Hospital Services (West London)

Simon Burns Excerpts

Wednesday 11th July 2012 Westminster Hall

[Mr Slaughter]

My hon. Friend missed the point that I made at the beginning: this affects all MPs and all communities in north-west London, not only those expecting the closure of services. The closures go against the thrust of the changes in the health service over the past five to 10 years, which have seen the huge pressure on A and Es relieved by the addition of urgent care centres, not the replacement of A and Es by them.

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

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[Ms Karen Buck (Westminster North) (Lab)]

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[Mr Slaughter]

Indeed, and I will come on to that when I talk about the process and history of the closure of services.

[Mr Burns]

I rise in response to the comments of the hon. Member for Harrow West (Mr Thomas) on A and E waiting times. Would he like to tell us what the percentage standard is for A and Es and what was achieved in his trust?

[Mr Slaughter]

I am here to question the Minister, and I hope that in response he will not adopt the complacent tone that he has just shown.

[Mr Burns]

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[Mr Thomas]

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[Mr Slaughter]

I am happy to trade statistics with the Minister, but the debate is not about incremental performance, but the fundamental change to services.

[Mr Burns]

I just want to inform the hon. Member for Harrow West (Mr Thomas), because he clearly does not know, that the percentage standard for A and E waits is 95% and in his trust in the past quarter it is 97.5%, which is 2.5 percentage points above the standard.

[Mr Slaughter]

I am glad that the Minister is praising the standards of health care in Hammersmith. Saving the recent problems over referrals, we are all very proud of the standard of clinical care that people receive in our world-class hospitals under a world-class trust. The subject of the debate, which I hope that the Minister will address, is the fundamental changes being wrought on that and other trusts in north-west London, which will damage the standard of medical care and the health of my constituents. He has entirely missed the point.

The headline news from the consultation launched last week is the proposed closure of both A and E departments in my constituency, along with two of those closest by: Central Middlesex and Ealing. Clearly, that is a disaster for everyone living in the area, perhaps particularly for those in Shepherds Bush, White City and Old Oak, which include some of the poorest areas in London, with low car ownership, poor health outcomes and low life expectancy. The consequences for the two hospitals however are very different. Although neither will provide emergency care for my constituents, Hammersmith will remain a specialist hospital, but Charing Cross will be reduced to little more than an urgent care centre on an otherwise vacated site. Of the 500 beds, all but 30 will be closed or moved elsewhere. One of the largest and busiest hospitals in London will effectively become a clinic.

I want to move on to talk a little about the process of the review. I want to spend time on that, because it is the reason why there is so much disquiet and so much need for external intervention. Proposals for the closure of hospitals in Hammersmith have a chequered history. In my constituency office, I have a photograph of the former Health Minister, Ann Keen, standing on a chair with a megaphone outside Charing Cross hospital, when she was head of nursing there in the early 1990s and there was a massive community campaign against the then Conservative Government’s attempt to close the hospital. That campaign was successful, as I am sure this one will be. Over and between the past two elections there were, what I can only call scurrilous rumours that Charing Cross hospital would close either wholly or in part. That substantially muddied the waters, and was done, I think, purely for electoral advantage, in that there was no substance to those rumours at the time.

The rumours resurfaced last autumn in an article on the front page of The Independent, which speculated that either St Mary’s or Charing Cross or both would close. Following that, I, my hon. Friend the Member for Westminster North (Ms Buck) and, I am sure, others, sought assurances from Imperial College trust that that was not the case, and we were given those assurances. We are now told in the documentation, which I have brought with me today and was approved by the Joint Committee of Primary Care Trusts two weeks ago, that, over the past two years, when we were being assured that there would not be closures of the type now mooted, a very close consultation was going on and we all knew about it.

To take one page from the documents, it tells me that I received five pieces of correspondence from the trust in relation to the closures, and that at a meeting in March, which I did not attend, I was represented by my hon. Friend the Member for Westminster North. She is in the room and may contradict me: I did not know about that meeting and I certainly did not authorise her to represent me at that meeting.

Although I do not rule out some of the documents having been sent to me, they are junk e-mails—I do not use the term offensively; it is accurate. They are electronic newsletters that go straight into the very efficient House of Commons spam system. If we retrieve the e-mails and look at them, we can read things like, “There will be major improvements at Hammersmith and Charing Cross hospitals in the near future.” Even the document sent on the Thursday before the decision was taken, which was hidden in another newsletter from the chief executive of the trust, did not spell out the proposals.

When we walked into the decision-making meeting at Central hall Westminster two weeks ago, we were handed a bundle of 18 volumes of documentation to look at, which I believe had been available online for two days before that—very generous. We were expected to understand and respond then. That is not consultation. We are now told that a thorough process has been gone through, in which opinion formers have been consulted, and therefore we can proceed to the public consultation. We are presented with a fait accompli. The medical director of NHS North West London, Dr Spencer, when asked whether it was worth people lobbying and petitioning as part of the consultation process, said:

“No. People are currently wedded to mediocre services. If we don’t do this then people need to realise that our hospitals will go bankrupt. We have already seen this in south London.”

That does not sound to me like open and reasonable consultation. What is taking place is a pretence of consultation.

The options are no options at all. There is a preferred option, which I am sure will be adopted, and two others. All of them involve closing the A and E department at Hammersmith hospital, and two involve closing the A and E department at Charing Cross hospital. We will get the usual farrago of road shows, boards and helpful-looking people standing around with clipboards asking for our views. I am told that there is a five-page document that will be delivered, doubtless summarising the much larger consultation document, to all households in the area. However, if someone actually wants to take part in the consultation, they either have to go online—a lot of my constituents do not have access to the internet—or request a questionnaire.

NHS North West London could not provide me with a copy of the questionnaire or indeed a copy of the consultation document for the meeting that I had last Friday. I managed to print one off the internet and Sir Humphrey would have a field day with it. Buried at question 15, it says:

“How far do you support or oppose our recommendation that we should use our high quality hospital buildings with spare space as elective hospitals?”

At question 17, it says, and this is the closest that the questionnaire comes to asking a clear question in all its 50 pages:

“How far do you support or oppose the recommendation that there should be five major hospitals in North West London?”

At the meeting where it was decided that there would be consultation, I specifically asked, “Will there be questions that people will understand? Will there be questions such as, ‘Do you agree that Hammersmith hospital’s A and E should close?’, or, ‘Do you agree that the hyper-acute centre should move?’, or ‘Do you agree that the A and E at Charing Cross should close?’” There are no questions of that kind. As far as I can see, there is no question that relates to Charing Cross hospital’s A and E department at all. The only question that relates to Hammersmith hospital says:

“All the options above include the recommendation that Hammersmith Hospital should be a specialist hospital. There would continue to be a maternity unit at Hammersmith. How far do you support or oppose the recommendation that Hammersmith Hospital should be a specialist hospital with a maternity unit?”

My constituents are supposed to take from that the fact that they are losing their A and E service. As I have said already, they are living in some of the most deprived communities in the country and many of them have English as a second language. So I do not accept that this consultation is a valid process.

I want to finish before 10 am, because I know that a number of Members wish to speak. However, I will just make two or three other points. First, there is professional opinion to consider. It is increasingly clear that this proposal does not have the support of the local GPs. At a meeting of Ealing GPs a week or so ago to which my colleagues—my hon. Friends the Members for Ealing, Southall (Mr Sharma) and for Ealing North (Stephen Pound)—may wish to refer if they speak, there was universal opposition to the proposal from the 50 or so local GPs who were present. The only local GPs who did not oppose the process were those who are involved in it, and they abstained. I have written to Hammersmith GPs and they have expressed only questions, queries and doubts about the process in response to my inquiries.

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

It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate the hon. Member for Hammersmith (Mr Slaughter) on securing this debate, the importance of which is indicated by the significant number of Government and Opposition Members who have either taken part or listened. I also congratulate my hon. Friends the Members for Ealing Central and Acton (Angie Bray) and for Cities of London and Westminster (Mark Field) and the hon. Members for Ealing, Southall (Mr Sharma), for Hayes and Harlington (John McDonnell) and for Ealing North (Stephen Pound) on their contributions.

Before I get to the nub of the debate, it is important to pay tribute to all those who work in the NHS in north-west London, including in the constituency of the hon. Member for Hammersmith, for the selfless dedication and determination that they put in day in, day out—whether doctors, nurses, consultants, porters or ancillary workers—to ensure that the people of north-west London get the quality of care that they deserve.

I am aware of the controversy and high emotions that surround any service reconfiguration, or proposed reconfiguration, and I respect the way that hon. Members, including my hon. Friends, rightly draw the attention of the House to their concerns about aspects of the proposed reconfiguration. I should like to give a general message to all hon. Members: I urge them to engage fully in the consultations, to the best of their abilities, and make their case and argument, which can be part of the information gathering and ideas that will be considered when the consultation process ends in early October.

The reconfiguration of services is a matter for the local NHS. I hope that the hon. Member for Hammersmith agrees that that should not be dictated or micro-managed by Ministers in Whitehall. Reconfigurations are affecting local services and should be determined by the local NHS in full consultation with stakeholders within the local NHS in north-west London and the local community.

[Mr Slaughter]

Given that the medical director of the NHS, who the Minister says has to make the decision, has said that the NHS is doing this because it would be out of money otherwise and given that he has said that it would not take any notice of the consultation, does not the Minister see a role for the Government?

[Mr Burns]

First, the hon. Gentleman has unintentionally only given the Chamber half the quote. Secondly, the medical director will engage in the consultation responsibly and fully. It is—hon. Members asked about this—a full, proper and valid consultation, which is why I urge all hon. Members to take part.

My right hon. Friend the Secretary of State for Health wrote to the hon. Member for Hammersmith on 3 July—he mentioned this in his speech—on the process and the localism of the decision making, following the conclusion of the consultation, and to set out the process for service change that my right hon. Friend strengthened in 2010. For the record and for other hon. Members, I remind the hon. Gentleman of the position. The NHS in London, as elsewhere, has constantly to evaluate how services can best be tailored to meet the needs of local people and to improve the standards of patient care. The proposals in north-west London seek to do that, and the local NHS has now embarked on a full consultation with patients, the public and the local NHS. It is important to remember that no decisions have been taken.

On Monday 2 July, NHS North West London launched the full public consultation. It will last more than 14 weeks —two weeks longer than the normal period—to take into account that it spans the traditional holiday month of August. Patients, staff and the public will have the opportunity to review the clinicians’ suggestions, look at the evidence provided and have their say.

The hon. Gentleman knows that the NHS has always had to respond to patients’ changing expectations and advances in medical technology. As lifestyles, society and medicine continue to evolve, the NHS also needs to evolve. Reconfiguration is about modernising the delivery of care and facilities to improve patient outcomes, develop services closer to home and, most importantly, save lives.

As I said, the Government are clear that the reconfiguration of front-line health services is a matter for the local NHS, which knows the needs of local people and how to deliver services far better than Ministers in Whitehall. That is why we are putting patients, carers and local communities at the heart of the NHS, shifting decision making as close as possible to patients, devolving power to clinicians and removing top-down influence.

In 2010, my right hon. Friend the Secretary of State set out four tests that all proposed reconfigurations had to pass. I trust that that will help to answer the point made by the hon. Member for Ealing, Southall about the decision-making process. Reconfiguration and the consultation process that accompanies it must have support from general practitioner commissioners, strengthened public and patient engagement, clear clinical evidence and support for patient choice. Without all those elements, reconfigurations cannot proceed.

The health needs of north-west London are changing as its health services are increasing. The local NHS does not believe that the way that it has organised its hospitals and primary care in the past will meet the future needs of north-west London. I understand that north-west London has 8% more internal hospital space per head of population than the English average, even after excluding the specialist hospitals. Indeed, when combined with the number of beds available, hospitals in north-west London have approximately 50% more space per bed than the rest of the country. However, much of that extra space is not suitable for clinical care and costs those hospitals more money to run and maintain every day.

Under the preferred option proposed for changes to hospital services, the NHS in north-west London will invest £112 million in capital that will add capacity for expanded services, develop local hospital sites in the community and address maintenance issues. For example, I am sure that hon. Members, particularly in the Westminster and Fulham side of the area, will be acutely aware that only two weeks ago the Earl’s Court health and wellbeing centre re-opened after having £2.7 million capital invested in it to serve the local community.

Emergency services have been mentioned a lot. The quality of care and the time taken for hospitals to see and treat patients varies. A recent study showed that patients admitted at weekends and evenings in London hospitals, when fewer senior doctors are available, stand a higher chance of dying than if they were admitted during the week. Clinicians in north-west London have agreed clinical standards for emergency surgery and A and E that include providing expert consultant cover 24 hours a day, seven days a week. Therefore, patients admitted in an emergency at the weekend will have the same standard of care as those admitted on weekdays. We would like that approach to spread throughout the country. Rationalising emergency care in five north-west London acute sites will enable the NHS in north-west London to meet these standards, address service variability and save an additional 130 lives per annum, on the basis of the number of lives expected to be saved across London.

Clinicians argue that, to provide safe and effective care, they need experience of the most acute cases regularly, which means centralising services on fewer sites. A good example of that is stroke care provided in London, in respect of which significant improvements in outcomes and the quality and safety of patient care have been made. I hope that hon. Members agree that that is the right way forward.

[Mark Field]

Will the Minister give way?

[Mr Burns]

I only have one minute left; I hope that my hon. Friend will forgive me.

Trauma services have also been centralised, with a major trauma centre sited at St Mary’s and the two heart attack centres at Harefield and Hammersmith, which will continue to provide service.

Let me remind hon. Members of the process after the consultation is completed. As the hon. Member for Hammersmith rightly said, after the consultation has concluded, the responses have been considered and a decision taken, if the local authority overview and scrutiny committees do not agree and do not think the proposition is in the best interests of the local community, they have the right to communicate with my right hon. Friend the Secretary of State to request that he refer it to the independent reconfiguration panel. If my right hon. Friend does so, the panel will independently consider the proposals and advise him whether it believes that they are right for north-west London, and he can then take a decision accordingly. There is full consultation, full involvement and a mechanism to allow the matter to be pursued further after the consultation has concluded.

NHS Services (Trafford)

Simon Burns Excerpts

Tuesday 10th July 2012 Westminster Hall

[Paul Goggins (Wythenshawe and Sale East) (Lab)]

I am pleased to be able to hold this debate. I am particularly pleased that my hon. Friend the Member for Stretford and Urmston (Kate Green) is with me. I hope she will have the opportunity to catch your eye later in the debate, Mr Robertson, and make a short contribution. I am also pleased to see the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) in his place, as I know that he takes a particular interest in the NHS in Greater Manchester. I look forward to hearing what he has to say in response to my comments and my hon. Friend’s.

This is a timely debate. It is expected that in the next few weeks, a major consultation will be launched in Trafford on proposed changes to the provision of hospital services in the borough. That is, rightly and understandably, attracting huge interest in the community in Trafford and elsewhere. Last week, 5 July, was the 64th birthday of the national health service. That has particular resonance in Trafford, as it was at Park hospital, now Trafford General hospital in the constituency of my hon. Friend the Member for Stretford and Urmston, where the story of the NHS began. That was the NHS’s birthplace. Aneurin Bevan went to that hospital on that day in July 1948 to launch the national health service, which remains the best health service anywhere in the world.

Last Saturday, my hon. Friend and I joined hundreds of local people in Trafford on a march and rally organised by the campaign to save Trafford general hospital. Many parts of the community were represented, including the two main political parties in Trafford—they were both represented in good numbers—and it was evident that the affection for and commitment to the national health service in Trafford remains, just like everywhere else in the country, as strong as ever.

I think that Aneurin Bevan would be truly shocked, 64 years on from that historic day when he launched the national health service at Park hospital, to learn that the life expectancy of a man who lives in the poorest part of the Trafford borough is 11 years shorter than that of a man who lives in the wealthiest part of the borough. The gap for a woman is six years. That is a gross inequality in health. Our main objective, irrespective of party, must be to reduce such massive and gross health inequalities in our communities.

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

The right hon. Gentleman makes an extremely valid point, in the light of which I have no doubt that he will welcome the fact that, for the first time—and, ironically, under a Conservative Government—there is enshrined in primary legislation a duty on the Secretary of State for Health to work to minimise health inequalities.

[Paul Goggins]

As I have said, Members of all parties should work together, although the legislation the Minister refers to contains many other elements about which I am a great deal more sceptical. In any event, tackling health inequalities should be at the forefront of our minds. If the national health services in Trafford are to be redesigned, that needs to happen in a way that helps us to tackle inequalities that blight lives and bring them to a premature end. We need a system of integrated care in Trafford that is capable of dealing with those issues and that can help us to tackle, in a meaningful way, the difficult problems of heart disease, diabetes, cancer and stroke that blight so many lives and bring them to a premature end. That has to happen. Frankly, the debate about integrated care in Trafford has gone on for long enough. We are signed up to it and it needs to come to fruition.

This time last year, there was great concern in Trafford about the future of Trafford general hospital. There had been serious financial problems at the trust and there was real fear in the community that those who run the NHS and who make decisions intended to privatise the hospital. I am pleased that, eventually, that did not happen and that Central Manchester University Hospital NHS Foundation Trust acquired the Trafford trust, so that Trafford general hospital, Stretford memorial hospital and Altrincham hospital are all still part of the NHS family. That has been widely welcomed throughout Trafford, but it is clear that further changes are on the way. It is vital that we have a full and frank consultation to inform the process of change that will, no doubt, ensue.

One particular issue—and the main focus of this debate—is the likely impact of changes to hospital services in Trafford on the nearby hospitals in the city of Manchester. If the consultation proposes to replace the accident and emergency department at Trafford general hospital with an urgent care centre, there is concern about the implications for Manchester hospitals, particularly Wythenshawe hospital, which is part of the University Hospital of South Manchester NHS Foundation Trust—UHSM—in my constituency.

Many Trafford residents already use hospitals outside the Trafford borough for their NHS treatment. Indeed, I estimate that about 130,000 of the 230,000 people who live in Trafford consider Manchester Royal infirmary in central Manchester and Wythenshawe hospital in south Manchester to be their local hospitals—the hospitals they have easiest access to. It is also true that, if someone suffers a major trauma, a stroke or a serious heart attack, they would not be taken to the A and E unit at Trafford hospital, even if they were a Trafford resident; they would go instead to one of the local teaching hospitals in either Manchester or, perhaps, Salford.

The end result of the geographical link between Trafford residents and hospitals in Manchester—and, indeed, of the requirements of the complex conditions from which people suffer—is that more than half of Trafford residents who need to attend an A and E unit go outside of Trafford in order to do so. That means 25,000 patients who live in Trafford going to Wythenshawe hospital for their A and E treatment. That is a third of all the Trafford residents who require A and E appointments in any one year.

UHSM estimates that if the A and E unit at Trafford general hospital closed, that would mean 7,600 additional patients at Wythenshawe hospital’s A and E unit in any one year. At present, Wythenshawe hospital treats 88,000 people at an A and E unit that was designed for 70,000 patients, so there is considerable concern at the prospect of patient numbers in excess of 95,000 if the changes are introduced. In addition, half of all unplanned admissions of Trafford residents to hospital are admissions to Wythenshawe hospital. It is estimated that, if the changes are introduced and if the A and E department at Trafford general hospital closes, 1,900 additional patients could be admitted, on an unplanned basis, to Wythenshawe hospital. In total, that means an extra 9,500 patients coming in for either A and E or an unplanned admission.

Even if the integrated care system that we all want is able to divert people from hospital and reduce the number of hospital admissions, there would still be significant additional pressure on Wythenshawe hospital. I have seen some estimates of the number of patients who may be diverted from hospital as a result of the changes. Some of the professionals involved in making the assessments predict that, even if the system is successful, a 20% diversion would be heroic. That means that Wythenshawe hospital’s A and E department would need more beds, more theatre time, more examination cubicles, more resuscitation bays and even a new fracture clinic. Although the tariff arrangements may pay for patients’ treatment, the capacity and the facilities will simply not be there, which brings me to the core of my argument: the facilities have to be there if we are to see the kind of major changes that may be proposed. If we do not have additional capacity at Wythenshawe, the consequence will be growing queues and cancelled operations. Nobody wants that to happen.

The case for additional facilities is being made by the UHSM management, but the silence of the response so far from the Greater Manchester cluster is deafening. We need engagement with those who run the cluster, so that we can start to get some proper answers to the problems. It is not as though this is a new issue. Elsewhere in the north-west in recent years, when Burnley’s A and E unit closed down, additional facilities were made available at Blackburn, and, when Rochdale’s A and E department was downgraded, there was investment in the Pennine acute trust. We are asking for the same process to be applied to Manchester hospitals if the A and E department at Trafford general hospital is replaced by an urgent care unit.

As I said, I hope that my hon. Friend the Member for Stretford and Urmston will catch your eye in a moment, Mr Robertson. My constituency next-door neighbour, the hon. Member for Altrincham and Sale West (Mr Brady), who, sadly, cannot be here today, has asked me to say that he fully supports my argument. He has also asked me to say specifically:

“Wythenshawe is the most important acute hospital for most of my constituents and I share the view that any additional demand at Wythenshawe arising from changes elsewhere will need to be properly resourced.”

We are looking today for a guarantee from the Minister that the necessary funding will be made available for the expansion of facilities at Wythenshawe hospital. UHSM should not be expected to take the financial risk to provide those facilities; the money has to come from elsewhere within the NHS.

The Central Manchester University Hospitals NHS Foundation Trust will face similar issues, although perhaps to a lesser extent, because the numbers are not as great. Of course, the relationship between central Manchester and Trafford general is different, because they are now part of the same organisational arrangement. However, the issue will still be there. If more patients are presenting at central Manchester for A and E and unplanned admission, there will be an additional burden that runs the same risk of longer queues, longer waiting times and cancelled operations. I am sure the Minister does not want to see that.

I look forward to hearing what the Minister has to say. I hope he is able to give a positive reassurance—indeed, a guarantee—that the facilities that will be required at Wythenshawe if the other changes go through will be made available. It would be wrong for my constituents who live in Manchester to discover that, because of changes in Trafford, they will face longer queues at A and E and operations being cancelled—that would be unfair. We have to see investment up front. We all want the integrated care model to work, but those patients will not disappear into thin air. Many more patients will be looking for their treatment outside Trafford if the A and E department becomes an urgent care centre. I hope the Minister will engage with that issue, and that we can have a positive assurance from him today.

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

It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate the right hon. Member for Wythenshawe and Sale East (Paul Goggins) on securing the debate and the hon. Member for Stretford and Urmston (Kate Green) on her contribution. Like the right hon. Gentleman, she shows a keen and continuing interest in the provision of health care in her constituency and in Greater Manchester. If I do not respond to all the points that they have made—I will seek to respond to as many as possible—I will definitely write to them as quickly as possible after the debate.

As ever with such issues, it is important to not only recognise, but pay tribute to the NHS staff in the constituencies of the right hon. Gentleman and the hon. Lady, as they do so much to improve the health and the well-being of their community day in, day out.

I would like to provide some context to the right hon. Gentleman’s concerns about health services in Trafford. I am sure that he will appreciate that the local NHS, working with commissioners, clinicians and local authorities, needs to determine for itself how best to meet the needs of local people. I am sure that he will accept that it is not for Ministers to intervene at that level. To ensure that all local NHS bodies can do so, we not only protected NHS funding, but actually increased it in real terms, albeit a modest real-terms increase, and that will continue throughout this Parliament. The extra money means better services for patients and, ultimately, healthier communities in the right hon. Gentleman’s constituency and beyond. In his constituency, Trafford primary care trust will receive more than £389 million in the current financial year, which is an increase of £10 million on last year. Manchester PCT will receive more than £1 billion, which is up by more than £29 million on the previous financial year.

Those increases come with a significant challenge, which was referred to by the right hon. Gentleman and the hon. Lady. The NHS as a whole needs to spend its money better. Nationally, it needs to find £20 billion of efficiency savings in the next few years to meet the rising demand for services. The right hon. Gentleman’s party made that commitment when they were in government, and we recognised it as the right thing to do and have adopted what has become known in some circles as the Nicholson challenge.

The hon. Lady asked whether the savings will be reinvested in front-line services. I can give her that commitment: all the quality, innovation, productivity and prevention Nicholson challenge savings will be reinvested in front-line services, not only in Manchester, but throughout the country.

It is to their immense credit that the NHS organisations, teams and individual members of staff are on track to meet that target. In 2011-12, the NHS made £5.8 billion in efficiency savings, which is testimony to the hard work that was put in by staff, managers and administrators throughout the NHS. However, let me be clear that by efficiency savings I do not mean savings that flow straight back to the Treasury, lost to the NHS. Instead, I am talking about efficiency savings where every penny will be reinvested to make care better. Of course, some parts of the NHS therefore face tough decisions, and that is true for the NHS in Trafford.

The right hon. Gentleman is concerned about how service changes in Trafford might affect the quality of services for his constituents. I am sure that he is aware that the NHS in Trafford and Greater Manchester has developed proposals for service changes affecting Trafford general, which are planned for public consultation later this summer. Following the consultation, a final decision about the changes will be made by the end of the year, with plans put into practice by April 2013.

The board of the Greater Manchester PCT cluster approved the proposals at its meeting in June 2012, and they will now be considered by the board of NHS North of England on 12 July 2012. I hope that the right hon. Gentleman understands that I do not want to—it would be wrong to—pre-empt or bias the local process before the consultation. However, I will try to address, as best I can, some of his concerns within that straitjacket.

The former Trafford Healthcare NHS Trust was acquired by Central Manchester University Hospitals NHS Foundation Trust in April 2012, so that the trust could move to foundation trust status, which it could not do independently. The acquisition also ensured that the trust was sustainable, so it could carry on providing health services to the people of Trafford.

Sustainability—the guarantee that the NHS will carry on providing high-quality safe services—is at the root of the right hon. Gentleman’s concerns. Trafford is the birthplace of the NHS, where Nye Bevan famously launched it just 64 years and four days ago. Unfortunately, history is not enough. Every corner of the NHS needs to be on sound financial footing, so that it is a viable service for years to come. That is what we all want, regardless of which side of the House we sit on.

Clinicians and general practitioners across Greater Manchester have developed proposals for a model of care that maintains high standards and improves value for money. Those proposals are called the new health deal for Trafford. Local people and local NHS organisations have been involved. The right hon. Gentleman might be aware that in 2008 the local NHS started work on a new integrated services model that aimed to deliver more care in the community and reduce admissions to hospitals.

The hon. Lady is concerned and wants the proposals for delivering more care in the community to be put in place properly, so that there is no fragmentation or disruption in the delivery of service. I share her concern and agree that such proposals must be part of driving the NHS to a more integrated programme and a policy of delivery and seamless provision of care. That is a challenge for the NHS, as it always is when moving on a part of the delivery of care, but Manchester is acutely aware of that and is working steadfastly to ensure seamless delivery of care and to meet the new challenges of the most appropriate care for patients in Greater Manchester. The right hon. Gentleman is interested in that model.

At the moment, Trafford provider services, which is part of Bridgewater Community Healthcare NHS Trust, delivers community services across Trafford. I understand that Trafford PCT launched a tender exercise for providing community services in Trafford, which should be completed by August 2012.

Clinical commissioners in Trafford are still keen for integrated care to go ahead. For that to happen, clinical services are being redesigned across Trafford, including the secondary care services provided by Trafford general. At the moment, Trafford general provides a full range of acute services, including A and E, as the right hon. Gentleman mentioned. The local NHS worked on several options for services that the hospital might offer in the future, spoke to clinicians, commissioners and public representatives to identify the right model of care and chose the following model. A and E services will be replaced with an urgent care centre, opening between 8 am and midnight, changing to a minor injuries and illness unit within two to three years; acute surgery will not happen there anymore; some parts of acute medicine provision will be removed but some will remain; and in-patient surgery will no longer be provided at Trafford general. The hospital will still provide elective orthopaedic surgery, including the development of an elective orthopaedic centre of excellence, day-case surgery, out-patient services, diagnostics and rehabilitation.

As I mentioned earlier, these proposals were approved by the Greater Manchester PCT cluster in June 2012. I understand that the PCT intends to submit them to the strategic health authority for approval and for a public consultation in which everyone will be able to have their say. I understand that the national clinical advisory team has reviewed the proposals and supports the clinical case for change. I also understand that a series of public events were included in the whole process, so that people could find out more and voice their concerns. There were regular meetings with local health overview and scrutiny committees, and local Members of Parliament have been briefed on what is and was going on.

[Paul Goggins]

I agree that full and frank public consultation is essential, but people need to have all the information. The Minister promised me earlier that he would write to me with further details that he is not able to cover in his speech. Will he undertake now to look in detail at the case made by UHSM for the additional facilities at the accident and emergency unit and elsewhere, at an estimated cost of £11.5 million, and will he comment on that?

[Mr Burns]

I will try to do better for the right hon. Gentleman by commenting on that in the remaining three minutes. I have an answer.

The consultation process has to be carried on within the setting of my right hon. Friend the Secretary of State’s four tests. The right hon. Member for Wythenshawe and Sale East is concerned about the impact of the proposed changes at Trafford on other hospitals, particularly Wythenshawe hospital. Local commissioners have assessed the potential impact of the changes in developing their proposals. However, the proposals are still at an early stage and have yet to go to public consultation. I am informed that local commissioners will continue to look at this issue. Ultimately, when the consultation is over and the responses have been considered and a final decision is made locally, if the local authority overview and scrutiny committee does not share the analysis and agree with the decisions that have been taken, it is open to it to write to my right hon. Friend the Secretary of State to request that he refer the decisions to the independent reconfiguration panel.

The right hon. Gentleman mentioned the £11.5 million for expansion of A and E at Wythenshawe hospital. I can give no such guarantees on that, for the following reason. Local commissioners have assessed the impact of the proposed changes at Trafford on other hospitals, including Wythenshawe. However, the plans are still at an early stage and are yet to go fully to public consultation, which will happen shortly. I am informed that local commissioners will continue to review the impact of the changes on other hospitals, including Wythenshawe. In that respect, I can give a commitment, but I cannot go the whole hog, as the right hon. Gentleman would like me to, and commit £11.5 million, or whatever other figure might arise, because that is not in my gift. These are local decisions freed from ministerial interference, which I think the right hon. Gentleman would agree is the right way forward.

The right hon. Gentleman, the hon. Lady and other hon. Members met Trafford PCT on 6 July 2012 to discuss the proposals. I hope that they found the meeting useful and helpful, and I hope that the right hon. Gentleman and other hon. Members in the area affected by the consultation continue to speak to the local NHS. I urge the right hon. Gentleman and his colleagues, constituents and everyone else who is interested in strengthening and improving the local NHS provision of service in Trafford and Greater Manchester to contribute to the consultation process, so that all views and opinions can be considered and that the decision can flow as a result of direct involvement by those people.

Violence against Health Workers

Simon Burns Excerpts

Tuesday 3rd July 2012 Commons Chamber

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

I begin by congratulating the hon. Member for Scunthorpe (Nic Dakin) on securing this debate on violence against health care staff. It is an issue that every Member of this House can agree is totally and utterly unacceptable in every instance. I would like to praise the reasoned and measured way in which the hon. Gentleman made his points. I also share with him the disgust about what has happened to some of his constituents who work—day in, day out—on behalf of patients in his constituency. Sadly, this problem is not restricted solely to his constituency, as it applies to all constituencies where, regrettably, acts of violence are directed against NHS staff. I can assure him that this Government have zero tolerance of that sort of treatment —physical or verbal—against people who work in our NHS on behalf of patients.

Violence against health care workers can never be tolerated. Nobody should expect to suffer violence at work. This is especially the case for those who are committed to caring for others. Clearly, the human cost alone makes it unacceptable; although the physical effects may be transient, the deeper emotional scars can often last a lifetime. Beyond the effect on the individual, too, there are other factors: the disruption to services caused by the incident and its aftermath; the impact on staff welfare, sickness absence, recruitment and retention and the cost of additional security, all of which divert resources, human and financial, away from providing health care.

In short, the cost to the NHS of violence is huge and it affects us all. I am determined that we should do all we can to prevent violence against health care staff and to take the toughest possible action when violence does occur to ensure that those responsible are held accountable for their actions. From the outset, the Government have been committed to taking action to tackle the problem of violence. We have encouraged NHS organisations to work more closely with their local police forces to clamp down on anyone who is aggressive or abusive to staff—and while we may have made progress, there is still a long way to go.

In 2010-11, the latest year for which figures are available, there were almost 58,000 reported physical assaults on members of NHS staff. Hon. Members are able to consult the reported figures for each health body, as these are placed in the Library each year. In the majority of those assaults—some 40,000—the patient’s medical condition was a factor. This means the culpability of the assailant may have been in question or that a legal sanction may not have been appropriate. However, that still leaves some 18,000 cases in which the assailant’s medical condition was not a factor. While this number is smaller than for the previous year, it is nowhere near small enough: 18,000 is 18,000 too many. We are committed to taking whatever further action is required. The hon. Gentleman expressed concern about sanctions and convictions. I can tell him that sanctions against offenders, ranging from cautions to fines to imprisonment, have increased—there was a 24% increase in 2010-11—but the number is still not high enough.

We are taking action in a number of ways. Some are new, while others have succeeded in the past and we have therefore continued to support them. Of course, the main priority is to prevent violence by protecting staff and managing high-risk situations before they escalate. NHS Protect, which the hon. Gentleman mentioned, is the body that leads the work to tackle crime throughout the health service. It has identified violence against staff as one of its key priorities for 2012-13, and has developed a work programme aimed primarily at preventing assaults.

There are trained security management specialists at more than 90% of NHS trusts in England. They are responsible for investigating security breaches, along with the police, and for implementing new systems to protect NHS staff more effectively. NHS Protect supports NHS organisations by providing advice, assistance and best-practice guidance.

The Criminal Justice and Immigration Act 2008 introduced powers to deal with antisocial behaviour on NHS hospital premises, which enable an authorised person to remove those who are suspected of creating a nuisance or disturbance. A three-year training programme funded by the Department of Health and managed by NHS Protect, which will end in April 2012, has enabled more than 600 staff at over 80 hospitals to be trained in the implementation of the Act. They have been empowered to respond to disruption such as foul language and verbal abuse, intimidating gestures, excessive noise in waiting areas or wards, and the obstruction of thoroughfares. Feedback from staff trained by NHS Protect in the use of the Act’s provisions indicates that the powers are working well in practice on the front line, helping to provide a safer environment for NHS patients, staff and visitors.

The hon. Gentleman raised the important issue of design, particularly but not solely in accident and emergency departments. In November last year, I was pleased to be able to speak at the launch of a project organised jointly by the Department of Health and the Design Council involving the use of design to reduce violence in A and E departments. Leading experts developed and tested potential solutions and identified areas for action. We are currently in the implementation phase of that project. Early indications are positive, but in order for the impact of the solutions to be fully evaluated, a detailed framework has been generated by the design team to record both quantitative and qualitative data. Those data will generate the evidence base that will formally endorse the concepts, proving their efficiency and their impact on the costs of violence and aggression in A and E departments. The evaluation has not yet finished, but we hope to communicate the results later in the year.

The Government intend to change the legal framework in respect of antisocial behaviour. One of those changes is designed specifically to tackle antisocial behaviour affecting the NHS. As Members may have noted from the Home Office White Paper that was issued in May this year, we propose that NHS Protect be named as a relevant authority to apply for crime prevention injunctions. That is intended to enable a quicker response to the problem of antisocial behaviour, and to avoid the need for the police or local authorities to apply for injunctions on behalf of an NHS body.

While much of the work will focus on assaults for which the person committing the act can be held responsible, we will not ignore cases in which a person’s medical condition is a factor in violence, especially as such cases represent the majority of reported physical assaults against NHS staff. NHS Protect is working with a clinically led expert group to develop guidance on the prevention and management of violence in circumstances in which the medical condition of a patient puts staff at greater risk of assault.

When necessary, we need to challenge the idea that the existence of a particular medical condition is a bar to prosecution. Whenever an assault occurs, an assessment of the assailant's culpability must be made. When assailants cannot be considered legally culpable for their actions, prosecutions cannot be appropriate, but when assessments reveal that people were in control of their actions and knew what they were doing, there should be a presumption that sanctions will be sought. Indeed, there is some clinical opinion that such action can assist in making a person understand the impact of their behaviour, and so affect it in a way that discourages repeated incidents. For action to be taken against offenders, we first need staff to report when they have been subject to violence, either verbal or physical. That staff have confidence in the action that will be taken is paramount in encouraging them to do so, and the role of the local security management specialists is key to that.

All the initiatives I have mentioned are designed to prevent violence from occurring. We must, however, remain prepared for the times this prevention activity is not as effective as we would like it to be. When violence does occur, we need to ensure that those responsible are held to account.

To pick up on the valid point the hon. Gentleman made about joint collaboration, NHS Protect has signed a three-way agreement with the Association of Chief Police Officers and the Crown Prosecution Service, with the stated intention of curbing violence and antisocial behaviour in the NHS. This agreement recognises that the police and the CPS are bound by guidance and codes of practice on communications with victims and witnesses, and that employers have a duty to support in every way they can staff who have been victims. This joint-working agreement supports the Government’s commitment to act. NHS Protect will this year be working to translate this national agreement into local protocols for more effective collaboration between the police, the CPS and health bodies in seeking appropriate sanctions for acts of violence. NHS Protect is currently identifying best practice in the management of physical assaults in mental health settings, with a view to issuing specific guidance for that sector. This will include working with the police to take forward prosecutions where it is appropriate to do so.

The hon. Gentleman also raised the important issue of how to protect the lone worker. To better protect lone workers, NHS Protect led the delivery of a lone worker alarm service for the NHS. Over 40,000 staff, and more than half of NHS trusts across England, now use this service, which enables a lone worker to signal covertly for help from the emergency services if they find themselves in a dangerous situation. The service also provides a system control centre, which enables listening to, and recording of, incidents in case evidence is later needed as part of a prosecution.

I wholeheartedly share the hon. Gentleman’s concern about violence against health care staff. We should always do everything we can to prevent it, and when we cannot prevent it, we should seek the strongest sanctions against those responsible.

I hope that the hon. Gentleman and the House are reassured by my account of the work we are undertaking, and by the Government’s and my own personal commitment to tackling this completely unacceptable problem.

I thank the hon. Gentleman. He rightly holds this subject very close to his heart. The Government share his concern, and we are determined to do all we can to minimise the cowardly, dastardly and disgusting attacks on people who do so much to help the frail, the vulnerable and the sick in this country.

Question put and agreed to.

Care Quality Commission Market Report

Simon Burns Excerpts

Thursday 28th June 2012 Written Statements

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

The Care Quality Commission (CQC) has today published its first quarterly report on the provision of health and adult social care in England, “Market Report Issue 1: 2012”.

The market reports are designed by the CQC to:

provide an update on compliance in each of the sectors that CQC regulates on a quarterly basis;

identify themes and trends in each sector’s performance;

flag issues of non-compliance to providers and other bodies who have responsibility for the health and adult social care system; and

demonstrate the volume and effectiveness of CQC’s inspection and enforcement action.

The report published today presents the results of inspections of more than 14,000 services, between June 2011 and 31 March 2012, across all the sectors that CQC currently regulates: healthcare, adult social care and dental care. This and future reports will provide a snapshot of the compliance of providers against the essential safety and quality requirements.



This report also includes a special feature on maternity services and focuses on midwife staffing numbers. The Department of Health is moving toward a workforce where the focus will be increasingly on supporting the whole maternity team to make the best use of their contributions by using innovation and new technology to drive up the quality of care and deliver value for money.

The Centre for Workforce Intelligence has been asked by the Department of Health to undertake an in-depth study of the nursing and maternity workforce. The final report will be published in summer 2012.

“Market Report Issue I: 2012” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

King's Mill Hospital

Simon Burns Excerpts

Monday 25th June 2012 Ministerial Corrections

The full answer given was as follows:

[Mr Simon Burns]

Information is not available at hospital level. Information is however available at trust level. King's Mill hospital is part of Sherwood Forest Hospitals NHS Foundation Trust.

The numbers of patients who waited longer than four hours in the accident and emergency departments at Sherwood Forest Hospitals NHS Foundation Trust in quarter 4 2010-11 and 2011-12 is shown in the following table:

[Mr Burns]

Information is not available at hospital level. Information is however available at trust level. King's Mill hospital is part of Sherwood Forest Hospitals NHS Foundation Trust.

The numbers of patients who waited longer than four hours in the accident and emergency departments at Sherwood Forest Hospitals NHS Foundation Trust in quarter 4 2010-11 and 2011-12 is shown in the following table:

Hospitals (Sussex)

Simon Burns Excerpts

Wednesday 20th June 2012 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mrs Brooke. I congratulate the hon. Member for Eastbourne (Stephen Lloyd) on securing the debate on an issue that I know is of considerable concern to him and his constituents, and to other hon. Members attending today.

Before I address the issues raised, I would first like to pay tribute to all those who work in the national health service in Eastbourne, whose dedication, determination and commitment provide first class care to the hon. Gentleman’s constituents and those of other hon. Members. I know the hon. Gentleman is committed to ensuring that his constituents have access to high quality health care whenever and wherever they need it. I also appreciate that when any changes to local services are mooted, people can become anxious and feelings can run high.

As lifestyles, society and medicine change, the NHS must continually adapt. The NHS has always had to respond to patients’ changing expectations and to advances in medical technology. Reconfiguration is about modernising the facilities and the delivery of care to improve patient outcomes, to develop services closer to home, and, most importantly, to save lives. The Government are very clear that the reconfiguration of front-line health services is a matter for the local NHS. Services should be tailored to meet the needs of local people and to provide them with the best possible outcomes. That is why we are putting patients, carers and local communities at the heart of the NHS, placing decision making as close as possible to individual patients by devolving power to professionals and providers, and liberating them from top-down control.

Those principles are further enshrined in the four tests introduced in 2010 by my right hon. Friend the Secretary of State. Local reconfiguration plans must demonstrate: support from GP commissioners; strengthened public and patient engagement; clarity on the clinical evidence base; and support for patient choice. Our reforms allow strategic decisions to be taken at the most appropriate level. We are enabling clinical commissioners to make the changes that will deliver real improvements in health outcomes, and we will provide incentives to providers to deliver higher quality and more efficient services.

We are also aware that the reconfiguration of services works best when there is a partnership approach between the NHS, local government and the public. That is why we are strengthening local partnership arrangements, under the Health and Social Care Act 2012, through health and wellbeing boards. They will provide a forum where commissioners, local authorities and the local HealthWatch can discuss and plan the future shape of services to meet the health requirements of the local health economy.

NHS Sussex and local clinical commissioning groups, such as the commissioners of East Sussex Healthcare NHS Trust, have been working with NHS South of England, with support from the National Clinical Advisory Team, to ensure that there is full and proper scrutiny of the proposals to reconfigure some services. That has included assessing the readiness of the local NHS to go out to formal consultation, including reviewing the case for change and understanding whether the four tests, as laid down by my right hon. Friend the Secretary of State, for service change have been met.

The services under consideration for reconfiguration at the trust’s two acute sites at Eastbourne District General hospital and the Conquest hospital, Hastings are: orthopaedics, higher risk and emergency surgery only; general surgery, higher risk and emergency surgery only; and stroke, hyper-acute and acute only. Those are the only services being consulted on under the proposals. The local NHS agrees that hyper-acute and acute stroke services, all emergency and higher risk elective general surgical procedures, and all emergency and higher risk elective orthopaedic procedures can no longer be provided at both of the trust’s acute hospital sites. I understand that the proposed changes were approved on 30 May by the two local clinical commissioning groups—Hastings and Rother; and Eastbourne, Hailsham and Seaford. NHS South of England strategic health authority formally reviewed those proposals and assured itself that the Secretary of State’s four tests have been met and will continue to be met. The trust will now look to launch a 14-week public consultation exercise, which it anticipates will commence on 25 June, or shortly thereafter.

The hon. Gentleman raised concerns about maternity services, and I will seek to reassure him. For the sake of clarity, the current proposed consultation will not include maternity services. I understand that maternity services will be included in a separate programme known as Sussex Together, which is still being developed. That will look at maternity services across the county as a whole. The proposals are focused on enabling the local NHS to deliver directly clinically safe and sustainable services for patients, now and into the future. I am sure the hon. Gentleman agrees that this is something we all want and expect from the NHS.

A great deal of work is taking place to develop a local clinical strategy, one that will ensure the future sustainability of health services in the county and the best possible outcomes for local patients. The clinical strategy centres on eight areas of care, described by the trust as primary access points, covering 80% of service delivery. They are: acute medicine; cardiology; emergency care—A and E; general surgery; maternity; musculoskeletal, trauma and orthopaedics; paediatrics and child health; and stroke. For each one, a report on current challenges, the case for change and the proposed option has been produced.

With those plans, the local NHS in Sussex wants to achieve greater integration across health and social care services, to provide more care within communities, together with, where appropriate, shorter stays in hospital and better support when patients leave hospital, to provide care that continues to meet national clinical standards and best practice, to improve patient access to clinical experts at the earliest appropriate opportunity and to deliver the best outcomes for local patients.

[Stephen Lloyd]

I appreciate what the Minister says. I share his belief that the broader we go on the consultation, the better it will be. I support the health and wellbeing boards, introduced under the Health and Social Care Act 2012, because they are a good idea and will have some clout under the legislation. Does he agree that as the ESHT goes through the consultation, our new health and wellbeing board should be part of that consultation?

[Mr Burns]

Yes. Anyone and anybody should contribute to the consultation on any proposed reconfiguration. A key role of the health and wellbeing boards, particularly when fully established and operating in their own right, rather than in their shadow form at the moment, will be to ensure that the interests of the local health economy and patients are met. I would be surprised if the health and wellbeing boards did not show an interest in any reconfiguration, whether affecting the hon. Gentleman’s constituency or elsewhere. I am sure that they would form a view about any proposals.

The plans have been developed by local clinicians, including input from local clinical commissioning groups, with involvement from patient representatives, local people and other stakeholders, taking into consideration national best practice. Local clinical commissioning groups are also working alongside NHS Sussex to lead work on assuring the plans. The local NHS says that it believes that the majority of the changes required can be achieved by redesigning services and introducing greater integration and productivity within and between services. The proposed changes should enable the trust to deliver best practice, such as early access to senior clinicians, dedicated units, with specialist support staff and facilities, and improved multi-disciplinary teams.

Under the preferred options, surgery and orthopaedic services would be provided from the same site to support trauma unit designation. However, stroke services would not necessarily have to be on the same site as those services.

As I have said, reconfiguration is a matter for the NHS locally. I hope that the hon. Gentleman accepts that it would be inappropriate for Ministers to intervene in local due process, because the ethos of NHS reform is to put an end to the constant interference and micromanagement of the day-to-day running of the health service by Ministers like me or civil servants in the Department of Health in Whitehall. The nub of our reforms is that decisions on local issues—the local provision of health care—should and must be determined locally within the local health economy.

[Stephen Lloyd]

I appreciate where the Minister is coming from. Again, I genuinely and profoundly agree with him. That is why it is so significant that the majority of senior clinicians, as well as the public, are singing broadly from the same hymn sheet. The significance of the changes in the Health and Social Care Act 2012 is, as our colleague the Under-Secretary of State for Health says, that they must be led by clinicians and patients. That is why I made the point in my speech. I am gratified that the Minister has reiterated that.

[Mr Burns]

Let me mention something that will be of some comfort to the hon. Gentleman when the proposals get to the appropriate part of the process. The local authority health overview and scrutiny committee, which comprises democratically elected members of the council, has powers to refer a service reconfiguration to my right hon. Friend the Secretary of State if it is not satisfied that the proposals are in the interest of the health service in the area and in line with the content of the consultation or the time that has been allowed for it and that the consultation has been conducted appropriately.

As this consultation has not yet even begun, the HOSC has obviously not yet had the opportunity to make any such decision on whether it has been conducted appropriately. I therefore encourage the hon. Gentleman, his constituents and other interested parties who may be affected by the proposals to engage fully in the consultation when it commences to ensure that their views are fully taken into consideration.

If a decision flowing from the consultation does not find favour with the overview and scrutiny committee, it will be open to that committee to write to my right hon. Friend the Secretary of State to express its concern and dissatisfaction with the process, the decisions taken and the conclusions reached and to request that he refer it to the independent reconfiguration panel. That is a number of stages down the road, because we have not yet even commenced the consultation.

I urge the hon. Gentleman and every other interested party in East Sussex and even further afield if they might be affected by this reconfiguration to engage fully in the process, so that their views and concerns and their ideas of the best way to provide local health services are met.

Question put and agreed to.

Community Hospitals (North-East)

Simon Burns Excerpts

Wednesday 20th June 2012 Commons Chamber

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

I congratulate the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) on securing this debate, and I pay tribute to NHS staff in his constituency, who do so much for the health and well-being of his and other hon. Members’ constituents.

Robust community services are a vital element of emerging models of care, providing treatment to patients closer to home and improving health outcomes. The Government remain committed to extending and improving access to care and treatment in the community and at home. This includes sharing best practice to enable the smooth discharge and transition of patients from acute settings to robust community services, allowing them to be cared for closer to home.

Community hospitals play an important role in that process. The care that Guisborough hospital provides includes rehabilitation and follow-up care in a community setting. Community hospitals have the potential to make considerable efficiency savings in the local health economy by shifting care, diagnostics, minor injuries and outpatient services, among others, from acute hospitals to the community. They provide both planned and unplanned acute care and diagnostics services for patients closer to home, support best practice in reducing the need for admission to acute hospitals and contribute to the local community by providing employment opportunities and support for community-based groups.

Those are a few reasons the community estate is a core part of the NHS. It can help to transform care pathways, moving care from acute settings to community settings. Local investment in this type of facility is part of a dynamic service model that supports health and well-being for the whole community. The hon. Gentleman will be aware that under the transforming community services programme, responsibility for community services was transferred from primary care trusts to NHS and other providers. To this effect, South Tees Hospitals NHS Foundation Trust took over the operation of Guisborough hospital in April 2011.

The transfer of community services enabled the NHS to develop new innovative models of care using local multi-disciplinary, clinically led teams to improve services and health outcomes for local patients, families and communities. This has enabled the NHS to be creative in its approach to delivering community services. However, I fully appreciate the context within which all NHS organisations operate. They have to provide high quality services while remaining sustainable and efficient in making the best use of limited resources. The Government recognise this challenge, which is why we have protected NHS funding and are increasing funding in real terms during this Parliament.

In the hon. Gentleman’s constituency, Middlesbrough PCT will receive an allocation in 2012-13 of more than £299 million, which is an increase of more than £8 million, and Redcar and Cleveland PCT will receive more than £269 million, which is an increase of more than £7 million. Despite this generous settlement, however, the NHS needs to do more. It needs to find up to £20 billion of efficiency savings over the same period to meet the rising demand for NHS services and to continue to invest in new technologies and drugs to help meet these demands.

We will not dictate from the centre how efficiency savings should be achieved. Decisions about local health services should be made as close to local people as possible. Local NHS commissioners are best placed to identify the scale of the financial challenge and the opportunities for making savings, while driving up and maintaining quality. Every penny of those savings can be reinvested in front-line services and health care.

[Guy Opperman]

An example of that, I would suggest, is Haltwhistle hospital in west Northumberland, which has been rebuilt by the local NHS trust to provide a hospital facility and an integrated care facility. Does the Minister agree that that is a good example of the Department and the trust supporting a community hospital?

[Mr Burns]

I am extremely grateful to my hon. Friend, because I understand that the campaign for that decision was kept up for more than 25 years. I congratulate NHS North of Tyne, Haltwhistle council and the friends of the hospital, as well as my hon. Friend, for all their work in ensuring that it is finally happening.

[Tom Blenkinsop]

It is good to hear that every penny saved will go back into the NHS. My main fear is that the new funding calculations that the Secretary of State for Health is proposing will be based not on deprivation but on age, which means that, as shown by studies by Durham university—a fine institution in my region—more than £600 million of the health funding that is currently given to north-east health services would be redirected south.

[Mr Burns]

I certainly note the point the hon. Gentleman makes, and I have read a number of his local newspapers, in which he and a number of his hon. Friends have been making it too. I am delighted that he accepts my argument that every single penny that is saved from the £20 billion of efficiency savings—which, of course, we inherited from the last Government and accepted, because it was the right policy to pursue—will be reinvested in the NHS.

I think the hon. Gentleman attended Health questions on 12 June, at which the right hon. Member for Newcastle upon Tyne East (Mr Brown) raised the funding formula and the basis for it with me. I explained that a variety of factors, of which health is one, will determine the allocation of funding—just as it was determined under his Government—and that the question was also being looked at by an independent body. I have seen the newspapers, and I fully appreciate that the hon. Gentleman and his hon. Friends are trying to drum up a storm by suggesting that they are going to be hard done by. However, if he reads the answer I gave to his right hon. Friend the Member for Newcastle upon Tyne East in Hansard, I hope it will reassure him, on reflection, about the current situation.

[Mr Graham Stuart]

The Minister will recognise that community hospitals in the north-east, as well as in Beverley and Holderness, were starved of funding under the last Government. We saw gross distortions in funding, as the formula used deprivation as a way of pouring funding into urban areas, where there were young people who, regardless of their social background, were not in need of health funding. That starved the community hospitals serving ageing populations, which did need the funding. What we need is not reverse gerrymandering, but health funding that follows clinical health need. We did not have that under the last Government, who starved rural community hospitals of funding. I congratulate the Minister on having the courage to face down the vested interests of the Labour party.

[Mr Burns]

Let me return my hon. Friend’s compliment in kind by saying that I am grateful for the valid points he makes. He knows as well as I do that this Government, under the leadership of my right hon. Friend the Member for Witney (Mr Cameron), are totally committed to community hospitals. I know that he will also be reassured that, unlike with the last Government, there is no question whatever of this Government gerrymandering the funding formula.

I know that the hon. Member for Middlesbrough South and East Cleveland is aware of the scale of the challenge facing his local NHS. Like every local NHS economy, the NHS organisations that commission and provide services in his constituency must take some fairly tough decisions to deliver sustainable health services in future. Let me also say to him—in the nicest possible way, because I respect him—that we are in the situation of protecting the NHS budget and giving it a modest real-terms increase, given our commitment to the NHS, simply because of the economic mess that we inherited, thanks to the actions of his Government, under the stewardship of the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown). That meant that there was not enough money to sustain the levels of real-terms investment that might have been available earlier this century.

I turn now to Guisborough hospital. I am aware that Chaloner ward, which provided palliative care and rehabilitation, closed permanently in February 2012. I am advised, however, that services were transferred to the hospital’s larger Priory ward, which I am assured has adequate room and staffing to continue to provide high quality care. I understand that the decision to close Chaloner ward was based on the need to deliver services safely, efficiently and effectively, as the ward had been under-utilised and was not making the best use of nursing resources. Staff were engaged on the decision. In fact, they advised closure—I hope that the hon. Gentleman heard that. The staff advised closure, and staff at the ward were redeployed within Guisborough hospital and to the nearby Redcar primary care hospital.

I am also aware that temporary changes were made to the opening times of the minor injury unit at Guisborough hospital. The MIU now opens between 9 am and 5 pm from Monday to Friday, and between 8 am and 8 pm at weekends. I understand that patients requiring treatment outside those hours use Redcar hospital, local GP walk-in centres or the accident and emergency department at the James Cook university hospital. I have been informed that the MIU is staffed by a small team of nurses, and that the changes enabled the unit to continue to provide a safe service for patients. I also understand that the South Tees Hospitals NHS Foundation Trust is looking at whether other staff can provide support to the unit.

I have been informed that, in the longer term, South Tees Hospitals NHS Foundation Trust is reviewing the provision of acute and community services across all its sites, including Guisborough hospital. The review is aimed at ensuring the future safety, quality and sustainability of services. The trust has been working with GPs, commissioners and local authorities to establish models of care that will enable more patients to be cared for at home and avoid unnecessary admissions to hospital—whether at the larger acute hospital, James Cook, or community hospitals such as Guisborough. Once that work is completed, the trust expects to take a more definitive view of the future role of community hospitals such as that at Guisborough. It is not yet clear when the review will conclude. However, I am assured by the local NHS that there are no plans in the near future for further service changes at Guisborough hospital. I hope that that will reassure the hon. Gentleman. Should there be any changes in the longer term, once the trust has completed its review of service provision, local stakeholders and the public will be engaged in this process. He might be aware that my right hon. Friend the Secretary of State has set out strengthened criteria for service changes. Any proposals for major service change need to be assured by the local NHS against the Secretary of State’s four tests for service change and, when necessary, to be subject to public consultation.

I am aware that the hon. Gentleman met the chief executive of South Tees Hospitals NHS Foundation Trust to discuss these matters in February 2012. I also understand that the trust provides him with regular briefings on these issues, and I hope that he finds that helpful and useful in formulating his views on the provision of health care in his area. I hope that being briefed personally by his local health service providers will allow him to have a more open mind in regard to what is actually going on in the NHS, rather than simply accepting the propaganda that all too often distorts his views. I strongly encourage him to continue that dialogue with the trust as it completes its review of service provision.

Question put and agreed to.

Mental Health

Simon Burns Excerpts

Thursday 14th June 2012 Commons Chamber

[Mr Kevan Jones (North Durham) (Lab)]

I congratulate the hon. Member for Loughborough (Nicky Morgan) and the Backbench Business Committee on securing this debate, and I pay tribute to her very well-informed contribution. She is obviously a great champion for people who in many cases do not have a voice in the health system. Let us hope that by securing this debate we can give those people the voice they need, and not only, as she says, in the health service; we also need to get the message across to employers and others that mental health issues are not an inhibitor to a good and successful career and a fulfilled life. I shall discuss that in a moment.

I declare an interest as the president of my local Chester-le-Street Mind group. I have had an interest in mental health for a number of years. The hon. Lady mentioned the role of the voluntary sector. It plays a fantastic role, not only in promoting the issue of mental health but in delivering services. In some cases, these organisations are better vehicles for delivering this localised help than some of the larger companies referred to by my hon. Friend the Member for Islington North (Jeremy Corbyn), or even the NHS itself.

The hon. Lady said that one in four people could suffer from mental health problems in their lifetime. The hon. Member for Southport (John Pugh), speaking from the Lib Dem Front Bench, is both right and wrong in what he said. Some people do have mental health issues because of events in their life—crises happen and people can get over them in a short time—whereas others have long-term conditions that have to be lived with throughout their life, by way of drug treatment and other effective therapies, as the hon. Lady said. There is a big difference between those two situations. Anyone in this Chamber or any of their family members could suffer from short periods of mental health illness or be long-term sufferers. That is the important thing to get out of today’s debate.

We also need to address the cost, which the hon. Lady mentioned. I am thinking not only about the cost to the NHS, and the personal cost to individuals and their families, but about the cost to UK plc. I reiterate that mental health issues can affect anyone. I know general practitioners who have gone through periods of severe depression. I know one who works as a consultant cardiologist and is brilliant in his field but who lives with mental health issues, and has for many years. He has a very understanding employer and is very open about it. Let us not say that there are any boundaries in mental health, because there are not; these issues can affect anyone in society.

I wish to discuss two issues, one of which is the effect of funding on mental health. The other relates to the welfare reform changes, to which my hon. Friend the Member for Bolton West (Julie Hilling) referred. They are having a disproportionate impact on people with mental health issues. I accept the view of the hon. Member for Loughborough that we do not want to get into a party political debate, but there is unjoined-up thinking in some parts of the coalition’s policy. I must say that I saw exactly the same thing when I was a Minister, when one Department does something that has an effect on others, and it is sometimes difficult to get round those circles. However, local authorities in the north-east are clearly having to cut back on funding for this. Mind has said in the briefing note it sent to us for today that about 22% of its funding at the local level has been cut. That is a shame because, as I said, those organisations are sometimes the best at not only being advocates for local mental health services, but at providing care. In regions such as my own in the north-east, funding is vital for those organisations. When I talk to local mental health professionals and charities, I find that it is unfortunately a fact of life that economic conditions at the moment mean that the demand for services is increasing.

The hon. Member for Loughborough referred to the Health and Social Care Act 2012, and I agree with her that it does present some opportunities, if things are done properly. Chester-le-Street Mind, under the great leadership of Helen McCaughey and her husband, Charles, delivers a local therapy service, commissioned by the primary care trust, and it is great. It is carried out in the community, and that is the model that I like to see. The only concern I have, from talking to GPs over the years, is that although some of them are passionate about mental health and understand it, others do not. The challenge for the new commissioners is to take a bold step and say that some of these services can be delivered in the community by groups such as Chester-le-Street Mind and others. The Government might have to be aware of that nationally. As my hon. Friend the Member for Islington North said, this does not have to involve just large companies, because the approach I have described would be effective. That is my only concern: that although I know some very good GPs, including my own, who have a clear understanding of mental health issues, others are not very good at giving this appropriate priority—I am sure that the hon. Lady is aware of some of those. We are thus presented with both an opportunity and a risk.

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

I am extremely grateful to the hon. Gentleman because he is making an extremely good point, but does he agree that, under the reforms and the new NHS, a crucial role will be played by the health and wellbeing boards, which are there to monitor and ensure that the local health needs of local communities are provided for?

[Mr Jones]

Yes, that is one of the key roles of those boards. Again, however, it will be important to ensure that we get the right people on those boards—for example, counsellors who really understand mental health. As the hon. Member for Loughborough said, people have empathy in respect of cancer, but do not quite understand mental health. I agree with the Minister that it is important that the boards are the counterweight to ensure that that happens, but I think that central Government also have to play a role in ensuring that it happens. As I say, we have some great opportunities here and the commissioned work that Chester-le-Street Mind delivers is excellent. In addition, it is cheap compared with some of the major contracts in terms of delivery, because it is delivered by well-trained professionals and by very committed and hard-working individuals in the community.

A lot of mental health charities also rely on charity funding from organisations. In the north-east this funding comes from, for example, institutions such as the Northern Rock Foundation, which has now been taken over by Virgin Money. There is real concern that as those sums contract, the money going into mental health services from those groups will also contract. We need to keep an eye on the situation to ensure that, be it through the lottery or through organisations such as the Northern Rock Foundation or the County Durham Community Foundation, where funds are limited because of the economic crisis, mental health gets its fair share of the funding available. I mean no disrespect when I say that people give happily to Guide Dogs for the Blind or to cancer charities, but it is very much more difficult to get a lot of people to recognise and give money to mental health charities, unless they have been through or had a family member who has been involved in mental health issues. We need to be wary of that, too.

I now wish to discuss the welfare benefit changes, which my hon. Friend the Member for Bolton West mentioned. I commend Mental Health North East, a very good group in the north-east that has interacted with the Department of Health. It is an umbrella group of mental health charities that not only campaigns for and raises awareness about mental health but delivers services to mental health charities and individuals. The organisation is run by a very dynamic chief executive, Lyn Boyd, and is made up of paid individuals and a large number of volunteers, many of whom have personal experience of mental health issues. They are very good advocates, not only ensuring that mental health is kept high on the political agenda but interacting very successfully with the Department of Health in consultations and so on.

One piece of work that that organisation has considered is on a matter that I have increasingly seen in my constituency surgeries. There are people with mental health issues who were on the old incapacity benefit and are now on the new employment and support allowance and who are, frankly, being treated appallingly. The way that is being done is costing the Government more money in the long term. I know that it is not the direct responsibility of the Department of Health, but some thought needs to go into how we deal with the work test for people with mental health illnesses. I am one of the first to recognise that, as most of the professionals say, working is good for people’s mental health; it is important to say that. However, we must recognise that certain people will have difficulties with that. If we are to get people with mental health problems into work, we must ensure that the pathway is a little more sympathetic than the one we have at the moment.

Another massive problem is the work needed with employers. If employers are going to take on people with mental health issues, they will have to be very understanding to cope with those individuals.

Oral Answers to Questions

Simon Burns Excerpts

Tuesday 12th June 2012 Commons Chamber

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

3. What the cost to the public purse was of NHS staff redundancies in 2011-12.

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

Audited 2011-12 figures on NHS exit packages, including redundancies, are not yet available. The data will be available in the summer, once the Department’s annual report and accounts are laid before Parliament.

[Alex Cunningham]

The latest figures from the Department show that the cost of reorganising the NHS on Teesside is more than £50 million, including £9 million in redundancy payments to hundreds of staff who have lost their jobs. At the same time the Minister is demanding massive cuts of £40 million from the local hospital trust. Will he apologise to the people of Teesside for wasting their money and confirm that none of those made redundant will be re-hired in the new structures?

[Mr Burns]

No, of course I will not. What the hon. Gentleman fails to recognise is that the NHS must continually evolve to meet challenges and that this is the best chance the NHS has to improve and drive up standards. What he fails to mention in his question is that the £1.2 billion to £1.3 billion cost of the reform will lead, between now and the next election, to £4.5 billion of savings, £1.5 billion every year thereafter until 2020, and every single penny of that money will be reinvested in front-line services.

[Rushanara Ali]

We already know that this Government spent more than £168 million nationally making NHS staff redundant over 2010 and 2011, and more than £3.8 million in Tower Hamlets, where my constituency is based. Can the Minister tell the House how many of those staff were re-hired in the new system?

[Mr Burns]

Yes, there have been redundancies in the NHS, but 15,500 managers and administrators have ceased to work in the NHS, where the savings are reinvested in front-line services. There are also 4,161 extra doctors, 934 more midwives and 151 more health visitors. That is where we are concentrating the money—more front-line staff, fewer administrators.

[Andrew Gwynne (Denton and Reddish) (Lab)]

At a time when almost 4,000 nursing posts have been axed, the Sandwell and West Birmingham Hospitals NHS Trust is using unpaid jobseekers through the Government’s Work programme to perform duties such as collecting drugs and giving food and drinks to patients. Does not the Minister understand that whatever the good intentions of the scheme, most people will see this as staffing on the cheap, and that there can be no substitute for the necessary number of nurses and health care assistants in our NHS?

[Mr Burns]

First, the shadow Minister is incorrect in the number of nurses who he says have left the NHS. The figure is nowhere near 4,000, as he mentioned—[Interruption.] It is 2,693. Secondly, he denigrates a scheme where people have the opportunity, through the jobcentres, to gain familiarity with the workings of the NHS so that they can take a view as to whether they want to invest their future talents in a career in the NHS. I should have thought that that was to be welcomed, rather than snidely denigrated.

[Mr Rob Wilson (Reading East) (Con)]

4. What estimate he has made of the cost of alcohol-related admissions to accident and emergency departments in (a) England, (b) the south-east and (c) Reading East constituency in the latest period for which figures are available.

--- Later in debate ---

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

11. What his policy is on the national authorisation process for clinical commissioning groups; and if he will make a statement.

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

The NHS Commissioning Board is responsible for considering applications from clinical commissioning groups to be established and for determining those applications. The process of authorisation is an important element of ensuring that CCGs are ready to take on their commissioning responsibilities. There are 212 aspiring CCGs that are preparing to apply for authorisation.

[Stephen Mosley]

West Cheshire clinical commissioning group is making excellent progress towards taking control of all NHS services in April next year. It is one of the first wave to undertake the national authorisation process. When can first-wave groups, such as West Cheshire, expect to hear whether they have been successful?

[Mr Burns]

I congratulate West Cheshire and other CCGs on the progress that they have made by aspiring to CCG authorisation. We expect first-wave applicants to be informed of the outcome of their authorisation applications by November. Once the outcome is known, the focus will be on ensuring a safe and managed transition from primary care trusts to CCGs on 1 April 2013.

[Nick Smith (Blaenau Gwent) (Lab)]

12. What assessment he has made of the effectiveness of the public health responsibility deal.

--- Later in debate ---

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

14. What his policy is on the resource distribution formula for primary health care commissioners.

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

From 2013-14, the NHS Commissioning Board will allocate resources to clinical commissioning groups. The Health and Social Care Act 2012 contains the first ever legal duties on health inequalities for NHS commissioners and the Secretary of State. This applies to everything the NHS Commissioning Board does, including allocating resources.

[Mr Brown]

Will the Minister give the House a clear assurance that he will not downgrade the importance of economic deprivation in his resource allocation formula?

[Mr Burns]

Yes, I can give that assurance. I know this has been of some concern to the right hon. Gentleman and the north-east, but I can tell him that we are not planning to alter resource allocation to transfer funds from the poorest parts of the country. There is also no mandate to propose a formula based purely on age. As he may or may not know, although age is the primary driver of an individual’s need for health services, the most recent primary care trust formula uses a range of factors to determine fair shares, including the age structure of the population, levels of deprivation and the unavoidable costs in providing services between areas.

[Duncan Hames (Chippenham) (LD)]

The last of those factors is relevant because community health care increasingly allows people to live at home for longer and to go home sooner after hospital admissions. However, that means that sparsity is a factor in the cost of providing health services in rural areas such as Wiltshire. Will the Minister therefore find a way of recognising that within funding allocations?

[Mr Burns]

Yes. I hope I can reassure the hon. Gentleman. As he may be aware, the Advisory Committee on Resource Allocation is currently reviewing the formula by which funding is allocated. We await its recommendations and will look at them carefully before making any announcements.

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

The reason the funding formula is causing such concern in the north-east is that we have some of the worst public health outcomes in the country, including on obesity, liver disease, vascular disease and so on. Given that there is to be no change to the funding formula, why has the Faculty of Public Health said that the inequalities will get worse because of the reforms the Minister proposes?

[Mr Burns]

No. I do not think the hon. Lady is right in that—[Interruption.] As she will appreciate if her hon. Friends on the Opposition Front Bench would just hush and listen for minute, there will be allocations for public health, but there will also be allocations for acute care in clinical commissioning groups. Those will be done to reflect the needs of areas up and down the country. No one area will be penalised at the expense of another. What is more, they will be done on the basis of independent advice, as I said to the hon. Member for Chippenham (Duncan Hames) in my earlier response.

[Steve Brine (Winchester) (Con)]

15. What progress his Department has made in introducing fully digital breast screening; and if he will make a statement.

--- Later in debate ---

[Julian Smith (Skipton and Ripon) (Con)]

T6. What progress has been made in discussions with primary care trusts on the transfer of assets to NHS Property Services Ltd?

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

The Department is currently reviewing updated lists of properties for proposed transfer. Thereafter, the boards of the sending and receiving organisations will endorse the transfers and give their final approval in the next few weeks to allow the legal transfer process and human resources consultations to commence. The legal transfer of assets to either NHS providers or NHS Property Services Ltd will take place on 31 March 2013.

[Heidi Alexander (Lewisham East) (Lab)]

T7. We have learned today that public satisfaction with the NHS has fallen dramatically. We also know that satisfaction with GP services has fallen for the second consecutive year, and that satisfaction with accident and emergency services is going down by 7% each year. The Prime Minister promised that the NHS would be his priority. Is it not about time that this Government lived up to that promise?

[David Mowat (Warrington South) (Con)]

T8. The Cheshire and Merseyside treatment centre has been closed for just over a year, since the private sector contract let by the last Government expired. Can the Minister confirm that the centre is now going to be brought back into the NHS as a fully fledged part of the Warrington and Halton hospitals trust, and will he give me an indication of the time scale involved?

[Mr Simon Burns]

I am grateful to my hon. Friend for giving me the opportunity to explain that the NHS trust and the PCT have made plans for the building to be used by the Warrington and Halton Hospitals NHS Foundation Trust for orthopaedic out-patients and surgery. Those plans should enable clinicians to provide the NHS services needed by local people in much-improved buildings, and I understand that services will be recommenced from those buildings in weeks.

[Rosie Cooper (West Lancashire) (Lab)]

In written responses to questions about clinical commissioning groups, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) incessantly replies—most recently on 18 April—that CCGs do not yet exist, so how can he offer assurances, as he has done today, that any real progress is being made by the CCGs, when they are currently being supported by PCTs? And will he explain his “now you see them, now you don’t” response?

Points of Order

Simon Burns Excerpts

Tuesday 12th June 2012 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

On a point of order, Mr Speaker. During Health questions, I gave a figure for nursing redundancies. It would appear that the Minister of State gave an incorrect figure in his reply, inadvertently including midwifery and health visitor posts as well as nursing posts. If that is the case, may I please ask the Minister to correct the record?

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

rose—

[Mr Speaker]

The Minister is literally falling over himself to do so. We must hear from the Minister.

[Mr Burns]

I hope that I am not falling over, Mr Speaker.

It may be useful to the House if I correct the shadow Minister’s misapprehension. What I gave, and what I stand by, were the latest figures for full-time equivalents in the NHS work force. Since May 2010, the number of qualified nursing staff has fallen by 2,693. That is the figure I gave the shadow Minister, and it comes from the category in the work force statistics headed “qualified nursing staff”—[Interruption]—which includes, as the chorus are echoing, midwives and health visitors.

[Mr Speaker]

I am reassured that the Minister has not fallen over, and I think that we are all better informed. What we cannot have, and what I am sure no one would seek, is a rerun of Health questions, but we have been given that clarification, for which we are grateful.