The Minister of State, Department of Health (Mr. Ben Bradshaw): Proposals for on how to change services to improve care for patients are for the NHS to decide locally. On 28 June, Barnet, Enfield and Haringey primary care trust launched a full public consultation on proposals to improve health care in the area.
Mr. Dismore: While there are concerns about the nature of the consultation, it could provide a real opportunity to improve services in our area. There are fears that if there were movement of patients from Chase Farm to Barnet, the new improved services at Barnet would not be in place before any changes were implemented at Chase Farm. Can my hon. Friend assure me that new services will be provided before any changes are made?
Mr. Bradshaw: Yes, I can. I am pleased by the welcome that my hon. Friend gives the proposals. I know that he has been closely engaged, meeting both local health service managers and his constituents. I assure him that it is very important that changes that result from the local discussions are made only once the services to which he refers are in place.
Anne Milton (Guildford) (Con):
I understand that the Healthcare Commission report states that the trust does not have an identified budget for infection control training and that attendance at infection control training is being monitored. The Government said in 2004 that 1 million staff would get training in infection control. Why is that not happening, and is the
Governments decision to cut 10 per cent. from the education and training budget part of the reason for that failure?
Mr. Bradshaw: As the hon. Lady knows, there has been a 9.4 per cent. increase in funds available to PCTs in the last financial year. I take it that she was referring to the Healthcare Commissions report on hygiene standards at Barnet and Chase Farm
Mr. Bradshaw: The hon. Lady did not specify that, but I am glad that that is the case. We are concerned about that, and the commission also expressed its concern. As a result of its report, the trust is investing an extra £500,000 in cleaning wards, screening patients before admission and a prudent antibiotic prescribing policy.
Mr. Andrew Love (Edmonton) (Lab/Co-op): Changes at Chase Farm hospital will have implications for other local hospitals, especially North Middlesex hospital in my constituency, which is just about to start a new PFI. Will my hon. Friend give me some reassurance that any changes that will have an impact on the North Middlesex hospital will be taken into account when that PFI gets under way?
Mr. Bradshaw: It is important that all elements of proposed changes, including the potential impact on PFI schemes, are taken into account when such service changes are proposed. I expect that my hon. Friend is already intensely engaged in the consultation process to ensure that his concerns about the impact on his constituency are made clear.
The Secretary of State for Health (Alan Johnson): Patients have a choice of four or more local hospitals for elective care and 114 other hospitals through extended choice. From April 2008, patients can choose any hospital that meets NHS standards and cost, beginning with orthopaedics this month. In June we launched the groundbreaking NHS choices information service.
I thank the Secretary of State for that reply and for writing to me about the regulation of Chinese medicine, which was helpful in setting a timetable. Does he accept that real problems are caused by the fact that demand from patients is out of sync with the supply of services, especially in complementary and alternative medicine? Primary care trusts are not listening to patient demand. The situation is well illustrated in London, where the Royal London homeopathic hospital, which provides a range of services that go way beyond homeopathy, is being cut. If the Secretary of State really believes in patient choice, which is to be his flagship with his new broom Front Benchers [ Interruption. ] Well, there are some new brooms, because all the old Ministers were sacked [ Interruption. ] Well, most of thema large
proportionwere fired. Will the Secretary of State please consider issuing guidelines to primary care trusts to take patient choice into consideration?
Alan Johnson: In preparing to reply to this Adjournment debate, I looked carefully at the points the hon. Gentleman made in his letter to me but I am not persuaded of the need to issue guidelines at this time. It is clear to me that many more patients want the benefit of complementary and alternative medicine and therapies; indeed, the most recent survey showed a high percentage of patients looking for that. What general practitioners do is very much a matter for them; for instance, I understand that in the Newcastle primary care trust area 69 per cent. of GPs deal with complementary and alternative medicines, so I see no need to issue guidelines at this stage, but I agree with the hon. Gentleman that such medicines are becoming an increasingly important part of GP prescriptions.
Andrew Miller (Ellesmere Port and Neston) (Lab): The technology driving some of the new health service systems has started to bite and is having a huge impact on our ability to improve patient choice, as well as delivering many other health benefit outcomes. With the departure, shortly, of Richard Granger, who has done such a splendid job on behalf of the NHS, will my right hon. Friend ensure that his replacement is of that calibre and that there is no shift in the Governments drive to improve health IT systems?
Alan Johnson: I shall meet Richard Granger just before his departure. My hon. Friend refers to an important area, where, as he says, we can extend patient choice and use new technology for the greater convenience of patients, citizens and clinicians, which is why it is important that we get the right person to replace Richard Granger.
Sandra Gidley (Romsey) (LD): How does the Secretary of State square his Governments supposed notion of choice with the large-scale closure of maternity units, especially midwife-led units, thereby depriving many women of choice, particularly in Romsey and the New Forest?
Alan Johnson: There are two issues, the first of which is choice, which we want to extend. An important GP survey was published today and I made a written statement about it this morning. The second issue is maternity care, and recently, with the full support of the profession, we published Maternity Matters, which makes it absolutely clear thatas in so many other aspects of medical carewe cannot simply defend the status quo. We need to ensure that we configure our services so that we save the lives of more babies; for instance, in Manchesteralthough there is still an issue of contention that has yet to be concludedthere are proposals by local health care specialists and local clinicians to save the lives of 40 babies a year. Such evidence cannot be disregarded.
Paddy Tipping (Sherwood) (Lab): Are not more than 90 per cent. of people who use our hospitals satisfied and think that the service is good? Those who have criticisms want basic things such as better catering and cleaner facilities?
Alan Johnson: Yes, I agree with my hon. Friend. In addition, many patients would like to choose how they are operated onfor instance, non-invasive surgery. If their consultant is not au fait with the latest techniques and cannot carry out non-invasive surgery, the patient should be able to say, Im sorry but thats the kind of operation I want. That would be good not only for patient choice but for driving up standards among clinicians.
Mr. Andrew Lansley (South Cambridgeshire) (Con): As the Secretary of State knows, it is the Governments promise that in two years time every mother should be able to exercise full choice about the circumstances in which they give birth, be it in a consultant-led maternity unit, a midwife-led birth unit or at home. Will the Secretary of State tell us how many additional midwives he believes will be necessary over the next two years to deliver that promise of choice?
Alan Johnson: I cannot say that at this stage because it depends on how things pan out in every area, but it is clear that an increase in the number of midwives will be needed. If we are offering that choice to every woman in the country, we must ensure that we deliver on it with the right staffing in the right places, which means that we cannot pull a figure out of the air, but there is an area of consensuseven between the Treasury Bench and the Opposition Front Benchon which we can work to make sure that things are properly implemented.
Mr. Lansley: I am grateful to the Secretary of State, but I am afraid that I cannot see how, locally, primary care trusts and hospitals can deliver the number of midwives that are necessary unless there is at least some work force planning to make that happen. The number of midwives, and the number of training places in midwifery, went down in each of the past two years, and the Secretary of State must know that in the past five years the number of live births has gone up by 13 per cent., whereas the number of full-time-equivalent midwives has gone up by only 5 per cent. We are therefore more than 1,000 short of where we need to be now, let alone where we need to be in order to extend choice in two years time. So will the Secretary of State promise today that he will go back and look at Maternity Matters and put some of the work force planning into Maternity Matters that simply was not there?
Alan Johnson: I think the hon. Gentleman is right in his assumption that we will need to get the work force right. He is also right that this is non-negotiable; it has to be in place by the end of 2009. He is also right in pointing out that there has been an increase in the number of midwives since we entered government. Putting all that together, I undertake to ensure that we have the proper work force planning in place at the right time to ensure that we can meet the commitments set out in Maternity Matters.
The Minister of State, Department of Health (Dawn Primarolo): I am not aware of any specific discussions with ministerial colleagues on reducing scalding within the home. However, the Department of Health supports policies and initiatives aimed at reducing and preventing the incidence of these injuries.
Mary Creagh: Keith Judkins, consultant anaesthetist at Pinderfields hospital in Wakefield and a member of the British Burn Association, tells me that every year 600 cases of first-degree burns are admitted to hospital, most of which involve children under five who have fallen into scalding hot bathwater, and each year 20 people die. A consultation to look at installing thermostatic mixing valves in the home is currently ongoing with the Department for Communities and Local Government. Will my right hon. Friend ensure that huge emotional and physical trauma costs, as well as the costs to the NHS, are taken into account in any analysis of whether to proceed with that measure?
Dawn Primarolo: I congratulate my hon. Friend, who has worked incredibly hard on ensuring that this campaign is drawn to our attention. I confirm to her that submissions will be made on that during the review of part G of the building regulations. I would go further and say to her that a vital role is also played by the third sector, and organisations such as the Royal Society for the Prevention of Accidents. We need to look again at how they are operating. None the less, I agree that both my right hon. Friend the Secretary of State for Children, Schools and Families, and the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), as part of his responsibilities for older people, need to consider how we can address the shocking figures that she draws to our attention.
Mark Pritchard (The Wrekin) (Con): Of course, elderly people are also affected by scalding, and one of the most effective ways of dealing with that is to get more help into elderly peoples homes. Does the Minister share my concern that this year, because of the underfunding of Shropshire primary care trust, the taxpayers of Shropshire, through Shropshire county council, will have to pay an extra £650,000 for community care? Will she agree to meet me and a delegation of other Shropshire MPs to discuss this issue?
Dawn Primarolo: Surely the hon. Gentleman will accept that the PCT in his area has actually seen an increase in funding. Surely he would also accept that in dealing with this very important issue we need to look at resources in local government, in the health service and in the third sector and ensure that there is a proper response to advice and support, particularly for the vulnerable. Surely he also accepts that he cannot come to the House and support a party that wants to cut spending on the national health service and then plead for more money for his constituency.
The Secretary of State for Health (Alan Johnson): Lord Darzi and I are already discussing a range of issues with staff, patients, the public and key stakeholders including the trade unions both locally and nationally to ensure their full involvement in the NHS next stage review.
Mr. Anderson: I thank the Secretary of State for his response. I advise him that the work of the trade unions in the past 10 years in helping to put in place the NHS plan and Agenda for Change is a model that should be adapted in the review, so that the unions continue to play a comprehensive and supportive role in making the NHS even better than it is today.
Alan Johnson: I agree with my hon. Friend. Indeed, Lord Darzi was in his constituency yesterday, while visiting Gateshead PCT, which might be just outside his constituency. He has also met the leaders of all the major trade unions, and I very much agree with my hon. Friend that the trade union input has been positive throughout the NHS plan and all the events over the past 10 years. This is a huge opportunity for us to re-engage with the work force, which includes, of course, their trade unions.
Tony Baldry (Banbury) (Con): Representatives of the midwives told the Oxfordshire health overview and scrutiny committee the other day that proposals to downgrade services at Horton hospital from consultant-led to midwife-led were utterly unacceptable. Will the Secretary of State and his team listen to the advice of the Royal College of Midwives and the Royal College of Nursing on those reconfiguration proposals, or will they simply be brushed to one side?
Alan Johnson: They will not be brushed to one side, and the hon. Gentleman knows full well that those proposals are local and are led by clinicians locally. I announced in my first week in this role that I would pass on all cases referred to me by the overview and scrutiny committee to the independent reconfiguration panel, which is clinician-led, because it is very important that those issues are driven locally, by clinicians in the area. The Royal College of Midwives, which has been to see me already, has very eloquent spokespeople on this issue, and they will be listened toof course, they willbut as for my involvement, it is right that politicians stay back and allow those working in the health service and those responsible for health care to lead the proposals.
Clive Efford (Eltham) (Lab): May I inform my right hon. Friend that one of my local newspapers claims to have a leaked e-mail from a middle manager of the Queen Marys hospital trust that sets out plans to downgrade accident and emergency services, close maternity and paediatric services and make cuts of £60 million? Such headlines will make it very difficult for Lord Ara Darzi to enter into a meaningful dialogue with local people and consult on the shape of future local services. What is Lord Darzi doing to address those speculative headlines, which are making it very difficult to have a meaningful dialogue about the future of our services?
Alan Johnson: I understand the point that my hon. Friend makes, because such headlines are totally unhelpful. [ Interruption. ] Of course, they are driven in part by the Conservative partys opportunism. I shall give an example of the paradox. A couple of weeks ago, the hon. Member for South Cambridgeshire (Mr. Lansley) used an Opposition day to debate the very important issue of stroke careit is absolutely essential that we debate such issuesand he quoted a National Audit Office report that came out in 2006 and said that, as a result of more efficient practice, £20 million could be saved annually, 550 deaths avoided and more than 1,700 people would fully recover who would previously have been disabled for life. We therefore have to change the health service to provide those kind of services. However, at the same time as pushing that, the Conservatives ask us for a moratorium on any change whatsoever. There cannot be such a moratorium, and we need to deal with the issues that my hon. Friend raises, not in headlines but in proper deliberative debate. That is what the Darzi review is all about.
Alan Johnson: I will encourage Lord Darzi to deal on a one-to-one basis with all MPs. I am writing to all MPs to let them know where Lord Darzi, David Nicholson and the other 60 clinicians will be over the summer period, so that if any MP wants to turn up and perhaps give up a couple of days in Tuscany, he or she can go there and chat to him at leisure.
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