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Andrew Bingham (High Peak, Conservative)

I want to raise the issue of ambulance stations in my High Peak constituency. First, for the sake of clarity, I should explain that the High Peak is a large constituency and as such is covered by two primary care trusts: Derbyshire in the south and Glossop and Tameside in the north. Consequently, the ambulance services are provided by the North West Ambulance Service NHS Trust and the East Midland Ambulance Service NHS Trust. I want to concentrate today on the East Midland Ambulance Service—EMAS—but if time allows, I will also briefly mention the North West Ambulance Service.

“Being the Best” is an EMAS proposal to rationalise the ambulance services and ambulance stations across the whole of the east midlands. I am sure many Members across the east midlands will have their own issues in their own constituencies. I want to highlight the consequences for the residents of a large part of the High Peak of what I believe are badly thought out and ill advised proposals.

EMAS is looking to create a hub-based model. A hub will be, as the word suggests, a large centre where ambulances will be based and where crews will go to collect their vehicles and return them at the end of the shift. The hubs will be supported by what EMAS calls “deployment units”. I have seen a photograph of a deployment unit and I venture to say that, if we in this Chamber saw one, many of us would say it looks remarkably like a portakabin. They look unattractive, which does not go down well in an attractive area such as the High Peak where the scenery is so well appreciated, and also seem to be of very little use. I can see the logic of a hub-and-spoke model, but the crucial decision within such a model is where the hubs are located. That is where I believe EMAS has got things so badly wrong for the High Peak.

There are presently two ambulance stations in the EMAS area of the High Peak: one in Buxton and one in New Mills. Under the EMAS proposals, both of them will be removed, leaving the area without an ambulance station at all, relying instead on a hub that is placed not in or even around the High Peak, but in Chesterfield—at a distance of over 30 miles from New Mills, which is the

furthest point. EMAS claims that the ambulances will not be parked there, but merely collected from and returned to the hub. That may be the case, but it creates further difficulties, as I shall explain.

The High Peak gets its name for a very good reason—it is high and there are peaks. The road from Chesterfield into the High Peak reaches at some points almost 1,000 feet above sea level. It is exposed to the elements. Many areas around different parts of the north and the east midlands might see only a sprinkling of snow, but Tideswell Moor, as part of the road is called, can easily be closed: owing to its exposure, only a small amount of snow is required to drift across the road to make it impassable for many vehicles. I use that road every week to catch the train to London. I well remember one occasion when I returned from London, got off the train in Chesterfield and quickly realised that I could go no further. I had to stay overnight in a Chesterfield hotel. I had that option, but somebody in the High Peak who needs an ambulance to use that road does not.

Let us imagine a crew collecting the ambulance to go on shift. They leave the hub, and within a short time a 999 call is received, requiring them to divert to, for the sake of argument, Clay Cross. The ambulance goes to the call, collects the patient and takes them to Chesterfield hospital—a process that could take some time. I have been out with the ambulance crews and I know how long these things can take. From Chesterfield hospital, the crew could get further diverted to, say, Alfreton or Matlock. That could mean the ambulance never reaching the High Peak, leaving my constituency with no ambulance cover at all.

I realise that my case requires a working knowledge of the geography of north Derbyshire, but that further makes my point, as it is precisely that knowledge that was lacking or ignored when the plans were drawn up. In meetings with me, EMAS says that the model has been computer generated. I have to say that it may look good on paper, but it does not and will not work in reality. EMAS also says that “Being the Best” is about improving the service and improving staff welfare. I fail to see how it can even begin to satisfy either of those criteria. How can staff welfare be increased when many of them will face an extra 30-mile journey to work both before and after what could easily be a 12-hour shift?

In addition, EMAS will be committed to compensating staff for excess travel for a certain period following the move. Extra fuel costs will be incurred by the to-ing and fro-ing from the Chesterfield hub—not to mention the cost to the environment with all the extra miles that the staff will have to travel. That means reducing staff welfare while increasing costs and reducing efficiency—to my mind, the direct opposite of what EMAS is trying to achieve.

The knock-on effect will be that, through staff turnover, the High Peak will lose ambulance men and women with the crucial local road knowledge. High Peak residents wishing to become paramedics or to work on the ambulances will now apply to the North West Ambulance Service, whose operational centres are nearer. We will arrive at a situation whereby whatever ambulances we get in the High Peak will be staffed not by local people who know the local towns, villages and hamlets in the area, but by able and excellent staff—I concede that—who

will be residents from miles away. They will not be able to find their way around—sat-navs do not work that well in the High Peak—and response times will increase even further.

The fundamental problem is the way the process has been undertaken and how the proposals have been arrived at. The North West Ambulance Service is looking at similar proposals, but it appears to be engaging with others, inviting key stakeholders to help to discuss and shape its plans. At a meeting, it referred to the hub-and-spoke model but, I am told, acknowledged that that method of delivery will not suit all areas. I do not wish to prejudge what NWAS may propose, but there appears to be an acknowledgement that one size does not fit all. EMAS, however, presented its proposals with little or no apparent discussion with anyone, key stakeholder or not, preferring to use what appears to be an off-the-shelf template.

As Members would expect, I am batting for my constituents. We deserve a better ambulance service. We have several large quarries and other industrial premises within the High Peak, and they can be dangerous places. Industrial accidents happen. Safety records in the High Peak are good, but there is still the risk of injury.

Let me also dwell a moment on what happens in the summer months. The High Peak can be flooded with tourists. The population swells, and with it the potential risk and the need for an ambulance rise. Walkers, hikers and runners swarm across the High Peak hills like ants. Theatre-goers fill Buxton and the surrounding towns and villages during the Buxton festival. Coach-loads of people come to my constituency during the summer months. Who will go to them if they need emergency assistance?

The first responders, who perform excellent work in the High Peak, have expressed opposition to these plans. I am a great supporter of Mountain Rescue. It does a fantastic job across the High Peak, and in some cases its specific services are needed to reach people in inaccessible areas. Even it has taken the unusual step of expressing grave concerns about these proposals. Derbyshire, Leicester and Rutland Air Ambulance is also a vital part of the emergency mix in the High Peak, but the main ambulance service is still the one that people call most often. These other organisations embrace their responsibilities, but I am concerned that these proposals are leading to EMAS abdicating theirs.

The consultation has now closed. The whole High Peak community has united as one against these proposals. Two public meetings were attended by hundreds of local residents incensed by the proposals. At one meeting I attended, the chief executive said he was “listening very carefully” to local people. I hope he is. I hope that, when he presents his final recommendations to his board, they are not the same ones that are on the table today, as they are inadequate, unfeasible and unworkable: they reduce, not enhance, the service; they hamper, not improve, staff welfare; and they desert, not embrace, the people of the High Peak in their hour of need. The current proposals may improve some response times elsewhere, in the more populated areas of the east midlands, but they will not improve response times in the High Peak.

12:07 pm
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Jim Dowd (Lewisham West and Penge, Labour)

Traditionally, Members raise constituency concerns in the House’s pre-recess Adjournment debates, and I shall raise a subject that has provoked not anger, but fury, and a feeling of unfairness and injustice among my constituents such as I have not known in the 20 years that I have served as a Member of Parliament and the 20 years before that when I was a member of Lewisham borough council. That subject is the appointment in July of a trust special administrator to the South London Healthcare NHS Trust. The TSA was appointed under the unsustainable providers regime, a provision of the National Health Service Act 2006 and amended, I think, in 2009. South London Healthcare NHS Trust does not include Lewisham. It covers the adjoining area, and principally comprises the Queen Elizabeth hospital in Woolwich, the Queen Mary hospital in Sidcup and the Princess Royal university hospital in Farnborough.

This is the first time the Department has used these provisions, so the step taken is ground-breaking, pioneering—

Photo of Jim Dowd

Jim Dowd (Lewisham West and Penge, Labour)

Yes, I think that is part of the TSA’s agenda. The way the Department has engineered this situation is disgraceful, dishonourable, disreputable and downright dishonest—and if we have not had enough alliteration, I could add devious, as well as underhand and fraudulent.

Hon. Members will not be surprised to learn that I am no great supporter of what the TSA has done. The Department is attempting to pervert the process because the major impact of what the administrator in the adjoining trust is doing is on Lewisham hospital. The draft report is a considerable document that has cost an awful lot of money and made an awful lot of money for a number of consultants, including McKinsey, KPMG and PricewaterhouseCoopers—they always seem to do well out of these things. The public consultation on the draft report has closed and the Secretary of State is due to reach a decision. The final report from the TSA will be presented in early January and the Secretary of State will be making a decision in February. I appeal today for the Secretary of State to suspend the entire process, because it has been perverted in the way that I have outlined.

I do not hold the TSA personally responsible. I have met him on a few occasions and find him to be a reasonable and rational person. However, I know that the devastating impact of his report is on Lewisham hospital—the impact there is beyond anything that will happen at Queen Mary’s, the Princess Royal or the Queen Elizabeth. The report will result in the closure of the accident and emergency department, and all medical and surgical emergency care, all maternity services, all children’s services and all critical care will cease on the Lewisham hospital site.

I had an Adjournment debate on this subject a couple of weeks ago. My right hon. Friend Dame Joan Ruddock and my hon. Friend the Member for Lewisham East

(Heidi Alexander) both raised the issue in the Opposition-day debate on health just last week. If I were to raise this matter every day in this House, I could not adequately reflect the burning resentment and anger that it has caused in the community in Lewisham, as the injustice is so severe. The Department could not appoint a special administrator to look at Lewisham Hospital NHS Trust, because it is a solvent, well-managed trust meeting all its performance and financial targets. What the Department has done is appoint an administrator next door and then, under the bogus and completely facile assumption that everything connects with everything else, focused on Lewisham hospital. That is what is completely devious about this.

At the public meetings the TSA has held on the matter, he has shown a little film setting out what he is trying to do. It included him quoting this age-old homily, “If your domestic finances are in mess, clearly you have to do something about it.” I do not dispute that the finances of the South London Healthcare NHS Trust are in a mess. At the meeting in Sydenham one of my constituents said to him, “If your domestic finances are in a mess, you may well have to do something about it, but that does not include breaking into next door’s house and nicking all their stuff.” That is precisely what is happening under this system. This procedure is being used for the first time. If it is used in that way, the Department will set a template for the rest of the country. It will then, in theory, be able to appoint a TSA anywhere and his or her remit will be such that they can look anywhere; they will not just focus on the area or trust they have been established to look into.

The Prime Minister and the Secretary of State repeatedly parrot four tests for reorganisations and reconfigurations. The first is that they should have general practitioner and clinical commissioning group support. The second is that they should have public engagement. That is a strange use of the vague term “public engagement”; they do not specify “public support”. The third is that the proposals have to be clinically sound. The fourth is that they have to increase patient choice. None of those factors exists in the recommendations for Lewisham hospital, and the TSA does not even maintain that they do. He openly admits that the proposals will reduce patient choice sharply. The clinicians, the hospital board, the CCG, and various groups of GPs across Lewisham and beyond all say that the recommendations are a threat to the standard of care that the people of Lewisham can expect and all are opposed to the TSA’s proposals. I say to the Secretary of State, via the Under-Secretary of State for Health, Dr Poulter, that he should abandon the scheme now, as the way it has been undertaken is clearly flawed, and he should protect the services that my constituents and people across south-east London have a right to expect.

12:15 pm
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Therese Coffey (Suffolk Coastal, Conservative)

It is a great pleasure to speak in this debate on a particularly important topic, in which the Minister shares an interest, as we are neighbours. First, I wish to thank our front-line staff in the ambulance service, our paramedics, who work very hard. I also thank our volunteers, the community first responders, who do a great job and genuinely participate in helping to save lives in our communities.

That is particularly important in the shires, as reaching someone in just a few minutes to provide life-saving treatment is crucial. I thank those people who give up their time.

A reorganisation is taking place in the east of England ambulance service, and I know that that is a concern to staff, who feel that patients will not get the treatment that they deserve. Change is always unsettling, but I genuinely believe that the management are trying to do this for the best reasons. One of the things we need to keep ensuring is that patient safety is the key priority.

The east of England ambulance service is hitting its targets—it has a regional target. Given that our region is so vast, it is no surprise that by focusing on certain cities it is relatively straightforward to hit targets. However, when we break down the performance by county, we start to see a very different story. I know that my colleagues from Suffolk and, indeed, my hon. Friend Norman Lamb have long been campaigning on that issue to try to raise it up the agenda, and it is vital that we do so. The presence of a new interim chief executive may start to help us to tackle that. We need to work hard to keep the chair and the board of the ambulance service on their toes, so that they recognise that saying that they have hit a regional target does not mean that the issue will go away—it will not.

One of the things I call on the board to do is think carefully about its responses to Members of Parliament when we are asking for greater transparency on performance. Belatedly—I am pleased that it has done this—there is an agreement that it will start to publish county by county performance details on a monthly basis. I believe that the board should and can go further. We already know that it provides performance data by postcode to the primary care trusts, and I believe those data should be published—they should certainly be available. Instead of getting into freedom of information exchanges, we need to ensure that, in line with what Sir David Nicholson told the Public Accounts Committee, every Member of Parliament should be able to get access to the data they need easily in order to monitor what is happening for their constituents and not be caught in a bureaucratic nightmare. As we all know, sunlight often brings a change in performance. Somebody trying to get to a village such as Shingle Street finds that it takes 10 minutes to get there just from the main road. When I say “main road” I am referring to a single track road. I recognise that not everybody will be able to do that, but it is still important that we try to get the postcode data published.

Earlier this year, after a successful meeting with my right hon. Friend Mr Burns, a Health Minister at the time, I was under the impression that there would be a contract with the county performance targets built into it. Indeed, that was important for the paying of bonuses. Disappointingly, the contract that was agreed with the ambulance service by the person agreeing it on behalf of the primary care trusts in the east of England contained an added caveat about hospital handover times. We know that that is an issue, but another thing that Members of Parliament are doing is putting the spotlight on where there are those problems as well. Ultimately, we want the best ambulance service

for our patients. We should not have to put up with sub-standard performance simply because the county is rural.

One disappointing thing about the contract, from which we expected so much, was that there seemed to be a lot of wriggle room. The new interim chief executive knows that well, as he negotiated the contract on behalf of the primary care trusts. He knows the issues our ambulance services face and I shall press him to ensure that the contracts this time make it clear what percentage of people in Suffolk should expect to see an ambulance within the regulated time.

Another thing that went wrong was the complaints process, although I am delighted that the chair of the ambulance trust has fixed that. I pay tribute to her and her staff for sorting that out. All these problems together have led me to voice my opposition—I will continue to do so—to the trust’s being allowed to have foundation status before a quality service is delivered consistently across the region. Simply placing ambulances close to Cambridge, Ipswich, Norwich, Luton and so on—near the big conurbations—is not fair on our rural areas. I point those people who say, “Well, it is a rural area,” to the example of the north-west. Cumbria has very similar characteristics as a pretty rural area with some big towns, yet the service there manages consistently to hit its targets.

Is there light at the end of the tunnel? I hope so. It is clear that MPs from Suffolk and across the east of England will not let up on the issue and I hope that we will have a step change in performance when we meet again in February.

Health care is very important to the people of Suffolk, but I also want to take this opportunity to thank my staff for all the hard work they have done in the last year. They have been extraordinary in helping my constituents tackle all sorts of issues and have also been very helpful this week, as we have sent out a mailshot of nearly 4,000 letters on Sizewell C—another issue that I share with my hon. Friend the Minister—and the impact that could have in the future. On that note, Mr Deputy Speaker, I wish you a happy Christmas.

12:21 pm
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John Healey (Wentworth and Dearne, Labour)

I wish to take the unusual step of telling the House and the Minister about the individual case of little Vinny Duggan to highlight a wider problem that the Government can solve by making legal changes so that other patients and other parents such as Andy and Andrea Duggan do not have to go through what this family has gone through in the past two and a half years. As Andrea has said to me, this is their fight, but it is also a fight for other people in their position.

I have been involved with the parents in the quest for information for only 10 months, whereas Mr and Mrs Duggan have been battling since Vinny was born nearly two and half years ago. At times, Vinny has fought for life. He is now a little lad who is full of life. I was with the family on Saturday, and he was smiling, laughing, climbing on the sofa and climbing on me, but he has a very serious congenital heart and lung condition. He has brain damage, likely to have been caused by a

lackof oxygen, and he is unlikely ever to be able to speak. His parents have told me that they are very proud of Vinny and very grateful that they still have him here.

It has been touch and go at times. He was born on 20 August 2010 at Doncaster royal infirmary. He was full term and was a healthy 7 lb 9 oz. However, within the first day his mum, in particular, became concerned that he was very blue, that he was not feeding properly and that he was very sleepy. The following day, he was diagnosed with a heart murmur and the day after that he was discharged against the parents’ wishes, as they were concerned and wanted tests done before he was discharged. He was at home for two days and after that time, when he had not properly woken up or properly fed and had stopped wetting his nappies, they phoned the hospital and were advised to take him to the children’s observational unit, where they arrived at 7 o’clock that evening.

Within the first hour, they were assessed by a triage nurse as non-urgent—green, in other words—and had to wait almost another five hours before a doctor saw them. During that night, Vinny was put on a heart monitor and given the tests he needed. He had a very high heart rate and was transferred rapidly to the specialist unit at Leeds general infirmary. He was diagnosed as having a very serious life-threatening heart and lung condition. He was given open heart and major lung surgery and spent five months in Leeds hospital, six weeks of that in intensive care and 10 weeks in the high-dependency unit.

The internal investigation at Doncaster hospital afterwards concluded that there were “no real concerns” about the standard of care in Vinny’s case, despite the fact that there were many chances to notice that he was unwell, to do the tests that could have been required and to listen to Mr and Mrs Duggan’s concerns. There remain important discrepancies between the evidence of the parents and that of some of the staff and the hospital in the investigation. It took two years and a new chief executive before, six weeks ago, Mr and Mrs Duggan received a welcome letter from the new acting chief executive, Mike Pinkerton, who ended by saying:

“The care that Vinny received fell below the standard you have a right to expect from us and I do sincerely apologise.”

Like so many other parents, Mr and Mrs Duggan had principally wanted an explanation—not retribution or compensation. However, like many parents, they were driven down the route of trying to get answers through the courts, and that is what they are having to do. They also rightly turned to the professional body, the Nursing and Midwifery Council, which is responsible for regulating Britain’s 670,000 nurses and midwives. Mrs Duggan submitted a complaint in September 2011, which was turned down in January 2012. She challenged it, which caused the council to look again at the argument that there was no case to answer, and the internal review concluded that the case should be referred back to the investigating committee for reconsideration.

The Nursing and Midwifery Council, however, has limited powers to review its decisions and that has been reinforced and restricted further by a High Court judgment in May in the case of R(B) v. NMC 2012. In other words, the NMC does not have the legal powers it needs

to review its own decisions. The chief executive, Jackie Smith, was good enough to meet me in the summer and to agree to commission independent legal advice on Vinny’s case and on the NMC’s restrictions. That independent legal advice came from Mark Shaw QC, who concluded:

The Order and Rules makes it plain that the NMC has no statutory power to review, re-open or reverse a disciplinary decision (in particular, a decision of the Investigating Committee that a registrant has no case to answer) beyond the specific circumstances stipulated in rule 7, namely: receipt of a fresh allegation within three years of the dismissal of a previous allegation against the same registrant.”

He went on to point out:

“Typically, other professional regulators have wider review powers, granted explicitly by secondary legislation.”

Those other professional bodies include the General Medical Council, which is responsible for regulating Britain’s 250,000 registered doctors. The GMC’s powers were rightly extended in 2004, so it has the power to review and re-open a complaint, to take a view that its earlier decisions might be flawed, to take new evidence into account and to act. It is considering a review of the complaint lodged with it about a doctor involved in this case and we expect a decision imminently.

The General Optical Council and the General Pharmaceutical Council have similar powers; the General Dental Council does not. At a time when complaints from patients are rising and pressures on staff are increasing, if we are to maintain trust and confidence in our health professionals and the NHS, we must have a better and more open system of complaints and we must have regulators with the powers to do the job they are set up to do: safeguard professional standards and safeguard patients and the public, too.

I know the Law Commission is reviewing the common enabling legislative framework for all health regulators. That could take three years, so I want the Minister to confirm today that he knows that there is a problem and that in the meantime, in advance of the Law Commission’s report, he will act to change the operating rules and orders so that those professional bodies can do the job. Otherwise, many other patients and parents will face the same fight for the truth—

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Nigel Evans (First Deputy Chairman of Ways and Means; Ribble Valley, Conservative)

Order.

12:29 pm
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Jeremy Lefroy (Stafford, Conservative)

In September 2012 the Royal College of Physicians published a report, “Hospitals on the edge? The time for action”, which sets out starkly the challenges facing our acute hospitals. It begins:

“All hospital inpatients deserve to receive safe, high-quality, sustainable care centred around their needs and delivered in an appropriate setting by respectful, compassionate, expert health professionals. Yet it is increasingly clear that our hospitals are struggling to cope with the challenge of an ageing population and increasing hospital admissions.”

It highlights the consequences of failing to meet the challenges and refers to the history of my own trust. When the public inquiry reports next month, we will have the opportunity to consider its implications for the NHS. Today I wish to concentrate on the Monitor

review of my trust in the light of the continuing rise in pressure on acute services that the Royal College of Physicians highlights.

There are three common themes that I hear in the NHS these days. The first is that we need to do much more in the community and at home and much less in acute hospitals, and that we must therefore close acute hospital beds and use the money in the community. Although I agree with the premise, I dispute the conclusion. Community care is essential, but it must work before it results in a reduction in admissions and lengths of stay. The fact that admissions are rising and, according to the RCP, the fall in length of stay has flatlined in the past three years, even rising for patients over 85, indicates to me that the shift to the community either is not happening fast enough or indeed will not happen as expected.

The conclusion also seems to ignore demography. In the area served by the Mid Staffordshire Trust, the population is expected to rise by some 10% in the coming 23 years. The number of people over 60 will rise by nearly half, and the number of those 75 and older—those most likely to need acute services—will double. I suspect that is the situation in many parts of the country.

Increasing admissions, rising and ageing population, flatlining length of stays—all of these indicate an increased demand for acute services in the coming 20 years, yet the talk is, and has been for many years, of further reductions in acute beds. It makes little sense to do that until community services and other medical advances mean that those beds are proved to be no longer necessary. In Stafford, there is a shortage of step-down beds, so rather than closing acute beds altogether why not keep them as community beds on the same site, leaving the door open for increasing acute services in the future, if and when the need arises?

The second theme is that we need to integrate primary and secondary care more closely. I agree, yet actions sometimes have the opposite effect. The previous Government took away the responsibility for providing 24/7 primary care cover from GPs. I regret that, as it detracts from integration. It may also be responsible for placing a greater burden on accident and emergency departments at night. If out-of-hours care is not to be the responsibility of GPs, let it be centred, where geographically possible, on acute and community hospitals. This makes better use of NHS premises and, by being adjacent to A and E or other emergency units, can help take the pressure off them while providing the hospital with extra income. That would certainly work at Stafford and Cannock.

Tariffs can produce strange results. The University Hospital of North Staffordshire has a block contract for A and E admissions. For any admission in excess of that, it receives only 30% of the tariff, so what is it supposed to do—reject emergency admissions on the basis that they will be loss-making? Of course not. I would propose that emergency departments are funded at what it costs to provide that service safely. In Stafford, the emergency department has a deficit of some 2 million per year based on throughput and tariff. The number of patients attending—more than 50,000—could not possibly be safely accommodated elsewhere. Surrounding hospitals

are already at capacity, so it makes little sense to impose a national tariff, which inevitably results in a loss and which in turn puts pressure on the hospital to prove that it is sustainable.

The third theme is that medicine is becoming increasingly specialised, so most work will inevitably migrate to large specialist units. There is truth in this belief, but there is also danger. There are 61 approved medical specialties in the UK, compared with 30 in Norway. As the RCP says, this has

“rendered the provision of continuity of care increasingly difficult.”

For older people, who often have complex and multiple needs, this can result in poorly co-ordinated care. This has not been helped by the introduction of shift-based systems under the new deal and the European working time directive, to replace the teams that took responsibility for individual patients. Specialisation also means that there is a much smaller pool of staff from which to select for each post.

If we were to design from scratch a hospital where those who will need it most— the elderly, as the statistics show—will receive safe and caring care for their complex needs as close to home and loved ones as possible, integrated into primary and community care, we would end up with something pretty much like the district general hospitals and community hospitals up and down the country, such as Stafford and Cannock.

This is not an argument for no change. I believe there must be much closer working between the larger and smaller trusts, for instance, and much more sharing of common services than at present. But it is a warning that national tariffs are not impartial arbiters. They generally work, I believe, against acute care.

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Jim Dowd (Lewisham West and Penge, Labour)

I am following what the hon. Gentleman is saying most carefully, as this is part of the problem that we experience in Lewisham. Does he feel, as I do, that instead of reflecting the needs of the population across the country and providing services that correspond with that, the Department of Health is trying to implement a template or a framework of its own making and inflict it on the nation?

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Jeremy Lefroy (Stafford, Conservative)

I thank the hon. Gentleman for his intervention. I am not convinced that that is the case at all. I believe Ministers are listening and are considering matters very carefully, but there is a danger, of course, that a template will be inflicted. The hon. Gentleman and I both earnestly trust that that will not be the case.

As I said, I believe that national tariffs are not impartial arbiters. They generally work against acute care, and there is a risk that the constant pressure which they are placing on acute care, particularly in district general hospitals, will make much of the sector unsustainable, yet without it, we do not have an NHS.

Finally, I wish to raise a specific point about Monitor’s review of Mid Staffordshire. Clearly, the population served by the trust is a very important consideration. The trust’s 2011-12 report said that it was around 276,000, yet I have heard reports that the Monitor team considers it to be as low as 220,000 and therefore potentially too small to sustain certain services. The facts that I have clearly support the trust’s figure, not the one that I have heard rumoured.

I have spoken much today about figures, because they are an important part of the Monitor review, but more important is the quality of services, for which Monitor also has a legal responsibility. Early next year, the Secretary of State will bring to the House the report of Robert Francis QC from his public inquiry into Mid Staffordshire. Julie Bailey and the Cure the NHS group, who from their own experiences brought to light the harm that was done, have set out radical and clear ideas for turning the NHS the right way up, with the patient at the top, not the bottom—right first time with zero harm to each and every patient. That is something which caring, hard-working staff in our NHS in Stafford and Cannock—where waiting times and mortality rates are improving, although there is much to be done—and right across the country went into the NHS to provide.

The NHS, as John Healey said, and the nursing and medical professions must make it clear that there is no place for anyone for whom quality patient care does not come above all else. The regulations must show that.

The Monitor review is an opportunity for Stafford and Cannock hospitals to become a model of how to provide sustainable high quality emergency, acute and community care to a mid-sized population. If Monitor succeeds in achieving this there and elsewhere, as Jim Dowd mentioned, it will have done the nation a great service, and I am sure the Minister will be remembered as someone who played a major part in improving our NHS. I urge Monitor to rise to the challenge.

12:38 pm
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Grahame Morris (Easington, Labour)

I thank the Backbench Business Committee for making this debate possible before the Christmas recess. I shall raise an important issue, access to advanced therapeutic radiotherapy. I have raised this previously and I make no apology for doing so again. I intend to keep raising it until my constituents and those all across the country have proper access to advanced and innovative therapeutic radiotherapy systems.

I remind the House that prior to the Conservative party conference the Prime Minister pledged that from April next year cancer patients who need innovative radiotherapy will get it. That pledge was confirmed to the House by the Secretary of State for Health on 23 October and by the Under-Secretary of State for Health, Anna Soubry, who has responsibility for cancer services, in written replies on 30 October.

The Department of Health’s press release on 8 October expanded on the Prime Minister’s statement, indicating that a new 15 million cancer radiotherapy innovation fund was being created, drawn from the underspend of the cancer drugs fund. I bring to the House’s attention the fact that the 200 million cancer drugs fund has been under-spent by an average of 150 million each year since it was established. That was reported to the House on 16 April 2012—column 134WinHansard.

The Health Minister confirmed on 30 October that the pledge meant three specific things: patients would have access to appropriate radiotherapy wherever they

lived; the new national Commissioning Board would be responsible for funding; and intensity-modulated radiation therapy, known as IMRT, stereotactic ablative radiotherapy, know as SABR, and stereotactic radiosurgery would be included.

Since the Prime Minister’s pledge, the Department of Health has contacted all cancer centres to inform them that the cancer radiotherapy innovation fund is a revenue fund only and that its use is to be focused on getting as many centres up to the standard of delivering 24% access to IMRT by April next year. In a letter to all cancer centre chief executives on 17 October, the cancer tsar, Sir Mike Richards, stated that only four of the 50 centres were reaching the 24% requirement set by the national radiotherapy implementation group.

In a letter to all radiotherapy service managers on 25 October, the national cancer action team stated that the cancer radiotherapy innovation fund was to be used effectively so that the Prime Minister’s pledge could be honoured and that if they are not delivering IMRT at the required 24% they were to submit an action plan by the end of November indicating how they would achieve that.

The letter also stated that the radiotherapy service managers could access initial funding of up to 150,000 to help them reach the target. However, the Health Minister, when questioned about funding for the pledge on 30 October, told the House that there would be no extra or ongoing funding similar to the cancer drug fund for commissioners to draw on and that any capital funding requirements would have to be met from the current 300 million bulk purchase fund announced earlier this year. In other words, there was no extra money. It seems to me that the pledge cannot be met, in terms of both revenue and capital.

Over the past two years adequate revenue funding has never been available to local commissioners to fund all the radiotherapy patients who have needed it. I know that full well from cases in my constituency. There is no indication that the new national Commissioning Board is to receive any additional funding. Without extra money, how will it fund care for the new 8,000 to 10,000 cancer patients the Prime Minister claims his pledge will help?

I would like to consider capital for a moment. I received an e-mail last night from the charity Breast Cancer Campaign, which indicated that, given the current age profile of the linear accelerators in England, an additional 147 new LINACs will be needed by 2016, at an average cost of 1.5 million. I want to ask the Minister how those will be funded. There are simply not enough advanced radiotherapy systems in the NHS to deliver the pledge. The Department of Health has admitted that only four of the 50 cancer centres are able to deliver IMRT to the required standard. At full capacity they could treat between 1,200 and 1,500 patients a year.

There are only four systems in the NHS delivering SABR up to the required standard, as the Minister has confirmed in written answers, and I have been to see one of the machines in St Bartholomew’s. At full capacity they could treat 1,000 patients a year. There is only one Gamma Knife in the NHS delivering stereotactic radiosurgery—in Sheffield—and at full capacity it could treat around 300 patients a year. With no extra capital available to fund new machines, it will be impossible for

patients in most of England, including my region, to be treated by the NHS. There are some machines in the private sector, but the treatment is very expensive.

I am asking not for more money for cancer care, but for a more equal distribution of resources. The Department of Health is telling commissioners that radiotherapy, in conjunction with surgery, is very effective, curing 70% of all cancers. I have come here neither to lambast the Minister, nor to condemn him with faint praise; I have come bearing gifts, as it is Christmas, in the form of a potential solution. If the total underspend from the cancer drugs fund was transferred to radiotherapy in each of England’s regions, the systems could be upgraded with the most advanced radiotherapy equipment by 2015, which would enable constituents in my region and across the country to access life-saving therapies and allow the Prime Minister to fulfil his pledge.

12:46 pm
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Keith Vaz (Leicester East, Labour)

It is a pleasure to follow my hon. Friend Grahame M. Morris. I share the concerns of all right hon. and hon. Members who have spoken so far about the importance of our national health service and our concerns about its current state. I think that the Minister—I have said this to him privately—is one of the most effective of the junior Ministers who have appeared at the Dispatch Box since the reshuffle. Because he is a doctor, I hope that he will take the concerns that I raise today on diabetes extremely seriously.

I suffer from type 2 diabetes—I declare my interest—having discovered it only five years ago after a routine test. I thought I had it under control, because I was taking my medication and doing a little exercise every day, walking from Norman Shaw North to the Palace of Westminster, until I read the national diabetes audit report published on 10 December. It states that people with diabetes are 48% more likely to suffer a heart attack, 65% more likely to have heart failure, 144% more likely to need kidney dialysis, 210% more likely to have leg amputations, 331% more likely to have part of a foot removed and 25% more likely to suffer a stroke. Overall, those with diabetes are, on average, 40% more likely to die each year than those without it. Members will understand my concern, as we approach Christmas, after reading statistics of that kind.

I know that other hon. Members have subsequently discovered that they, too, have diabetes. My hon. Friend Phil Wilson, who is in the Chamber, discovered he had it only after being tested here in Parliament by the Silver Star charity. He went to see his GP and then knew that he had been diagnosed.

We are facing a diabetes epidemic, and I ask the Government to take more note of what is happening as far as diabetes is concerned. Generally, people with diabetes look fairly normal—I do not know whether you think I look normal, Mr Deputy Speaker—and do not make a virtue of telling people we have diabetes, except in debates of this kind. That normality lulls us into a false sense of security. We need a national campaign on diabetes in the same way as for other illnesses. Because people are getting treatment and are able to go and get their Metformin or other medication on a regular basis, they feel that everything is going to be all right.

This issue will not only not go away but will get worse. At the moment, 3.7 million people have diabetes, and that figure will rise by another 700,000 in a few years. Some 80% of amputations are preventable with proper care and management. I say to Ministers that this is something we can help the population with now. If we do so, we can save the 10% of the budget that is currently spent on diabetes care and the 1 million an hour that is spent on medication and care in our hospitals. These issues are very much in our hands.

I welcome the new Minister with responsibility for diabetes, the Under-Secretary of State for Health, Anna Soubry, who has made an excellent start. The first thing she did was to hold a summit for those with an interest in diabetes. It included Diabetes UK, which does some fantastic work on the subject, Silver Star, a charity of which I am privileged to be the patron, and others, including clinicians. She said what very few Ministers have said in my career in this House—“I want you to tell me what I should do about this subject”—and she was given a lot of good advice and ideas about how to take these matters further.

One thing that we could do immediately is to send out the message to GPs, even in the current climate of ongoing changes within the NHS, that it takes only a minute to offer each patient who comes to see them a diabetes test. I know that we are having screening for those of a certain age and disposition, but people go to see GPs for all kinds of reasons. Campaigning organisations such as Silver Star and Diabetes UK are able to go out to communities and conduct these tests. Indeed, anyone can conduct them. I have my kit with me, and although I am obviously not medically qualified, I can still conduct the test on people and am happy to do so. It is very easy to do. We should say to GPs, “Don’t wait for the screening process—begin now by testing anyone who comes to your surgery.”

We need to send out through the Department of Health a message about what we eat. You have changed physically, Mr Deputy Speaker, in all the years I have known you. I know of your great interest in rugby. You used to be a very beefy character when you were first elected to this House, but you have slimmed down, perhaps since you have been an occupant of the Chair. If people look after their lifestyles better by taking exercise and being careful about what they eat, that could help them. Every time anyone drinks a glass of Coke, eight teaspoons of sugar go straight into their system. When I went over to Atlanta and met the chief executive of Coca-Cola, I asked him what he was doing about it, and he said that Coke Zero is the answer, but it is only part of the answer. The kids in our schools are offered drinks in vending machines which have a huge amount of sugar, and then they get addicted to it for the rest of their lives. This is about things that we can do ourselves and things that parents can do to bring down the bill for the NHS.

When I finish this speech, and after I have listened to the Minister, I will be going to the Tea Room. When we get to the very helpful people there, we find that we have chocolates and mince pies on offer to us. If we turn to the left, we see a lot of food that is totally unfit for diabetics. Of course, I continue to eat this food because we do not have a choice, but it would be possible,

through labelling of the drinks and food that we consume, as for people with a nut allergy, to add the words “Suitable for diabetics” or “Unsuitable for diabetics”.

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Jeremy Corbyn (Islington North, Labour)

My right hon. Friend is making an absolutely excellent speech. Does he think that we should take the bull by the horns and legislate to reduce the amount of sugar in all food products? If we look at any kind of food, we often find totally unnecessary sugar in it as well as in all the soft drinks that he mentions.

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Keith Vaz (Leicester East, Labour)

Yes, I do. However, I remember that one time I met my hon. Friend when he was off to have dinner with his sons and was taking them to McDonald’s.

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Jeremy Corbyn (Islington North, Labour)

No, that is not true. I wish to place on the record that my right hon. Friend has been deeply misled on this matter. I have not taken my sons to McDonald’s, I have no intention of taking them to McDonald’s, and I have no intention of visiting McDonald’s myself. Is that clear?

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Keith Vaz (Leicester East, Labour)

I will not tease my hon. Friend, but I think that the word “McDonald’s” did enter the conversation somewhere. However, I accept that his response is now on the record.

I would support legislation aimed at ensuring that we are very careful about the amount of sugar, and salt, in our diet. Indeed, I have introduced a ten-minute rule Bill that says exactly that. Denmark started a “fat tax” but then decided that it was unworkable because the food industry lobbied so heavily against it, and so the tax was removed. I am not saying that the Government are going to legislate on this; I do not think they will. The food industry is one of the most powerful in this country. The sugary drinks industry, from Red Bull, a can of which contains more than eight teaspoons of sugar, right down to the people who make Coke and all these other drinks, will fight very hard on this. In the meantime, let us send out a message and work together to stop this epidemic consuming and subsuming our country.

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Nigel Evans (First Deputy Chairman of Ways and Means; Ribble Valley, Conservative)

For the wind-ups, the guideline on speeches is 10 minutes, but the clock will not be in operation.

12:56 pm
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Daniel Poulter (The Parliamentary Under-Secretary of State for Health; Central Suffolk and North Ipswich, Conservative)

I have very much enjoyed sitting through this debate on health. I remember that when we had the equivalent debate last year, many speakers did not have the time they wanted to make their speeches. The fact that we have had longer today has enabled many right hon. and hon. Members to make valuable contributions on a number of subjects, focusing not only on health care issues in their constituencies and on important individual cases that highlight the need for changes in the system, but on the big challenges that face the NHS in tackling long-term medical conditions.

In the time available to me, I will do my best to answer the questions and points put across by Members on both sides of the House. My hon. Friend the Member

for Stafford (Jeremy Lefroy) and I have met on a number of occasions, along with my hon. Friend Mr Cash, to talk through the challenges facing Mid Staffordshire trust. My hon. Friend the Member for Stafford has been a great advocate for, and a great support to, the patients and staff at that trust. I would like to put on record my thanks to him for all that he has done for all his constituents. His advocacy during his time in this House has been tremendous.

My hon. Friend the Member for Stafford raised some important issues. We know that it is desirable, not only because it makes good health care economics but, more importantly, because it is good patient care, to keep people well and looked after in their own communities and in their own homes. My hon. Friend threw up a legitimate challenge when he said that if we are to deliver good care in the community and in people’s homes, we need to find a way of moving from the current situation. At the moment we have a crisis management response by default, where people are rushed into A and E, and he is right to highlight the fact that some parts of the country do not have an adequate GP out-of-hours system to look after people around the clock. We need to ask how we go from a system set up around crisis management to one that is better placed to meet the future needs of preventive care and looking after people with long-term conditions such as diabetes, dementia and heart disease in their own homes and communities. The Government are taking steps to address this issue by making sure that GPs and local health care commissioners, through clinical commissioning groups at a local level, will hold a lot of the health care budget. That will ensure that the focus is on primary preventive care and on better looking after people with long-term conditions.

My hon. Friend is right to say that we need sufficient numbers of hospital beds, but as time passes there might less need for beds in some hospitals if local CCGs effectively meet the challenge of ensuring that that they invest in community and preventive care. In the interim, we need to support good commissioning of beds locally. We must have intermediate care beds available at community hospitals and in other care settings in the community for step-up care, step-down care and respite care.

On the other side of the River Thames, the clinical director of St Thomas’ hospital, Ian Abbs, is looking into year-of-care tariffs, which look after patients with long-term conditions such as diabetes and heart disease in a holistic way that enables them to be supported when they need a hospital bed and need to be looked after in the community. That has to be the right way forward. We in the Department’s ministerial team will work with clinicians, medical directors, trusts and commissioning boards to make sure that Eurocare tariffs are in place, so that we can shift the focus away from the community, but in a managed way that means that hospital beds will still be available as people require them.

Grahame M. Morris has been a strong advocate—he has raised his concerns many times—for constituents and others throughout his part of the country who are patients who need access to cancer care, cancer services, the cancer drugs fund and, indeed, high-quality radiotherapy. It is worth

setting out some of the background—he outlined it himself in his speech—to the Government’s commitment to improving care for patients with cancer.

In 2011 the Government made a commitment to expand radiotherapy capacity by investing more than 150 million more over four years from 2011. As the hon. Gentleman knows, that was to increase the utilisation of existing equipment, support additional services and ensure that all high-priority patients with a need for proton beam therapy get access to it. In April 2012, the then Secretary of State announced that the Department had set aside up to 250 million of public capital, to be invested by the NHS in building proton beam therapy facilities at the Christie hospital in Manchester and the University college London hospital, to treat up to 1,500 patients each year. In October we announced a 15 million radiotherapy innovation fund for 2012-13, which brings this Government’s additional investment in radiotherapy over the spending review period to more than 165 million. The fund is designed to ensure that, from April 2013, radiotherapy centres will be ready to deliver intensity-modulated radiotherapy to all patients who need it.

The hon. Gentleman was right to say that, in spite of that increased investment, there are ongoing concerns about the variability of access to radiotherapy services in the NHS. I hope that it will reassure him that, in response to the requests of radiotherapy centres to the fund, we will go beyond the original commitment and will this week notify the centres of allocations totalling almost 23 million. We have taken on board the hon. Gentleman’s concerns and are making sure that we continue to invest in high-quality radiation in the years ahead. I know that he will hold the Government to that task in the coming years.

John Healey has rightly raised issues of principle arising from the Vinny Duggan case. I want to put on record my best wishes to the family concerned. I will deal with two issues: first, the issue that arose from the way in which the trust handled the complaints procedure, and secondly, the wider point about the Nursing and Midwifery Council.

First, as the right hon. Gentleman has highlighted, the trust clearly failed to acknowledge to any adequate degree that mistakes happened and that the quality of care was not of the standard that it should have been. That much was clear in this regrettable episode in the trust’s history. Two years is an unacceptable amount of time to wait for an apology or for an adequate explanation for what went wrong. The right hon. Gentleman is absolutely right to say that what patients want when things go wrong is a sincere apology and an explanation as to why things happened. We all know, no matter how good the care is in the NHS, that bad things will sometimes happen, but we need to know that that mistake has been recognised, that there has been an apology and that lessons have been learned for the future. We cannot rewrite history or always unpick mistakes, but we can learn lessons for the future and make sure that such bad things do not happen again. That is what good medicine is about. Clearly, in this case there were problems with the way in which the complaints were addressed.

Secondly, on the wider point raised by the right hon. Gentleman about the NMC and the disparity between how different professional regulators approach the complaints process, he is right that the NMC can review or reopen a case only when new evidence is available. If old evidence is reconsidered or if it changes, as in this case, it is very difficult to review it. There are differences between the medical and other professional regulators with regard to how such cases are handled, and the Law Commission has rightly highlighted those inconsistencies. There needs to be more consistency throughout all parts of the medical, nursing and allied health professional groups, in order to make sure that patients know that, when complaints are made and concerns are aired, they will be looked into and, where necessary, complaints can be reopened and reinvestigated.

The Law Commission proposals are expected to be introduced to the House in 2014. The right hon. Gentleman asked whether we could do anything sooner than that, but, as he will know, if we brought in a section 60 order, it would take about two years for it to get through the full parliamentary process. Given that the Law Commission proposals are holistic and apply to not just the NMC, but all health professions, we believe that the right approach is to consider those proposals in 2014. We hope that that will bring a lot more consistency, which I think we all feel is desirable, to future cases involving the professional conduct of all medical, nursing and other health care professionals.

I thank my constituency neighbour, my hon. Friend Dr Coffey, for her kind comments about the work that I, other Suffolk MPs and, indeed, the Minister of State, Department of Health, my hon. Friend Norman Lamb, have done in relation to problems with the East of England ambulance service. People in more rural counties, particularly North Norfolk and parts of Suffolk, appear to be getting a service that is not of the standard that we would expect. We need more transparency with regard to response times, not just on a regional level, but on a county-wide level. My hon. Friend the Member for Suffolk Coastal asked whether there could be a breakdown by postcode. That is a little more challenging, because it is possible that, in any given month or response period, not enough people in a particular postcode will need an ambulance. There is a desire, however, for more transparency with regard to sub-geographical regions.

My hon. Friend Peter Aldous has also taken a keen interest in the issue and has recently been out with the ambulance service on a number of evenings.

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Peter Aldous (Waveney, Conservative)

I am grateful to my hon. Friend Dr Coffeyfor raising the issue and to my hon. Friend the Minister for responding. Having been out with the ambulance service, I have two observations. First, does the Minister agree that we have tremendous, dedicated staff and that we owe it to them to work with the management and others to get the service right? Secondly, the problems facing the service are diverse and multiple, but they can be solved with a lot of effort. For example, on the particular problem of blocking at hospitals and handing over to them, James Paget hospital in Galston has shown that, when the hospital and ambulance service work together, the problem can be solved.

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Daniel Poulter (The Parliamentary Under-Secretary of State for Health; Central Suffolk and North Ipswich, Conservative)

My hon. Friend is absolutely right and I pay tribute to him for taking the time to go out with the ambulance service and see first hand the problems that have been experienced in some parts of Suffolk and Norfolk. There have been problems with the handover time at some hospitals in the east of England and that is clearly unacceptable, because if the ambulance and hospital staff are engaged in lengthy handovers, it means that other patients are not being treated and seen in a timely manner. Those issues need to be addressed by some trusts in the east of England.

My hon. Friend the Member for Waveney has written to the ambulance service and his letter was made available to my noble Friend Earl Howe. In it, he highlighted the trust’s decision to publish more performance information online from February and stated that it was important that that was done by geographical area to ensure that there is greater transparency in the quality of response data in areas such as Beccles and Bungay, relative to more urban areas such as Ipswich. That is an important point. I urge him and my hon. Friend the Member for Suffolk Coastal to continue pushing for transparency in the ambulance service’s data, and to continue their fight for improved response times for more rural areas of Suffolk and Norfolk. I know that my noble Friend Earl Howe would be happy to meet hon. Members to discuss the matter further.

Let me turn to the issues that were raised by the other three Members. I will be brief, Mr Deputy Speaker, because I take your hint. My hon. Friend Andrew Bingham raised concerns about a number of ambulance stations, including one in Buxton. I know that my hon. Friend Karen Bradley, who lives in a nearby constituency, shares those concerns. A review is currently taking place. We all welcome reviews if they are going to improve the quality of care for patients and improve ambulance response times. However, there are local concerns that the review must take into account issues such as rurality and the difficulties that patients on high land or in harder-to-access areas have in accessing all types of health care services.

I note the concerns that the review is making proposals that do not necessarily take account of those factors. My hon. Friend the Member for High Peak has put those concerns on the record today. If that has happened, I echo his concerns, because it is important, in the review of any service, that issues such as rurality and difficult-to-access areas are taken fully into account. This is, of course, a local health care decision. If he wants to discuss the matter further with Ministers, we are happy to discuss it with him.

Jim Dowd put across his strong advocacy for Lewisham hospital. I trained in south Thames and have colleagues who work at Lewisham hospital. We all know that Lewisham faces particular challenges. It has demographic challenges, given its difficult population groups with considerable health care needs, and great health care

inequalities. It has a large migrant population, which brings particular health care challenges and means that people do not always have English as a first language. Such people need to be looked after properly. It is important that those issues are taken into account during the discussions.

I take on board the concerns of local staff that they are being drawn into the big financial concerns with South London Healthcare NHS Trust. However, we also have to recognise that no one hospital operates in a vacuum. We must ensure that hospital services and the care that is provided reflect the needs of the wider geographical area. My right hon. Friend the Secretary of State will be looking into these issues.

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Daniel Poulter (The Parliamentary Under-Secretary of State for Health; Central Suffolk and North Ipswich, Conservative)

I will take an intervention very quickly, but I am pressing on Mr Deputy Speaker’s patience.

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Jim Dowd (Lewisham West and Penge, Labour)

Nobody disputes the Minister’s last point. That is why there is a reconfiguration process especially for that purpose. That is what should be used, rather than this back-door method.

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Nigel Evans (First Deputy Chairman of Ways and Means; Ribble Valley, Conservative)

Order. Please complete your contribution within 60 seconds, Minister, so that we can move on.

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Daniel Poulter (The Parliamentary Under-Secretary of State for Health; Central Suffolk and North Ipswich, Conservative)

I will do so, Mr Deputy Speaker.

I am sure that my right hon. Friend the Secretary of State will take those considerations into account when he receives the report and comes to his conclusions in due course. I know that the hon. Member for Lewisham West and Penge will continue to make his views clear.

Finally and importantly, I turn to the good remarks made by Keith Vaz. He is right to point out that one of the big challenges facing this country in health care terms is to better look after people with long-term conditions. Diabetes is a key challenge. Patients with diabetes have a higher risk of coronary heart disease, stroke, amputation, vascular disease and a number of other medical problems. One key way to deal with that is to focus more on prevention, rather than cure. That means investing in more GP-led care and primary prevention, rather than picking up the pieces in hospital. We should focus on helping people with type 1 diabetes to have a normal life by educating them to understand their condition, through the use of insulin pumps and by helping younger people to manage their condition.

The Government are committed to preventing diabetes and bad lifestyle habits from developing in the first place by focusing on better education in childhood. When local authorities have control of public health budgets, that will be a key priority for them. We must set good lifestyle habits from the early years to ensure that people do not develop diabetes later on.

Thank you, Mr Deputy Speaker.