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House of Commons

Tuesday 12 May 2009

The House met at half-past Two o’clock


[Mr. Speaker in the Chair]

Oral Answers to Questions


Mental Health Services (Sutton)

1. Tom Brake (Carshalton and Wallington) (LD): How much funding is planned for mental health services in the London borough of Sutton in 2010-11; and if he will make a statement. [274098]

The Minister of State, Department of Health (Phil Hope): Mental health services receive funding from primary care trusts according to the priorities and needs of the local population. Sutton and Merton PCT and the Government organisation Working for Wellness will invest £2.4 million over three years in improving access to psychological therapies. In 2010-11 Sutton and Merton PCT expects to spend £53.6 million on mental health services, which represents 9.1 per cent. of its allocated budget.

Tom Brake: The Minister may be aware of debates in the House on the future of Henderson hospital and that a consultation entitled “Shaping the future: Supporting people with complex personality disorder” is under way. Can he reassure me that the model of a therapeutic community with a residential component will be given reasonable consideration in plans for dealing with personality disorder, and will he receive from those dealing with Henderson hospital an update on the future of that service?

Phil Hope: As the hon. Gentleman knows, Henderson hospital is temporarily closed because of falling demand and lack of clinical viability, but, as he says, that is subject to a consultation due to end on 27 July, to which organisations and individuals can of course make representations. The matter is obviously one for local decision making, but he has today drawn the House’s attention to the services that he wants to be provided in future and I shall ensure that his representations are fed into that local consultation.

Maternity/Paediatric Services (Greater Manchester)

2. Paul Rowen (Rochdale) (LD): What recent progress has been made on the proposals to reconfigure maternity and paediatric services in Greater Manchester. [274099]

The Minister of State, Department of Health (Phil Hope): Service reconfiguration is a matter for the local NHS. The North West strategic health authority reports
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that the “making it better” reconfiguration of children and maternity services across Greater Manchester will see four new state-of-the-art hospitals open this summer in central Manchester, at a cost of £500 million. There will also be expanded facilities in north Manchester, Bolton, Oldham and south Manchester. Services will be transferred in stages to ensure a smooth and efficient transition for patients and staff.

Paul Rowen: I am sure that the Minister is aware that “making it better” is now over budget—the plan was for £60 million, but the figure is now £100 million—and over schedule. What assurance can he give us that it is still fit for the purpose?

Phil Hope: The hon. Gentleman may not know, but over the next three years the NHS in Greater Manchester plans to invest more than £100 million in new buildings to improve facilities for women, children and babies, including new maternity units at North Manchester general, Royal Bolton, Royal Oldham, St. Mary’s and Wythenshawe hospitals. In-patient children’s and maternity services will be provided in eight new centres of excellence across Greater Manchester and the number of neonatal units will increase from two to three. The review was driven by clinicians, in particular the desire of doctors, nurses and midwives to improve safety. I commend them for the work they are doing.

Graham Stringer (Manchester, Blackley) (Lab): The consultation on the reconfiguration of children’s services and the associated discussions has lasted for more than a quarter of a century. Obviously not everyone is satisfied with the outcome, but now that decisions have been made, it is important that the schedules set are kept to. Will my hon. Friend assure me that that will happen and that the decisions made will not be changed?

Phil Hope: The local NHS bodies in Greater Manchester are responsible for implementing the reconfiguration. It has taken some time, but the results are now there for all to see in both the hospitals that are opening now and the plans for the future. These are exciting times for the Greater Manchester NHS, and all MPs on both sides of the House representing constituencies in the area will see their constituents benefit from the changes. I understand my hon. Friend’s desire to ensure that the changes are delivered on budget and on time. I shall make sure that the local NHS bodies in Greater Manchester are aware of the strength of his feelings on the matter.

Mr. Andrew Lansley (South Cambridgeshire) (Con): The Minister may recall that when the proposals to shut obstetric units were made in January 2006, the consultation document said:

That was not true when it was written, and since then, in the space of two years, the number of births in Greater Manchester has increased by 7 per cent. When facts change, so can conclusions. Will Ministers therefore reconsider the plans to remove obstetric services from Fairfield hospital in Bury and the Rochdale infirmary, the effect of which will be that, each year, well over 5,000 mothers living north of the M62 will be without local access to full obstetric care?

Phil Hope: I always enjoy it when Opposition Members question the investment and reform being made under a Labour Government. I remember that during the 18 years of Conservative rule, hospital services in Greater
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Manchester were pretty much abandoned. A great deal of thought and planning went into deciding the size of the new maternity units. Account has been taken of the number of births, ongoing changes to maternity practice and projected birth rates. Taking all factors into account, all the new maternity units will have the flexibility for additional capacity, should it be needed. That will allow the NHS in Greater Manchester to give women choice over where they wish to have their babies, which they would not have had under the Conservative party.

Out-of-Hours Primary Care

3. Lorely Burt (Solihull) (LD): What assessment he has made of the standard of out-of-hours primary care in (a) Solihull constituency and (b) England; and if he will make a statement. [274100]

The Minister of State, Department of Health (Mr. Ben Bradshaw): The independent regulator, the Healthcare Commission, recently reviewed urgent and emergency care in England. Solihull was given a rating of three—five being the highest and one the lowest—with out-of-hours services contributing to 25 per cent. of that score. The review found that, nationally, out-of-hours services had improved significantly since 2005. Where the local NHS has concerns about the performance of its out-of-hours providers, it must take urgent and robust action to address them.

Lorely Burt: Following the death of Mr. David Gray at the hands of Dr. Daniel Ubani, is it not the case that the Minister cannot give me an assurance for my constituents in Solihull, or indeed for constituents anywhere else, because there is no mechanism for assuring the quality and consistency of out-of-hours service? Do not patients need some guarantee on what basic level of assistance they are likely to receive?

Mr. Bradshaw: The hon. Lady is wrong; the quality of out-of-hours services is monitored and assured in a number of ways: first, primary care trusts have clear legal responsibilities to provide safe, high-quality out-of-hours services; and, secondly, strategic health authorities act as performance managers. The regulators, as she will be aware, are now investigating the provider that ran the services that led to the tragic death of David Gray. I would like to update the House. East of England strategic health authority informed me this morning that it had discovered new issues of concern about Take Care Now—the provider of the services in the case in question—and its performance that predate the Dr. Ubani case. The SHA is now reviewing, with the PCTs concerned, its previous decision to continue to use TCN services, pending the outcome of the Care Quality Commission investigation.

David Taylor (North-West Leicestershire) (Lab/Co-op): Both the National Audit Office and the Public Accounts Committee have, for some time, pointed to significant flaws in the private provision of out-of-hours general practitioner care. As the hon. Member for Solihull (Lorely Burt) said, there have been fatal shortcomings in outsourcing an essential aspect of primary care. Does the Minister agree that more and more PCTs across the country should follow the example of Leicestershire County and Rutland primary care trust,
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and bring outsourced out-of-hours provision back in-house? Failing that, should not the performance of organisations be tracked much more closely by the Department of Health, so that our constituents are not left to the mercies of cowboy clinicians?

Mr. Bradshaw: Decisions such as that taken by my hon. Friend’s PCT are for local primary care trusts. I have to challenge him on his interpretation of the National Audit Office findings and the Healthcare Commission’s findings. The NAO report did not find any evidence of risk to patient safety in out-of-hours services, and it showed that eight out of 10 patients were satisfied. As I have said, the Healthcare Commission report found significant improvements in performance since 2005. Neither of the reports found that there was variable performance between private and non-private providers.

Dr. Richard Taylor (Wyre Forest) (Ind): The vetting procedures referred to by the Minister must be hopelessly inadequate to allow a cosmetic surgeon from Europe who did not even know the correct dose of diamorphine to work in this country. He has admitted killing the patient with a dose 10 times too great. Whatever vetting procedures we have are inadequate, and I ask the Minister to take steps to improve them, particularly in relation to doctors coming from the European Community.

Mr. Bradshaw: As a doctor himself, the hon. Gentleman will know that this country has among the highest levels of vetting of professionals of any country in the world. Employers have a legal duty to ensure that all doctors whom they appoint are fit to practise, and all doctors, including locums, must be on an official performers list, and must be registered with the independent regulatory body, the General Medical Council. He is right: we are talking about an absolutely terrible case, for which the doctor has been tried in his absence. As a result, as I informed the House, the SHA, with local primary care trusts, is reviewing the contract given to the company concerned. There are clear legal obligations on PCTs and strategic health authorities to ensure that their out-of-hours services are safe. Something went terribly wrong in the case that we are discussing, and he is right that it is important that both the local and national NHS learns the lessons as a result of it.

Sir Patrick Cormack (South Staffordshire) (Con): But is it not elementary that the best out-of-hours services are provided by doctors who know their patients and their records? Should we not have a concerted campaign to try to ensure that, wherever practicable, out-of-hours services are conducted by family practitioners who normally look after those patients?

Mr. Bradshaw: The hon. Gentleman makes a very good point. The vast majority of out-of-hours services up and down the country are still provided by local GPs, whether working in co-operatives or social enterprises, or for private organisations that are contracted or commissioned by the primary care trust. The difference between the system now and the previous system is that they are not compelled to do so. The problem with the previous system was that GPs often felt overtired: mistakes were made and the service was patchy and dangerous in many places. The Conservative idea of going back to the bad old days of forcing all GPs to provide out-of-hours-services would be an absolute disaster.

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Norman Lamb (North Norfolk) (LD): Following the question from the hon. Member for Wyre Forest (Dr. Taylor), Medical News Today reports that

However, they could end up—and have ended up—working in our out-of-hours services. While it is not possible to prevent such doctors from practising in this country, it is possible to stop them being employed in NHS out-of-hours services. Is it not time that the Minister ended that practice and made it an absolute requirement on out-of-hours providers that they cannot employ anyone without the training required for British-trained GPs, as well as for those GPs who come from outside the EU.

Mr. Bradshaw: Without repeating what I have said about the legal duties of the commissioners of the service and employers to verify whether someone is fit to practise, and about the role of the GMC, I am sure that all those organisations, including the GMC, will be very interested in the article that the hon. Gentleman has just produced.

Mark Simmonds (Boston and Skegness) (Con): May I press the Minister a little further? I do not wish to repeat what has already been said, but it is quite clear that the Government mismanaged the negotiations on the 2004 GP contract resulting, whatever the Minister says, in an out-of-hours service that is at best fragmented and inconsistent. As we have heard, the tragic death of David Gray in Cambridgeshire starkly highlighted the inconsistencies and variations in primary care trusts’ registration of locums, as well as the lack of co-ordinated quality in patient safety standards. That needs to be addressed urgently. Does the Minister agree that that demonstrates that GPs are closest to their patients and the communities they serve, and are therefore in a significantly better position to commission out-of-hours care on their patients’ behalf, without necessarily having to provide it themselves?

Mr. Bradshaw: It is only since 2004 that we have had a framework that is supposed to deliver a uniform service across the country. People behave and talk as if there was some golden age in which there was a wonderful out-of-hours service, but it did not exist. Some parts of the country did not have a service at all; in other parts, the service was dangerous or patchy. Doctors resented being forced to do that work, and we had massive recruitment problems, particularly for women doctors. Doctors were often overtired, and there were serious accidents. We now have a system in place with a legal responsibility on the commissioners at local level—the PCTs—to deliver a quality service for their population. They are overseen by the regional level of the NHS and by the independent regulator, who did not exist before. We therefore believe that we have the right systems in place—it is the implementation of those systems that we need to ensure is right, and as the independent Healthcare Commission itself says, the quality of out-of-hours services has improved significantly since 2005.

Influenza Pandemic

4. Mr. James Gray (North Wiltshire) (Con): What contingency plan his Department has in the event of an influenza pandemic; and if he will make a statement. [274101]

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The Secretary of State for Health (Alan Johnson): We have been preparing for a flu pandemic for the past five years. On 22 November 2007, I made a statement to the House introducing the national framework for responding to an influenza pandemic. That document, jointly published by the Department of Health and the Cabinet Office civil contingencies secretariat, is the cross-Government strategy for dealing with an influenza pandemic. The planning process is supported by exercises carried out by the Health Protection Agency. The framework is guiding our response to the current H1N1 outbreak, and the World Health Organisation has recognised Britain as one of the best-prepared countries in the world.

Mr. Gray: I am grateful to the Secretary of State for that reply. We are all glad that the spread of the flu seems to have slowed, at least for the moment; we are particularly glad that, rather puzzlingly, there have been no fatalities outside Mexico. I do not know why that should be, but there it is.

Mr. Andrew Lansley (South Cambridgeshire) (Con): There have been a few.

Mr. Gray: Perhaps there have been one or two; I have been corrected by my hon. Friend on the Front Bench.

Does the Secretary of State agree that if an awful pandemic were to occur, an important tool in dealing with it would be the national flu helpline? Will he explain why the Government have announced that the helpline will not be operative until the end of this year?

Alan Johnson: First, I should correct the hon. Gentleman. There have been three deaths in the USA, one in Canada and one in Costa Rica. However, it is true that the majority of deaths have been in Mexico. I am pleased to say that we will have a debate on this issue on Thursday. When we discussed it last Thursday, the issue of the flu line came up. I say again that we agreed the contract with British Telecom last December. It will be ready in October, after the most thorough testing. No country in the world has such a sophisticated system. Its purpose is to enable people who are symptomatic to go home and stay there, ring a number or go on the internet, go through an algorithm, get a code and send someone else to collect their antivirals. In that way, people will not walk around spreading the disease further.

No country in the world has such a system. We have the opportunity to introduce it in October, but, as I said to the House last week, there was no way we were going to introduce it without the most thorough testing. The last thing we need in the middle of a pandemic is the breakdown of an IT system—and we have a certain amount of history on that.

Ms Sally Keeble (Northampton, North) (Lab): Is my right hon. Friend aware that there have been two cases of swine flu in my county, one of them in my constituency? One of the issues is how people can best protect themselves and know where the outbreaks are without anybody’s confidentiality being breached and without an excessive sense of panic being created. Can my right hon. Friend say how he would balance those issues, so that people know enough to protect themselves without there being undue concern about the number of cases and where they are?

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