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Prepared: 15:16 on 22 July 2008
House of Commons
Tuesday 22 July 2008
The House met at half-past Eleven o’clock
PRAYERS
[Mr. Speaker in the Chair]
Oral Answers to Questions
HEALTH
The Secretary of State was asked—
Primary Care
1. Lynne Jones (Birmingham, Selly Oak) (Lab): If he will make a statement on the implementation of the proposals in the NHS next stage review final report on equitable access to primary care. [220333]
The Secretary of State for Health (Alan Johnson): Primary care trusts continue to make good progress in securing more than 100 new GP surgeries in under-doctored areas and 152 GP-led health centres, to be open to patients 12 hours a day, 365 days a year. Those services will improve access, extend choice and complement existing family doctor services.
Lynne Jones: According to a recent survey of people attending a mental health day centre in south Birmingham, 85 per cent. did not have a GP. That shocking result demonstrates the need to expand primary care services and fill the gaps, so the Government’s increased investment is welcome. However, the confusion about the rules on expanding those services is not so welcome. Will my right hon. Friend take this opportunity to clear up the confusion by explaining the difference between giving money to existing GP practices to expand, which is apparently not allowed, and GP practices bidding to provide additional services, which is?
Alan Johnson: Yes, I am happy to do that. We are giving £100 million to all GP practices this year to improve the care that they offer patients. On under-doctored areas, we believe that there is a genuine need in the most deprived areas—the 25 per cent. of primary care trusts with the worst provision—to provide new services and new centres, not only for GP services, although they will be GP practices, but for the facilities to screen, and to deal with issues such as smoking cessation and all the problems that health inequality encapsulates. That is not to say that we are not also giving extra money to existing GP surgeries, but we believe that we need new services, some for the capacity reasons that my hon. Friend mentioned.
Sir Patrick Cormack (South Staffordshire) (Con): Apart from taking a well-deserved holiday, will the Secretary of State spend some time during the recess considering the sort of letters that primary care trusts send to those to whom they have to decline grants or treatment? Some are grossly insensitive and written in the most insensitive, bureaucratic language. Will he have a look at that?
Alan Johnson: I thank the hon. Gentleman for wishing me well on my holidays. I hope that on his holidays he will read the NHS constitution, which is out for consultation until 17 October. It includes a paragraph that relates precisely to the point that he makes. If a PCT decides that a drug that is outside the NICE process will not be approved, it should do that transparently. Under the constitution, patients will have a right to receive lucid and transparent information about the PCT’s decision.
Paddy Tipping (Sherwood) (Lab): But do a significant number of patients not want more flexibility about seeing their GP at weekends and in the evenings? In the 60th year of the NHS, should we not back the patients rather than the professionals?
Alan Johnson: My hon. Friend is right. Incidentally, we now have the latest figures. Since concluding the agreement with the British Medical Association in April, in which we sought the extension of provision in the week and on Saturdays—we expect 50 per cent. of GP surgeries to offer that extended provision by the end of the year—we have already moved in the first couple of months to 28 per cent. coverage. That is what patients need, not least in the constituency of my hon. Friend the Member for Birmingham, Selly Oak (Lynne Jones): in Birmingham recently, patients had a specific concern about access to GP surgeries.
Sandra Gidley (Romsey) (LD): Although the GP centres in under-doctored areas are welcome, does the Secretary of State agree that he has missed a trick on the GP-led health centres, which have been imposed on PCTs? If PCTs had a little more time, they could have consulted local communities and probably placed the GP-led health centres in areas where they were needed, and people would not feel quite so put upon.
Alan Johnson: I do not accept the hon. Lady’s point. There is a genuine problem with capacity—we are not considering a zero-sum game. From next year, we want all men and women between the ages of 40 and 74 to come in on a call and recall basis under a vascular screening programme. When we announced that earlier this year, the BMA said it did not have the capacity. There is a genuine need for those services. Each PCT must consult on the new GP-led health centres, and they will be welcomed. As the Health Service Journal said of the Opposition a couple of weeks ago, it is easy to campaign against closures but it takes a perverse genius to campaign against openings.
Geraldine Smith (Morecambe and Lunesdale) (Lab): Although the extra Government investment in GP services is most welcome, why is there not the flexibility to allow existing GP practices to expand to meet the need, rather than having to create a new practice, which could have the effect of destabilising existing GP services? That is a real concern to GPs in my constituency. This should be done in that way only if the primary care trust wants that, but the PCT in my area blames the Government; it says it would like to do it another way, but the Government will not allow it to do so. What is the true situation?
Alan Johnson: My hon. Friend has raised this point with me, and a letter about the disgraceful attitude of the PCT is winging its way towards her. Although there may be numerous PCTs which are trying to duck this issue by blaming the Government, they are wrong. We are talking about the provision of care for their patients. My hon. Friend is talking about under-doctored areas, and they have been under-doctored for 60 years. If that was just a matter of handing over the money to the British Medical Association, which is what its political representatives on the Opposition Benches argue for, it would have been resolved years ago. We are saying that the new GP services are important for these areas as they are in the interests not only of patient care but of something I know my hon. Friend is passionate about: tackling health inequalities.
Mark Simmonds (Boston and Skegness) (Con):We in this House all agree that there must be the highest standards of patient care, and the Darzi report rightly highlights the lack of accessible information about some GP practices, which hinders patient choice. However, this issue was identified in a previous Government report that was published two and a half years ago in January 2006, yet to date there has been minimal progress. Will the Secretary of State explain how patient care is to be improved, specifically via all-important innovation, when GPs do not have, and will not have, control of real budgets, the centralised target culture is to be maintained and extra tiers of regional bureaucracy are to be created via this report, instead of a responsive, patient-centric, outcome-based service?
Alan Johnson: There is obviously an audition on the Opposition Front Bench. There will be a reshuffle soon by the Leader of the Opposition, and with the hon. Member for South Cambridgeshire (Mr. Lansley) away, this is the other shadow Ministers’ chance to audition.
Let me unpick the question a little. The argument that the hon. Member for Boston and Skegness (Mark Simmonds) uses is that GP practices somehow do not have any control over the situation. We negotiate with the BMA constantly. There are issues around improving patient care on which we agree with the BMA, and we are working closely with it to resolve them. The point about a bureaucracy emerging from the Darzi review is nonsense. The Darzi review takes into account the views of thousands of clinicians across the country, and it is about the opposite of this kind of bureaucracy. It says that with the right metrics—I apologise for using that dreadful term, but they use it—in place, quality can be measured and thus improved.
On central targets, I pointed out in the last debate we had on this issue that 16 years after the Conservatives came to power, their Secretary of State for Health was setting a target of waiting no longer than 18 months for important clinical treatment. The fact that that will be 18 weeks maximum by the end of this year is a tribute to the NHS, but a necessary part of achieving that was the introduction of those targets.
Foundation Trusts (Local People)
2. Alun Michael (Cardiff, South and Penarth) (Lab/Co-op): What assessment he has made of the progress made by NHS foundation trusts in recruiting local people as board members and engaging them in planning. [220334]
The Minister of State, Department of Health (Mr. Ben Bradshaw): The 103 NHS foundation trusts have recruited more than 1.2 million members and more than 3,000 governors. Independent studies show that they have been successful in bringing decision making closer to their local communities.
Alun Michael: I thank the Minister for that reply. When I visited Homerton hospital in Hackney with Treasury officials last year, we were impressed by the way in which a wide membership of the local community was proving a source of inspiration to senior medical and other staff in the NHS trust. Has my hon. Friend taken note of the recommendations in the report prepared by Chris Ham and Peter Hunt, which says the potential that would arise from having more than 1 million members in these trusts could be fully engaged only if there was a sustained commitment of resources to members’ services? Will he ensure that that wide engagement of the public is made a mainstream preoccupation within NHS trusts, and that this continues to be a success story?
Mr. Bradshaw: Yes indeed. As I am sure my right hon. Friend will know, the legislation states that foundation trusts must engage with local communities, encourage local people to become members and ensure that their membership is representative. He cites one example, and I could give one from my constituency—my local foundation trust—where the engagement of local people has led the hospital to have objectives of eradicating all waiting by 2010, introducing single rooms for those who want them by 2012 and completely eradicating avoidable infections by 2010. That is an example of local people setting local priorities for an excellent local hospital.
Dr. Richard Taylor (Wyre Forest) (Ind): The Minister will be aware of the Local Government Association’s health commission report “Who’s accountable for health?” It stresses the importance of local involvement networks—LINks—and overview and scrutiny committees, so will he ensure that foundation trust memberships fully engage with LINks and overview and scrutiny committees?
Mr. Bradshaw: Yes. It is very important, of course, that foundation trust memberships do that, although the roles of overview and scrutiny committees and of LINks are slightly broader—they cover the whole of a local health economy—than the specific, narrow responsibility of foundation trust governors or members. It makes sense for them, and I hope that good foundation trust organisations take on the engagement that the hon. Gentleman suggests.
Ms Gisela Stuart (Birmingham, Edgbaston) (Lab): The group of people whose input can contribute greatly are those who have a bad experience and simply want to ensure that it does not happen again. Their desire to be involved may be a short one; they may want to be involved for less than a year. Will the Minister ensure that that group is not overlooked and that we do not end up with local involvement that becomes politicised, with a small “p”? We should use individual experiences, even though these people are difficult to recruit.
Mr. Bradshaw: My hon. Friend has touched on something very close to my heart: the importance of ensuring that patients and staff do complain, do not feel frightened of complaining and are supported in that complaints process. If she has not come across this, she might like to examine the excellent role played in many places by the patient advice and liaison services—PALS—system, which acts as an advocate and a navigator for people who want to ensure that something that has happened to them does not happen to someone else without their having to stay involved in the system on a long-term basis. She rightly says that many people just do not have the time or inclination to stay involved in that way.
Sir Nicholas Winterton (Macclesfield) (Con): What importance do the Government place on the appointment of really local people on the board of NHS foundation trusts? By “really local”, I mean people who live in the core area of that trust. Are not such people really likely to be able to reflect the view of the local people about the quality and extent of the service being provided at their hospital?
Mr. Bradshaw: As I have said, the trusts are under a legal obligation to ensure that their board is representative of the local community. The hon. Gentleman might have an example of a foundation trust’s board of directors that is not as representative as it might be, but I suggest to him that the governors have it in their power—after all, they are elected by the whole membership, which can number tens of thousands of people—to ensure that such a board better reflects the local community.
Dan Rogerson (North Cornwall) (LD): Transparency will be vital in encouraging local people to get involved in the management and scrutiny of their local services. When will the Minister publish the review of the market forces factor?
Mr. Bradshaw: As we have already said in a written statement to this House, we intend to publish that alongside the operating framework in October.
Mike Penning (Hemel Hempstead) (Con): May I ask the Minister to join me in congratulating Monitor on the excellent work it has done over the years to get the right trusts—the viable trusts—through as foundation trusts? Can he explain why so many trusts fail the Monitor test? Even though they have gone through their own board, their health authority and his Department, Monitor still says that a third of the trusts are not suitable. Is that not a waste of money, and should it not be picked up earlier?
Mr. Bradshaw: No, that happens because Monitor rightly has a high standard. We are working closely with Monitor and with the trusts concerned to ensure that those that apply are more likely to get through the process. If we want to ensure that foundation trust hospitals are hospitals of high quality, it is right that we set the bar high—that is necessary. The hon. Gentleman seems to be suggesting that any trust should become a foundation trust, regardless of the quality of its finances and its care.
Social Enterprise Start-ups
3. Mr. David Drew (Stroud) (Lab/Co-op): What assistance his Department offers to social enterprise start-ups in the health sector. [220335]
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): The Department has allocated £100 million for the social enterprise investment fund over four years from 2007 to 2011. That includes £73 million capital and £27 million revenue funding. We have already awarded £10 million to social enterprises, including start-ups, in 2007–08.
Mr. Drew: I hear what my hon. Friend says, and as a Co-operator I like social enterprises. But is it not fair to say that it would be much better if we were to look at new ideas and start-ups from social enterprises, rather than looking at ways the NHS could be run differently? There is at least a degree of confusion out there, and I wonder if it would be better if we changed our attitude to organisational reforms—which are necessary—as the best place for social enterprises.
Mr. Lewis: We need to do both. We need to encourage innovation and original ways of working, with organisations coming in that can offer health and social care services in a different way. If we look at the challenge of health inequalities and reaching black and minority ethnic communities and other hard-to-reach communities, we find that social enterprises have an important role to play in helping us to tackle that. Equally, if existing groups of staff in the NHS feel that they can offer a better, more innovative and flexible service through a social enterprise, we want to give them the right to ask the question and have their proposal seriously considered by a primary care trust. We will certainly use many of our resources to encourage new organisations to come into the NHS and social care system to provide the innovation and flexibility that we want in a modern health care system.
Miss Anne McIntosh (Vale of York) (Con): Surely the most social enterprise of all is allowing GPs to continue to dispense to patients who live more than a mile away from a pharmacy or the GP practice. Will he look favourably on that as part of his social enterprise agenda?
Mr. Lewis: It is very important to understand that we are reviewing the provision of those services following the publication of the community pharmacy White Paper. No final decisions have been made. When we make the decisions, we are concerned about the best interests of the communities and patients. That should be our priority, rather than the narrow interests of one group of professionals.
Mr. Andy Reed (Loughborough) (Lab/Co-op): My hon. Friend is right to say that social enterprise, especially co-operatives, can play an important part in delivering very local services. The capital money is worth while and very valued, but will he ensure that there is a culture, right through the NHS, that ensures that when people come forward with co-operative or social enterprise ideas, they are not rejected out of hand? This should not be an isolated programme, but a core part of what the NHS does. As my hon. Friend rightly says, organisations such as Shepshed Carers, a co-operative in my constituency, provide some of the best care because they believe in the co-operative principle and they deliver services locally.
Mr. Lewis: My hon. Friend is right. At the heart of world-class commissioning is a recognition of the fact that we need to commission not only traditional in-house provision, but imaginative solutions. We also need to look at facilitating and building the capacity of the voluntary sector and social enterprise in local communities, not simply wait for bids from existing organisations. The new NHS constitution makes it clear that any organisation providing NHS services in the future will have to take account of the fundamental non-negotiable principles it contains. That provides safeguards for hon. Members who have concerns about diversification in the NHS. For the first time, voluntary organisations, social enterprises and the private sector will have to play by the rules in the constitution in an integrated NHS.
Dr. Vincent Cable (Twickenham) (LD): Is the Minister actively promoting the Sunderland model of social enterprise, which has been used to organise community nursing and is proving to be a much more satisfactory alternative than privatisation, which would undermine the tradition of public services?
Mr. Lewis: It is not my job to actively encourage one model against another. If something is working, clearly making a difference and achieving better outcomes for patients, we need to ensure that information about that model is available across the system. As part of Lord Darzi’s report, we have, for the first time, given staff the right to request the chance to set up a social enterprise. We have also introduced new arrangements for pension provision for existing staff who wish to become part of a social enterprise. Essentially, we have removed many of the obstacles and the barriers that in the past have prevented staff who wanted to take that option from doing so. We will certainly look at the model that the hon. Gentleman mentions, and where we can learn from it we will share best practice.
Diabetes
4. Keith Vaz (Leicester, East) (Lab): What steps his Department is taking to improve awareness of diabetes. [220336]
The Parliamentary Under-Secretary of State for Health (Ann Keen): “Putting Prevention First” states that everyone aged 40 to 74 will receive an individual risk assessment for vascular conditions, including diabetes. The associated Reduce Your Risk campaign, announced in “High Quality Care for All”, will be aimed at raising awareness amongst the general public of the risks of diabetes and other vascular diseases.
Keith Vaz: I discovered I had type 2 diabetes only after I attended a local screening centre organised by my local GP. It is estimated that half a million people in the UK have undiagnosed diabetes. In fact, some right hon. and hon. Members will have diabetes but will be unaware of it. Does my hon. Friend agree that the best way is to spend money on prevention rather than cure and that awareness is therefore crucial? Will she welcome the establishment of the new centre of excellence for diabetes in Leicester that is being paid for by the PCT?
Ann Keen: Diagnosing people with diabetes so that they can receive care and treatment is vital and I am pleased that my right hon. Friend has had the treatment that he needs to manage his diabetes. My right hon. Friend will be pleased to know that the quality and outcomes framework has resulted in an extra 200,000 people being diagnosed with diabetes in the past year alone. Initiatives such as the Silver Star Appeal are vital in reaching all areas of the population. I congratulate my right hon. Friend and Leicester PCT in particular on the work that they have to done for those who are at an increased risk of diabetes. I congratulate him on establishing that charity. The work on the proposed diabetes centre of excellence will continue and that centre will, we hope, spread good practice around the country.
David Tredinnick (Bosworth) (Con): Apart from the excellent work in Leicester, is the Minister aware of the work at King’s college hospital, particularly the DAFNE course? That one week course in dose adjustment for normal eating has been described in the British Medical Journal as improving
“blood glucose control, quality of life and treatment satisfaction.”
Will the Minister look closely at that one-week course? If she does, she will probably find that it is much safer for diabetics once they have done the course and that it reduces the amount of insulin consumed.
Ann Keen: That is a very interesting comment. We need always to be ready to learn and to consider new research. I would be happy to look at that research and to take the subject up with the hon. Gentleman if he wishes.
Jeff Ennis (Barnsley, East and Mexborough) (Lab): May I declare my interest as a diabetic? I agree with the comments made by my right hon. Friend the Member for Leicester, East (Keith Vaz); diabetes is an illness that creeps up on a person. I guess that it was more than two years before I was diagnosed with diabetes. Early diagnosis is crucial.
Will the Minister join me in congratulating Barnsley district general hospital on its recent improvements and investment in its diabetes centre? That has really improved the service for diabetics in Barnsley.
Ann Keen: Of course, I am pleased to congratulate Barnsley. I give my hon. Friend my best wishes in dealing with his diagnosis. We should perhaps screen more Members. If more of us are confident with our own health care, we can go out and be ambassadors to our constituents.
Anne Milton (Guildford) (Con): The incidence and prevalence of diabetes are greater in areas of high deprivation, the incidence of type 2 diabetes is five times higher in black and ethnic minority groups, and diabetes is predicted to grow by 9 per cent. by 2010. Will the Minister outline what she is doing to address the health inequalities that are very prevalent as regards the disease?
Ann Keen: The strategy published last week addresses all those issues. I am pleased to see that the hon. Lady is concerned about health inequalities, because we want our health centres and our out-of-hours facilities to address them. Screening with specialist nurses, in particular, will take place so that we can look after members of BME communities in a special and different way.
Children’s In-patient Services(Leeds)
5. Mr. Paul Truswell (Pudsey) (Lab): What progress has been made on the centralisation of children’s in-patient services in Leeds. [220337]
The Parliamentary Under-Secretary of State for Health (Ann Keen): Plans to centralise children’s in-patient and critical care at the Leeds general infirmary are well under way. Each specialty within children’s services has established a planning group to look at how improvements can be delivered, and the location of children’s facilities has now been agreed.
Mr. Truswell: I thank my hon. Friend for that response. I also thank her on behalf of the young patients, their parents and the health professionals for the personal interest that she has taken in this project, which is very much to be commended. The strategic health authority has submitted a bid for public dividend capital to part-finance the project. Can she assure me that she will look at that bid favourably and speedily and that she will retain her interest in the project to make sure that it is delivered by the target date of November next year?
Ann Keen: My hon. Friend has been exceptionally persuasive in developing my interest in this local scheme, as have all other Members in the area. I thank him for his comments, but the people of his constituency, and of Leeds in general, also need to thank him, because he has certainly led the campaign to improve and change children’s services. I have had the privilege of meeting the parents, carers and clinical staff, and the parents and carers, in particular, have done sterling work. I believe that my hon. Friend is meeting the chief executive tomorrow, and I am sure that they will both keep me informed and update me as appropriate.
Pharmacies
6. Mr. Graham Stuart (Beverley and Holderness) (Con): What effect he expects the outcome of the pharmacy consultation to have on the viability of local GP practices in (a) Beverley and Holderness constituency and (b) England. [220338]
The Minister of State, Department of Health (Dawn Primarolo): We have no proposals in the pharmacy White Paper “Building on strengths—delivering the future” that should affect the viability of GP practices. The White Paper is considering the control of entry provisions for dispensing services, not general medical services offered by GPs.
Mr. Stuart: GPs who serve rural areas, such as the Hedon group practice, which I visited on Friday, provide a highly valued dispensing service to the surrounding areas. The practice uses some of the income from that to subsidise unprofitable branch surgeries, such as the one in Keyingham. Will the Minister accept that the pharmacy White Paper proposals do threaten the viability of those carefully constructed and excellent services?
Dawn Primarolo: No, I do not. The average GP partner of a practice who does not dispense earns about £120,000 a year; a dispensing GP partner would earn, on average, about £20,000 a year more, taking their income to £140,000. It is also true that dispensing GPs have smaller list sizes, but even allowing for that, the average income a year for a GP dispensing medical services would not become unviable. I reiterate that there are no proposals to end dispensing by doctors. I accept entirely the point that Members have made about the need to look carefully at each area to make sure that provisions are available, but we have a duty, when considering the extension of pharmacy, to consider the rules for dispensing doctors, which have been in place since 1912.
David Taylor (North-West Leicestershire) (Lab/Co-op): But the suggestion is that where dispensing chemists exist within 1 mile of a GP practice, the right of that practice to dispense will cease. That would hit very hard practices that serve rural areas in north-west Leicestershire, such as the Measham medical unit, which uses the money that it gets to provide more doctors and better facilities. Can the Minister suggest how the high reputation of such practices and the high quality of service that they provide to many thousands of patients in rural areas will be protected under the proposed framework?
Dawn Primarolo: If my hon. Friend looks at the White Paper on pharmacies, he will see that it is to do with extending the provisions through the 10,000 pharmacies in this country, making them health centres and ensuring that they can do some of the diagnostic work that Members discussed earlier, such as diabetes testing. As regards the 1,100 dispensing practices in this country, I would say to my hon. Friend that there is no suggestion whatever in the White Paper that dispensing GPs are to be abolished. That is an unfortunate proposition, which is being put around by some, and it simply is not true. The points that my hon. Friend makes about ensuring continued provision in rural areas are entirely accepted on the basis of the services needed.