lives. Again, it would be inappropriate for a Minister, in a top-down way, to start decreeing what should or should not happen; I believe that decisions about such services and facilities must be taken locally. I am sure, however, that the relevant authorities will not only learn of my hon. Friend’s contribution, but no doubt benefit from his expertise in lobbying them to ensure that the service continues.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Will the Minister take a very quick view from the Opposition Benches? We are old friends.
Mr Sheerman
Some of us were rather caught short, because we did not realise that the debate would start so early. For someone who lives in Huddersfield with a child who needs specialist care, the common sense consideration seems to be accessibility. Why do we not get more specialists in Leeds, so that we can access the vast population in our parts of Yorkshire and Lancashire?
Mr Burns
The hon. Gentleman is a very experienced parliamentarian, and I do not say this in any rude way, but he was not present when his right hon. Friend the Member for Leeds Central spoke. That is not a criticism, but I shall make to the hon. Gentleman the same point that I made to his right hon. Friend: the consultation process and review is being carried out not by Ministers and politicians, but by the JCPCT. As we are engaged in the consultation process, it would be inappropriate and wrong of me to pontificate from this Dispatch Box on the merits or demerits of one case or another. I hope that the hon. Gentleman will accept that that is meant to be a helpful reply, even if it is not the answer that he was seeking. [Interruption.] Fair enough. I am not criticising; I just want him to understand the position that I am in, because I do not want—[Interruption.]
Mr Deputy Speaker (Mr Nigel Evans)
Order. We cannot have chit-chat across the Chamber in this way.
Mr Burns
Thank you, Mr Deputy Speaker. [Interruption.] The hon. Gentleman is indeed being nice to me, and I appreciate it.
As I was saying, smaller surgical units often struggle to recruit and retain new surgeons. They also find it difficult to provide a safe service around the clock.
Under the auspices of the review, an expert group has developed a comprehensive set of service standards, taking into account the contributions of parents and professionals. The standards cover the whole of children’s heart services. They also reference other relevant professional standards and guidance, including the co-location of other clinical services that are interdependent with children's heart surgical services, the need for larger surgical teams to be able to provide a 24/7 emergency service, and the development of clinical networks of providers to ensure a coherent service for children and their families. I think that in some ways that picks up on the point made by my hon. Friend the Member for Pudsey. The current centres have been visited and assessed against these standards by an independent expert panel.
I would like to go into a little more detail on a few of these standards to clarify areas which cause particular concern. On the standard on the number of procedures and surgeons, I can assure my hon. Friends and Opposition Members that there is convincing evidence from this country and overseas that larger centres, seeing more cases, are better able to consolidate their expertise and deliver better clinical outcomes. The recommendation on the number of procedures—between 400 and 500 a year—is based on the level of activity needed to provide good-quality care around the clock while enabling ongoing training and mentoring of new surgeons. This recommendation is based on the outcome of international research on minimum numbers of procedures in surgical centres. It has strong professional support in this country, including from the steering group of professional experts that was convened under the auspices of this review. In addition, there is a consensus among professional associations on minimum staffing levels that four surgeons in each centre should avoid the risk of surgeons not being able to maintain and develop their skills.
At this point, I would like to pay tribute to the commitment and dedication by talented NHS staff delivering congenital cardiac services. We have a responsibility to ensure they are supported as well as possible, and that includes ensuring that they do not risk burn-out if left to practise alone. Transforming a service from one that is “adequate” to one that is “optimal” requires sufficient volume, expertise and experience to develop what Sir Bruce Keogh calls “accomplished teams”.
Co-location, which I mentioned earlier, refers to the proximity of other critical services to the children’s heart surgery service. In this context, these services include specialised paediatric surgery; paediatric critical care; paediatric ear, nose and throat; and paediatric anaesthesia. The accepted definition of “co-location”—services either on the same hospital site or on a neighbouring hospital site—and which services should be co-located was set out in the 2008 publication, “Commissioning safe and sustainable specialised paediatric services: a framework of critical inter-dependencies”. This guidance is endorsed by the relevant professional associations, including the Royal College of Paediatrics and Child Health, the Royal College of Surgeons and the Royal College of Physicians. I can assure hon. Members that the safe and sustainable review has correctly applied the accepted definition of “co-location”, as set out in the guidance, as meaning either on the same hospital site or on a neighbouring hospital site.
Hilary Benn
I am grateful to the Minister for giving way again. It would be very helpful for the Members present who care about Leeds if he could clarify whether it is the case that to figure in any of the options—obviously Leeds figures in one—the units that are listed must have met the test that he has just very helpfully described to the House. If that is the position—he cannot say this, but we will—it further strengthens the case that we have been making this afternoon.
Mr Burns
I am just giving a moment’s thought to that, partly because I do not want to interfere. Probably the most helpful thing that I can do so that I do not mislead the right hon. Gentleman is to write to him shortly with a definitive response to that important question.
On the question of travel times, which has been raised in this debate, I recognise that there may be concerns that with fewer centres, people will have to travel greater distances. However, the review has consulted parents around the country, and they have said repeatedly, as I mentioned to the House earlier, that issues of quality and good clinical outcomes are paramount in the treatment of their children. The review team recognises that this is a significant issue, and I have sought and received assurances that it has been looked at extensively as part of the review process. We need to recognise that although some families will have to travel further for elective surgery, the review proposes to reduce journey times for non-surgical care by bringing assessment and follow-on care closer to home through the development of congenital heart networks. I have also been assured that all the options comply with the Paediatric Intensive Care Society standards, which have been developed by experts in the field and stipulate maximum journey times for children who require emergency retrieval by ambulance.
The review has taken account of other criteria such as a centre’s physical location in relation to others and the impact of reconfiguration on other important services, such as paediatric intensive care services and heart transplant services.
For the information of hon. Members, who I think will be interested, I will briefly answer the question of who will take the final decision. Once the public consultation has been concluded, the decision on the future number and location of surgical centres in England will be made by the joint committee of primary care trusts on behalf of local NHS commissioners. There are circumstances in which the Secretary of State for Health may be called upon for a decision. However, as we are currently in the consultation period, it would be premature to consider that further at this point.
Julian Smith
I thank the Minister for giving way yet again. Given that PCTs are in the last phase of their lives, does he agree that it is concerning that PCTs, whose eyes may not totally be on the ball, are making this critical decision?
Mr Burns
I can see where my hon. Friend is coming from and I appreciate that he may have concerns. I hope that I can give him the reassurance that he seeks. I do not think that PCTs are in a situation where they have not got their eyes completely on the ball. First, from all the evidence that I see, day in, day out, of the work of PCTs up and down the country, they continue to be highly professional and to do a first-class job. Secondly, the date when PCTs will cease to exist because of the modernisation of the NHS is not so close that they will not be able to fulfil their functions properly. I have every confidence in the JCPCT doing a first-class job of carrying out the consultation and reaching its conclusions in a highly professional and acceptable way. I hope that reassures my hon. Friend.
Mr Sheerman
I understand entirely where the Minister is coming from and that he must leave the matter to those with expertise. We had a similar situation in relation to maternity services in Huddersfield and the number of cases there had to be for people to be fully trained up. At the end of the day, it will always be a political decision. What if all the experts said that there could be only one unit—in London or somewhere else? Surely that would be politically unacceptable to the Minister and he would have to intervene.
Mr Burns
The hon. Gentleman is trying to tempt me to go places where I should not stray. I believe that the premise of his intervention is incorrect, and that the situation he describes will not happen, because the outcome will not be the recommendation of just one site in the whole of England.
I hope my remarks over the past few minutes have reassured the hon. Gentleman that in the lead-up to the consultation process, the drawing up of the final report and the options has been carried out by people who are very familiar with this specialised and sensitive area of medical care and with clinicians. They have come up with recommendations in which I have confidence, to be considered and consulted on. What we have to do now is use the consultation process so that everyone who has an interest, whether they are clinically qualified people in the NHS or members of the public, patients or Members of Parliament, can get across their views and arguments. In that way, the right decisions can be made at the end of the process, within the framework that I have outlined in the debate.
I reinforce the point that the review is being undertaken in response to the concerns of parents and professionals about the future capacity and capability of children’s heart services. I can give the assurance that it is a genuinely open process and the outcomes are not predetermined. The options have been arrived at by a thorough and comprehensive process that has the support and endorsement of the professional associations and national children’s charities. I thank all those involved for their time and their input into the review so far. Children deserve the best possible care, and we are determined to provide it.
Finally, I make the plea again that in this crucial matter, we have to get the finest quality care for a vulnerable group of patients—very young children. We have to ensure the best outcomes because, frankly, that is all that matters to parents when their children are suffering. I urge everyone who has an interest, a view and a contribution to make to take part in the consultation and help ensure that the right decisions are taken to achieve the aims and ambitions on which we are all united.
Question put and agreed to.
Hospital Services (Worcestershire)
Simon Burns Excerpts(13 years, 2 months ago)
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Mr Simon Burns (Chelmsford) (Con)
I congratulate my hon. Friend the Member for Redditch (Karen Lumley) on securing what she rightly describes as an important debate. May I say how pleased I am to see my hon. Friends the Members for Bromsgrove (Sajid Javid), for Worcester (Mr Walker) and for West Worcestershire (Harriett Baldwin) here today? Together with my hon. Friend the Member for Redditch, their commitment and interest in the NHS in Worcestershire is second to none. They make a fine team, fighting on behalf of their constituents for the finest health care, which, as my hon. Friend the Member for Redditch said in her closing remarks, is at the forefront of the modernisation of the NHS outlined by my right hon. Friend the Secretary of State. I am delighted to hear of my hon. Friend’s commitment not only to increasing choice for her constituents but to our modernisation programme; local decision-making will give far greater flexibility in effecting local health economies.
I take the opportunity to pay tribute to the many who work so hard to deliver high-quality NHS services in Redditch but, equally important, across Worcestershire, for the benefit of my hon. Friend’s constituents and those of the other hon. Members who represent that fine county. They do a tremendous job, and the Government will support and empower front-line staff to continue improving services like none before them.
I join my hon. Friend in welcoming the creation of the Worcestershire Health and Care NHS Trust. The new trust will manage all mental health services in Worcestershire, and all community services currently managed by the PCT’s provider arm. That can only be of benefit to the people of Worcestershire. Sarah Dugan, formerly chief executive of NHS Dudley, has been appointed as chief executive of the new trust, and the full board should be in place by the end of March. It will officially come into being on 1 July, giving it sufficient time to complete its registration with the Care Quality Commission.
The people of Worcestershire are also benefiting from the new Malvern community hospital, which, as my hon. Friend the Member for West Worcestershire said, was recently opened by the Princess Royal. The hospital brings together the expertise of nurses, physiotherapists, occupational therapists, speech and language therapists, dieticians and a Macmillan team to provide integrated, patient-centred care for patients in the community and in their homes. Providing more NHS care in that way is essential if we are to improve health outcomes while making significant efficiency savings across the health service. Frankly, outcomes are of the utmost importance to our constituents, as part of their care pathway.
My hon. Friend the Member for Redditch is concerned also about the current shortage of full-time health care professionals, which is due in part to restrictions on recruitment from outside the European Union. I appreciate that she is concerned because of the impact that the problem is having on her constituency. The Government’s policy on immigration seeks to balance the obvious benefits that people can bring to the UK while limiting additional pressures on local services such as housing and schools.
We still want the UK to benefit from the brightest and the best individuals who can contribute positively to the UK economy and to the NHS. The Department of Health is working closely with the UK Border Agency to ensure that the NHS has continued access to the best candidates, in order to provide the best quality care for NHS patients. I hope that that goes some way to reassuring my hon. Friend that we are aware of the situation and are working to find a practical solution that stays within the general philosophy and the wider scope of our immigration policy.
My hon. Friend raised a related issue—the ongoing impact of the working time directive. The Government committed themselves in the coalition agreement to limiting the application of the directive in the UK. The Department of Health and the Department for Business, Innovation and Skills are working closely together to achieve greater flexibility in the application of the directive in the NHS.
I understand that Worcestershire Acute Hospitals NHS Trust currently has 24 vacancies for middle-grade doctors in specific specialities, including emergency medicine, paediatrics and anaesthetics. That has caused the trust to rely on expensive short-term locum doctors. I agree with my hon. Friend that that is a far from ideal situation. She rightly said that if one is paying more for locum doctors it means that there is less to be reinvested in front-line services. In the current economic climate, it is crucial that we save as much money as we can from inefficiencies, or working practices that need to be improved, and that every penny of those savings is reinvested in front-line services for the benefit all of our constituents.
It is the responsibility of NHS trusts to plan and manage their demand for temporary staff in the context of local business and work force planning. Worcestershire Acute Hospitals Trust is actively looking to recruit doctors from the Europe Union; as my hon. Friend said, the trust had success recently in recruiting doctors from Poland and the Czech Republic. Eight of the 24 vacancies have thus been filled, and I assure my hon. Friend that every effort is being made to fill the rest. I totally agree that it is crucial that the trust is able to fill those placements as quickly as possible.
My hon. Friend mentioned the success of cancer care in Worcestershire, as did my hon. Friends the Members for Worcester and for West Worcestershire. Worcestershire Acute Hospitals NHS Trust has been held up by the national cancer survivorship initiative team as an example of how to run a successful prostate cancer service. It reflects extremely well on the staff of the trust that they have been able to deliver that quality of care—and received justified recognition for what they have achieved. The trust has just celebrated the first anniversary of its being declared a level 1 paediatric oncology shared-care unit, for providing better and more local care to children and families in Worcestershire. There is now a Macmillan cancer information and support centre at each of the three hospital sites. I join my hon. Friend in welcoming these developments, as it means better quality cancer services for her constituents and those of other Members.
I am glad to see that Worcestershire Acute Hospitals NHS Trust, University Hospitals Coventry and Worcestershire NHS Trust, and Warwickshire NHS Trust are working together to build a new specialist radiotherapy centre in Worcestershire. That is a subject and an interest that is close to the hearts of all Worcestershire Members, but particularly to those here today. As my hon. Friends will know, patients in Worcestershire travel in excess of a million miles every year for treatment, but by the end of 2013 the centre will mean that 95% of radiotherapy and almost all chemotherapy will be delivered within the county.
I am sure that my hon. Friends as well as the people of Worcestershire will accept that that is the right way to go, because when it is justified—it certainly is in these circumstances—care should be provided as locally as possible so as to reduce or eliminate the need for people to travel too far, especially if it is not necessary. My hon. Friends will agree, particularly for cancer care and radiotherapy, that it can be extremely upsetting, distressing and uncomfortable to people to have to travel long distances rather than being treated in the local hospital. For Worcestershire patients to have to travel in excess of a million miles every year for treatment is excessive, and I congratulate the Worcestershire trusts on coming up with such a proposal.
The trusts will work with existing cancer service providers to ensure that there is no disruption for patients who are currently receiving treatment. As my hon. Friend has said, they need to decide whether to locate the new centre at Worcestershire Royal hospital in Worcester or at the Alexandra hospital in Redditch. The local NHS will work with patient and clinical groups to make a decision as soon as possible based on the clinical and operational benefits of each site.
I understand that my hon. Friend has been encouraging the trust to locate the centre in Redditch. I suspect that my hon. Friend the Member for Worcester is doing exactly the same with regard to his constituency. I can assure my hon. Friend the Member for Redditch that her views will be taken fully into consideration when the decision is made. I hope that she is satisfied with that. She realises that it would be totally inappropriate for me to seek to interfere with the process because it must be decided locally—by local clinicians and local trusts. I am confident that a decision will be reached at the appropriate time, and I urge all my hon. Friends to have some patience because an announcement will be made in due course.
Oncology patients and diagnostics will continue at Alexandra hospital, Worcestershire Royal hospital and at Kidderminster hospital. I hope my hon. Friends will be reassured and pleased by that.
My hon. Friend also raised concerns over the impact of GP-led commissioning on local NHS services, following her recent meeting with health care professionals in Redditch. While the new commissioning arrangements will be led by GPs, they will work not in isolation, but in partnership with their clinical colleagues. When one starts to bring together clinicians from primary, secondary and community care to discuss how best to design local services, organisational distinctions quickly fall away. The conversation instead becomes one about the most appropriate pathway of care for a particular group of patients. I am pleased to say that that is already starting to happen in Worcestershire. Again, that must be the right way forward.
There are currently two pathfinder consortia in Worcestershire: South Worcestershire GP Commissioning Consortium and Wyre Forest GP Commissioning Consortium, with a third group, covering Redditch and Bromsgrove, in the pipeline.
Worcestershire Acute Hospitals NHS Trust is starting to build good relationships with these new consortia and has already had some very positive discussions with its GP colleagues. Indeed, each hospital, including the Alexandra hospital, has set up a commissioning board and is already meeting regularly with GPs. The trust’s recent restructuring has enabled its senior clinicians and management team to develop further the relationships, and individual boards are now in place at each hospital site. That will allow the hospitals to work with consortia on a regular basis and jointly to agree the most appropriate way in which to provide safe, effective, patient-centred care for the people of Worcestershire.
Whatever concerns have been voiced by local clinicians in my hon. Friend’s constituency, I hope that the practical experience of working with consortia—as opposed to working separately from them via primary care trusts—will soon change minds. Once the pathfinders have established themselves and their working practices and become more familiar with their enhanced role within the modernised NHS as laid out in our White Paper, I am confident that they will come to appreciate the system. GPs have the best knowledge of their patients’ requirements. For the vast majority of patients, their first contact with the NHS is through their GP, and GPs are best qualified to identify their needs and requirements. I am sure that as the system beds down, GPs will come to appreciate their greater independence and their proactive role. In effect, there will be a bottom-up provision of commissioning for the health care requirements of patients rather than the existing top-down procedures through the PCTs. It will be a boon not only for GP consortia in Worcestershire but throughout England as the system becomes more established.
My hon. Friend is concerned about the possible impact on the Alexandra hospital of the financial challenges that lie ahead. Last year, the Alexandra hospital made a surplus of approximately 1.3%, which was roughly in line with the trust’s surplus. Figures for this year are not yet available. However, as part of the need for the NHS to make up to £20 billion of efficiency savings in the coming years, Worcestershire Acute Hospitals NHS Trust faces a significant efficiency target in 2011-12. The Alexandra will have to find its share of those efficiency savings. Budgets are in the process of being set and hospital teams are currently identifying where savings and efficiencies can be made. I hasten to reassure my hon. Friends about the savings. Every single penny of those savings will be reinvested in front-line services, providing care for the constituents of my hon. Friends and people elsewhere in the county, and, indeed, the country. It is crucial that we make savings to cut out inefficiency and ensure that the provision of care is of the highest quality and delivered in the most effective and efficient way. Let me repeat again, all of the £20 billion that is saved over the time period will be reinvested in front-line services. That is what providing health care is all about. That is what we will do and what must happen so that we can maximise the money available for front-line care for patients.
The trust assures me that it has no plans to reduce the status of A and E services at Alexandra hospital, which I hope reassures my hon. Friend. Indeed, the terms of reference for the ongoing surgical review at the site state that there must be a viable A and E service in Redditch. I trust that my hon. Friend and her constituents will be reassured by that commitment.
My hon. Friend was also concerned that rural constituencies such as her own may be losing out under the NHS allocation formula. Rural communities generally have a higher proportion of elderly people and, because of the increased difficulty in reaching providers, rural populations may make less use of health services. Some argue that the previous formula may have disadvantaged such areas.
The Advisory Committee on Resource Allocation examined the issue but found no evidence that an adjustment was needed for rural areas other than the continued need for an emergency ambulances cost adjustment to account for geographical variations in the cost of ambulance services. However, my right hon. Friend the Secretary of State has asked ACRA to look again at the unavoidable cost differences in rural areas in the light of the move to GP consortia. ACRA is due to report its findings to the Secretary of State in June 2011. I cannot anticipate what those findings will be, but it is important to get an independent body to examine an issue that is of great concern not only to my hon. Friend but to other hon. Members who represent rural constituencies in England.
In conclusion, there is a great deal to be positive about in Worcestershire, and I am sure that my hon. Friends will agree with me on that. The addition of a new radiotherapy centre is a particularly exciting new development. Indeed, all my hon. Friends showed great enthusiasm for the centre, calling it a positive enhancement of local health care. They also expressed their wishes as to where it should be located. Even more exciting is the changing nature of the clinical relationships that our modernisation of the health service will bring and the potential for significant improvements in NHS services for my hon. Friend’s constituents.
I am delighted to have had this opportunity to discuss the local health service in Worcestershire. There is a lot of positive news. My hon. Friends still have to express some of their views to the relevant authorities, and in due course, decisions will be taken.