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My responsibility is to lead the national health service in delivering improved health outcomes in England, to lead a public health service which improves the health of the nation and reduces health inequalities, and to lead the reform of adult social care which supports and protects vulnerable people.
Cheshire East council is working closely with local health care partners in my constituency to tackle the growing challenge of alcohol abuse, which not only causes serious illness and injury but costs our local primary care trust £34 million a year. Does my right hon. Friend agree that that is the right way in which to tackle this growing problem, and will a member of his ministerial team meet me, along with representatives of the council, to help secure the best possible outcomes in Macclesfield?
Of course we will support the efforts of my hon. Friend and his local council to tackle alcohol abuse. He will have heard what was said earlier by the Under-Secretary of State for Health, my hon. Friend Anne Milton, which I entirely endorse.
Local authorities and their communities should have a greater say in what happens in their areas. We will enable them to do so, through the Health and Social Care Bill, the establishment of local health improvement plans, and-as my hon. Friend the Under-Secretary said-the alcohol strategy that we will introduce following the public health White Paper later in the year.
No, I do not. I am glad that the hon. Gentleman has asked that question, because I think that there is a world of difference between the question of the exercising of clinical leadership by general practices as members of a consortium in an area and the question of from whom they derive management support. I believe that many will derive it from existing PCT teams, the voluntary sector and local authorities. Sometimes the independent sector will be involved, but it is a question of the consortium choosing where to go rather than being taken over.
Some care homes that have received critical reports from the Care Quality Commission are reopening under the same management but with different names. The CQC's practice is to remove earlier poor reports from its website, leaving potential customers in the dark about the poor record of those homes. Will the Minister remind the CQC of its responsibility to highlight poor practice in care homes, and request that it change its practice?
I will certainly ensure that the CQC understands that that is a matter of concern. When it discharges home owners and deregisters them, after receiving an application for a fresh registration, it conducts a thorough appraisal and assessment of their fitness to provide the service. The new owner of a home may well have done a great deal of work in improving the quality of training given to staff, but I agree that it ought to be possible for people to look at the CQC's website and see reports on the quality of the previous provider so that they can assess that as well.
A year ago, writing in The Sun, the Prime Minister made a firm and passionate pledge to increase the number of midwives by 3,000. Last week, the chief executive of the NHS told the Public Accounts Committee that the NHS is now short by 4,500 midwives. Will the Secretary of State tell the House when he intends to implement plans to honour the Prime Minister's pledge-or can we take it that it is just another Conservative broken promise on the NHS?
Well, I do not wish to embarrass the chief executive of the NHS, but actually, he told me he made an error-he was referring to health visitors, not midwives, when he was talking to the Public Accounts Committee. We are short of health visitors precisely because, through the life of the last Government, the number was continuously going down, and we are going to recruit more. Actually, we share the last Labour Government's commitment to increase the number of midwives, not least because of the increase in the number of births, and to do so in pace with that. As a consequence, in conversations that the Under-Secretary of State for Health, my hon. Friend Anne Milton, and I have had with the Royal College of Midwives, we have made it clear that we will do all we possibly can. We already have more midwives in training than at any other time in our history.
As Ministers are aware, GPs in north Cumbria are supportive of GP commissioning and are already working hard for its success. However, given the rural nature of the area, what support will be given to the local hospitals to ensure that they can provide secondary health care within the new regime, when they have to accommodate the additional costs of providing health care in a rural environment?
Yes, I entirely endorse what my hon. Friend says about GPs in Cumbria. They are indeed very forward-looking and show that, even under the last Government, practice-based commissioning was demonstrating its benefits, and we are building on that. I mentioned earlier the duty in the Health and Social Care Bill on the NHS commissioning board to reduce inequalities in access to health care. That will be important for rural areas. The pricing arrangements, led by the commissioning board and Monitor, must also take into account varying costs associated with the delivery of care in different localities.
If the Government will not even trust GPs with the responsibility of ordering flu vaccine, how on earth can they trust them with commissioning the care and treatment of cancer victims?
Of course, it was the last Government who agreed the arrangements with GPs. It was the last Government who, in 2007, undertook a flu review when central procurement of flu vaccine was recommended, but did nothing about it. The public health responsibility is distinct from the commissioning responsibility for health care of patients. We will look at, and we have still to make a decision about, how we procure flu vaccine in future years. We may do it through central procurement or through continuing GP procurement; but either way, we will make sure that we improve on the system we inherited.
The straightforward answer to my hon. Friend's question is, £18 million per annum. The decision to use single-use instruments as opposed to reusable ones is based on many complex clinical factors. For this reason, these decisions are left for the determination of local trusts on the basis of safety, quality and value for money.
May I ask the Secretary of State directly about leaked documents seen by The Northern Echo? They show that a £53 million NHS contract to provide health care services to the prison service in the north-east was awarded to a private company, Care UK, even though the NHS provider was marked higher on quality, delivery and risk. Care UK beat the NHS provider only on price. Is this confirmation of the Minister of State's remarks on Newsnight, that this Bill will create a full market and full competition?
The hon. Gentleman is asking about arrangements that we have inherited from his Government; they are from before the election and are nothing to do with the White Paper or the Bill. The contract to which he refers was let by the North East Offender Health Commissioning Unit. This was its procurement decision and it states that a competitive, robust and transparent process was followed. This was not a decision taken or influenced by the Department of Health.
In support of national obesity fortnight, which is currently running, I wish to raise awareness of this serious condition, which causes numerous deaths and other serious health conditions. Redditch has high levels of obesity compared with the average in England. NHS Worcestershire is doing a fantastic job, but what more can the Government do to ensure that the NHS will not be overly burdened with increasing obesity problems?
I thank my hon. Friend for raising this issue, and I know that her local council is running a number of schemes. As she knows, we have published a White Paper on public health, "Healthy Lives, Healthy People". In the spring, we will publish a document on reducing obesity, and we will set out how this will be tackled in the new public health systems and in the NHS. It is important to remember that at this time of year a number of people go on diets and try to lose weight and get fit, and I urge them all to carry on, including Members of this House.
Does the Minister accept that during times of illness people often experience associated problems, for example, difficulties with employment and housing, and personal problems, with which they can be helped by the information available through StartHere? Will he ensure that his Department and others treat StartHere as essential to the provision of high-level public service?
I am very grateful to the right hon. Gentleman for that question because, as he is aware from meetings that we have had, we have been supporting StartHere through NHS Choices. We are now reviewing the benefits of this joint working, and that will help us to understand potential contributions to savings to improve the information flow to those who may be excluded from the use of the internet. He may be interested to learn that I have today written to Ms Hamilton-Fairley, outlining where we are at the moment. I am anxious to resolve this as soon as possible, once the review has been completed.
What does the Minister think is the likelihood of the pathfinder consortia examining commissioning arrangements for neurological conditions? This is particularly important, because conditions such as Parkinson's are not familiar to many general practitioners, and commissioning arrangements for these complex conditions are tricky, so they need specialist knowledge. They need to be getting expert support and advice, including from patients and third sector groups.
The hon. Gentleman makes some important points about how the new system provides the opportunity to access a range of new resources to develop the way in which commissioning is provided for people with neurological conditions. Not the least of these are the way in which the Neurological Alliance is working to provide a new structure for its way of operating at the local level to offer commissioning support and, from the Department, how the neurological commissioning support group will be able to work with early implementers of the health and well-being boards and pathfinder GP consortia to provide them with the necessary support to develop their capability in this area.
The Minister of State referred earlier to Labour Members cherry-picking quotes, but I do not believe that Laurence Buckman, chair of the British Medical Association's GP committee, was mincing his words when today he described the Government's reorganisation plans as "fatally flawed", warning that they
"would see the poor, elderly, infirm and terminally ill in large parts of the country losing out".
Why does the Secretary of State believe that he knows better than Dr Buckman?
I do not recall the BMA ever agreeing with the previous Government. Let me provide one quote to the hon. Lady:
"The general aims of reform are sound-greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes-and are common ground between patients, health professions and political parties."
The NHS Litigation Authority has presented NHS Wiltshire with a bill for more than £3.5 million in clinical negligence scheme payments this year. Nationally, among closed claims, legal fees made up more than a third of costs last year. How does the Minister propose to switch this expenditure away from lawyers and towards front-line health services?
I wish, first, to say two things, but there may be further to add. First, my right hon. and learned Friend the Secretary of State for Justice is working on the implementation of the Jackson review. That, in itself, will help considerably in reducing the extent to which these costs are consumed in legal fees, rather than proper compensation for clinical negligence. As we made clear in response to Lord Young's report, we will also pursue the question of whether we can have a fact-finding phase following up a claim against the national health service, so as to mitigate what is otherwise considerable additional cost on conditional fee arrangements and getting expert witnesses.
Why is it that the Secretary of State does not compliment the Labour Government on providing £110 billion, starting with £33 billion in 1997? Is it not a fact that waiting times have fallen as a result of the nurses, the doctors and that money? Is he frightened to utter the words because in 2001 every single Tory MP marched through the Lobby not to give the money to the national health service?
Let me remind the hon. Gentleman that at the general election we just fought we were the party that was committed to increased resources for the national health service. We are the coalition Government who, over this Parliament, will increase resources for the national health service by £10.7 billion, even in the face of the deficit we inherited from Labour. The hon. Gentleman's party's response was to tell us that we should cut the NHS, and we are not going to do it.
I thank my hon. Friend for his question and I know that he has a keen interest in this subject. I share his frustration that the previous Government spent a long time not doing anything about it. The Medicines and Healthcare products Regulatory Agency has identified the possibility of creating a national regulatory scheme, allowing authorised herbal practitioners to continue to commission unlicensed manufactured herbal medicines after
Specialists in the field state that the figures that point to a more than 50% rise in young drinkers ending up in hospital are a gross underestimate of the serious problem. What further steps can the Department and the Government take to address this important problem?
As the hon. Gentleman will recall from earlier exchanges, it is absolutely right that we must have a series of measures to tackle alcohol abuse. Price is part of it, as is the enforcement of legislation. Community alcohol partnerships have been very promising. We must have better alcohol education, and I spoke at the first annual conference of Drinkaware yesterday, encouraging it in the work that it does. We must understand that we have to change people's behaviour and that the damage that can be done is intense. As a consequence of chronic alcohol abuse, large numbers of people are coming in and out of intensive care units, presenting an enormous burden to the health service as well as doing great damage to themselves.
The College of Emergency Medicine recently stated that if a hospital A and E unit is to be downgraded to an urgent care centre, the nearest A and E unit should be no more than 12 miles away. Will the Secretary of State revisit the cases of A and E units that were recently downgraded by the previous Government to urgent care centres when the nearest A and E unit is more than 12 miles away?
Yes. My hon. Friend makes a very important point. I promise I will discuss with John Heyworth of the College of Emergency Medicine precisely the point that my hon. Friend has raised. The College of Emergency Medicine says that it does not recognise what an urgent care centre is. From its point of view, hospitals should either have an emergency department or an A and E or they should not. If they do not, it is very important to be clear that they do not. I feel that we need to be much clearer about the nature of the service provided in A and E departments and the distinction between that and the service provided in minor injury or minor illness centres.
Do not the reorganisation plans for the NHS, coupled with cuts to local authority budgets, mean that public health projects in this country will effectively be binned?
No, they will not. We are making very clear our determination to ring-fence public health budgets so that prevention does not suffer, as it did under the hon. Gentleman's Government. In 2005-06, the first things to disappear as a consequence of financial pressures were the public health budgets and public health staffing. We will not allow that to happen.
I entirely understand my hon. Friend's point, and the rules we have set out for the NHS are very clear. We are also clear that we will ensure, through the NHS, that people have access to the privacy and dignity they have a right to expect, contrary to what Liz Kendall has said. She said that as long as they get the treatment through the NHS, it does not matter whether they are in mixed-sex accommodation, but that is not our policy. It does matter, and we will enforce it.