The Parliamentary Under-Secretary of State for Health (Ann Keen): The role of doctors in child protection work is fundamental and very highly valued. That is fully recognised in the comprehensive guidance and support measure that we have provided for doctors and other health care professionals.
Dr. Harris: I am grateful to the Minister for that answer. Will she accept first, for the record, that it is her view, and the Governments view, that fabricated and induced illness in children exists as a condition? Secondly, does she recognise the concerns of the Royal College of Paediatrics and Child Health and other paediatricians that the campaign that exists against doctors who argue for the diagnosis of that condition is deterring, and will deter, paediatricians from taking part in child protection work and that if that happens, the most vulnerable in our societychildren who are being abused or who are at risk of abusewill be the ones who suffer?
The hon. Gentleman raises some serious issues. A joint letter in my name and that of the Under-Secretary of State for Children, Schools and Families,
my hon. Friend the Member for Cardiff, West (Kevin Brennan), was laid before this House outlining the professionals duty of care in child protection, the legal framework in which professionals operate and the basis on which sound professional judgments should be made, fully recognising the role of doctors as vital to the safeguarding of childrens welfare.
Mr. Kevin Barron (Rother Valley) (Lab): My hon. Friend probably knows that I am a lay member of the General Medical Council. Does she agree that it is not in the patients interest, the public interest or the professions interests if doctors work incompetently and inappropriately?
Ann Keen: I agree with my right hon. Friend, because the seriousness of the issue of child protection could not be more important to the House. It is worth noting that the GMC takes the issue very seriously, and that it is doing so in the recent case, which has brought everything into the public domain yet again.
Tim Loughton (East Worthing and Shoreham) (Con): The Minister will know that the key finding of the Laming report into the Climbié death was a recommendation for better joint working between professionalsnot least between hospital clinicians and social workers. Last month, I raised the issue of the National Childrens Bureau report with the Secretary of State for Children, Schools and Families. It said that only 47 per cent. of hospitals have hospital-based childrens social workers, even though having such social workers was a recommendation of the national service framework in 2004. He promised to take the matter up with the Secretary of State for Health and report back to me. I have not been given that report, so perhaps the Minister could let me know what action has been taken in this vital area of joint working to protect children.
Ann Keen: I thank the hon. Gentleman for his points. Every Child Matters is such a serious document, and the operating framework recently published by the Department of Health raised the profile of childrens health. We are happy to inform hon. Members from both sides of the House about the important joint working that the Department for Children, Schools and Families and the Department of Health are undertaking on this issue.
Ms Gisela Stuart (Birmingham, Edgbaston) (Lab): Cities such as Birmingham have specialist childrens hospitals. Will the Minister ensure that the specialist skills and paediatrician skills that have been concentrated in such facilities are also being conveyed to more general hospitals in the area to recognise child protection issues and to ensure that we do not have an over-concentration of skill in the specialist hospitals? We must ensure that such skills are distributed into the wider area.
Ann Keen: I thank my hon. Friend for that point, because sharing best practice on this issue is vital. That is why we are so pleased that the operating framework puts children as a high priority for the national health service, as it is for other Departments.
Sir Patrick Cormack (South Staffordshire) (Con): Does the hon. Lady accept that although it is crucial that we recognise the vital work that paediatricians do and we are not suggesting that their profession has been called into disrepute, the careless evidence and misguided practices of just a handful have caused untold hardship to a number of women, who have suffered unnecessarily in jail?
Ann Keen: This is always a great worry and the hon. Gentleman is right to raise it. We always need to learn lessons, and that is what we are doing in co-operating with other Departments and, in particular, outside bodies that are familiar with the topic.
The Minister of State, Department of Health (Mr. Ben Bradshaw): The independent committee that makes recommendations to the Government has requested and been granted an extension for its work. That means that it was not possible to announce three-year allocations. We announced allocations to primary care trusts for 2008-09 last week, giving them a 5.5 per cent. increase. We plan to implement the formula changes for the 2009-10 and 2010-11 allocations, which will be announced by summer 2008.
Hugh Bayley: I welcome the Governments decision to increase the budget for North Yorkshire and York primary care trust to £1 billion a year, but according to the Library, half of all PCTs in rural and mixed rural/urban areas are in deficit, compared with less than one in five PCTs in urban areas. In Yorkshire, rural East Riding PCT is in deficit and the mixed rural/urban North Yorkshire and York PCT is in deficit, but none of the urban PCTs are in deficit. There are pockets of deprivation in places such as York
Mr. Bradshaw: My hon. Friend is right to highlight the fact that his PCT is in deficit. In fact, it is one of only eight PCTs that are forecast to be still in deficit at the end of the year. That is a considerable improvement from the 28 per cent. in 2006-07 or the 36 per cent. in 2005-06. He will acknowledge that there were historical problems in the four PCTs that were amalgamated into one. There is no evidence that it is especially difficult for rural PCTs and in fact the vast majority of rural and semi-rural PCTs are well in surplus.
Sir John Butterfill (Bournemouth, West) (Con): When the review takes place, will the Minister ensure that the present arbitrary allocation of specialist units is looked at more carefully? That has affected the Royal Bournemouth hospital, which has probably the finest cardiac angioplasty unit in the south of England, at great cost, but has not been so designated. Can he confirm that even under existing arrangements PCTs have a degree of discretion in designation?
Mr. Bradshaw: PCTs have more and more discretion all the time. The issue that the hon. Gentleman raises about Bournemouth hospital was raised with me during a visit to Dorset last Friday and I have taken it up within the Department. What he is talking about is slightly different from PCT allocations and is about whether a particular service is defined as a specialist service in a given hospital, which affects the funding that that particular service attracts. I will write to the hon. Gentleman about his particular case.
Kelvin Hopkins (Luton, North) (Lab): My hon. Friend will be aware that several PCTs have suffered underfunding way below their fair funding targets for a long time, and Luton is one of them. In any reform of the funding formula, will he seek to ensure that such areas, which have serious health inequalities, will not be disadvantaged?
Mr. Bradshaw: Inequalities are the very reason why the independent review committee has asked for more time to consider the way in which it will change the allocations. I am pleased to tell my hon. Friend that although Luton PCT has had a deficit problem in the past, it is not forecast to have one this year. Like all PCTs, it has received a considerable increase in funding over the past two years. Whereas three years ago one PCT was more than 22 per cent. below its target formula, now no PCT except Northamptonshire is more than 3.5 per cent. below. That considerable improvement has meant that those PCTs that were historically underfunded have moved up to the fair funding level.
Mr. David Heath (Somerton and Frome) (LD): Is there not a need to examine the tariff for individual surgical procedures within the funding formulae? At the moment, the tendency is for independent sector treatment centres, where they exist, to take the low-cost procedures, thus causing an imbalance in those remaining for the NHS units. Do we not need to review that to take account of the fact that the NHS hospitals have to deal with a higher proportion of more complex cases?
Mr. Bradshaw: The tariffs are slightly different from PCT allocations, but they are constantly reviewed. One of the reasons why the hon. Gentlemans local trust in Somerset has become only the second in the country to meet the 18-week maximum wait a whole year early is partly because of the valuable contribution made by the independent sector treatment centre in Shepton Mallet, which is very popular. It is working at above 100 per cent. capacity and we should not deride its contribution to the tremendous achievement on waiting times in his area.
Mark Simmonds (Boston and Skegness) (Con):
We on this side of the House have pledged to match the Governments spending plans, with the NHS being our No. 1 priority. There is, however, significant evidence of enormous disparities in cancer and stroke funding between trusts, which fails to reflect the prevalence of disease. Given the top-slicing of primary care trust budgets, which exacerbates funding inequalities, and consistent calls both from the Opposition and the Health Committee to make funding formulae more equitable, why have the Government taken so long to
bring forward urgently required new proposals for funding formulae that more accurately reflect the burden of disease?
Mr. Bradshaw: The hon. Gentlemans point about PCT top-slicing is out of date, and I do not see how he can claim that the Opposition are promising to match our funding when they have a £20 billion hole in their spending plans. He may not have noticed, but the Government have made major announcements on both cancer and stroke, and considerable new resources are being made available to help tackle some of the problems that he highlights. By any fair and objective measure, massive strides have been made in respect of both cancer and stroke in this country, but the Opposition have opposed some of the very important reorganisations that would help improve stroke care still further.
The Secretary of State for Health (Alan Johnson): My Departments policy on severance payments in the NHS is that they should be made only in accordance with the contract held between employer and departing employee, and that they must comply with Treasury requirements and represent good value for the taxpayer. In addition, we are considering the practicalities of restricting notice periods for senior staff to a maximum of six months.
Mr. Spellar: I congratulate the Secretary of State on taking action against the disgracefully high payouts made to incompetent bureaucrats in the health service, but does not that reveal the further scandal that many of those who have received those payouts are able to slip into other highly paid jobs elsewhere in the NHS? Will my right hon. Friend consult with hon. Members of all parties to determine the extent to which that is happening, and put a stop to it?
Alan Johnson: My right hon. Friend raises a point that will be echoed by hon. Members around the Chamber. The hon. Member for Ilford, North (Mr. Scott) is not currently in his place, but I can tell the House that he has also been extremely helpful on these matters. We have to put an end to the culture that my right hon. Friend has described, not least because we must protect the integrity of those senior managers who never benefit from such payouts. Where a persons conduct has been unsatisfactory, we must ensure that he or she does not receive an inappropriate payment or receive a glowing reference that may lead to reappointment in a health trust somewhere else. That is another element of the guidance that we have issued.
Mr. John Horam (Orpington) (Con):
I very much welcome what the Secretary of State has said. Is he aware that, in the past year, payments to 124 top-level managers averaged £308,000, or roughly two years salary? Frankly, people who have done very badly in the private sector would never get two years salary as severance pay. In my area, the Bromley PCT has an historic deficit of £89 million and a forecast operating
deficit this year of £23 million. I therefore very much welcome what the right hon. Gentleman has announced in response to the right hon. Member for Warley (Mr. Spellar), and I hope that he will take the initiative further.
Alan Johnson: The hon. Gentleman raises an important point about the total amount of money that has been paid out, but we need to separate the inappropriate payments that we are discussing from redundancy paymentsabout which, incidentally, we have also issued advice and guidance. The vast majority of nurses and others are Agenda for Change staff, and the redundancy agreements that pay people with more than 24 years service a maximum of two years salary should also apply to senior managers. That is the statutory obligation for redundancy arrangements and it is covered by agreements, but senior managers should not get extra payments on top of that. We are looking to put an end to that practice as well, but the hon. Gentleman has raised another element of a matter that is causing concern right across the House.
David Taylor (North-West Leicestershire) (Lab/Co-op): Earlier this year, the University Hospitals of Leicester pathway project was scrapped after costs spiralled towards £1,000 million, and that led to the departure of its excellent chief executive, Dr. Peter Reading. Is it fair that the abortive costs of that project, which had been under way since 2000, should fall on the people of the city of Leicester and the county of Leicestershire? Does not the real fault lie with those who push private finance initiative projects, even though they are prohibitive in cost, flawed in concept and intolerable in consequence for the taxpayers, patients and clinicians of the United Kingdom?
Alan Johnson: I think my hon. Friend demonstrates a certain prejudice against PFI hospitals [ Interruption. ] Obviously, I understate the point, although I do not blame him on the experience in Leicester, where there was a cost overrun and we are looking to reinvest that money in the health community. However, I doubt very much that we would have been able to instigate the biggest hospital rebuilding programme in the history of the NHS without the use of PFI, and I doubt very much that we would have seen so many new hospitals and excellent facilities across the country without PFI. That is not to diminish the serious problems that have occurred in Leicester, but they have not occurred everywhere.
Norman Lamb (North Norfolk) (LD): I wish the Secretary of State and his ministerial colleagues a happy Christmas. Over Christmas, will he look into the case that the hon. Member for North-West Leicestershire (David Taylor) has just raised? Peter Reading, the highly respected former chief executive of the University Hospitals of Leicester NHS trust, left his job, earning £170,000 a year, without working his six months notice. He received a £700,000 pay-off and was replaced by an interim chief executive who has earned £100,000 in a three-month period, which included three weeks away in New Zealand. Does not such an experience stick in the throat of nurses, who have had a staged pay increase, and of patients who have seen cutbacks to services when trusts get into deficit?
Alan Johnson: I thank the hon. Gentleman for his kind wishes for Christmas. May I reciprocate? I believe Santa Claus is bringing him a new leader this Christmas. Next Christmas, the Liberal Democrats will probably get a new one againlots of fun
The hon. Member for North Norfolk (Norman Lamb) introduces another element to the issuethe question of pension payments. My understanding is that a large chunk of the money received by the individual he mentioned was his pension entitlement, so in the overall question raised by my hon. Friend the Member for North-West Leicestershire (David Taylor) we have to keep things absolutely separate. There is a question about unjustified payments for failurein essence, there is an issue about proper redundancy payments and there is an issue about pension entitlement. We do not seek to interfere in any way with pension entitlement, nor with redundancy payments where they apply to the norm. A nurse should receive exactly the same as a chief executive in terms of redundancy arrangements; what we want to stop are inappropriate extra payments, which my hon. Friend has raised constantly. There is no justification for them and indeed, in a recent high profile case, no Treasury clearance.
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