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Andy Burnham: May I pay tribute to the hon. Gentleman for the important leadership role that he has played on those matters in this Parliament as a distinguished chair of the all-party group on cancer? I want the NHS to focus on the early diagnosis of cancer-I agree with him about that-and one-year survival figures will help to get the focus that we need, published for as many cancers as possible and by PCT. Where I must take issue with him is on his comment about input-based targets, or process targets, as Conservative Members often call them.
When it comes to cancer, process equals time, and time matters. That is why Labour will enshrine in the NHS constitution the two-week guarantee so that people can see a cancer specialist, and why we are making a flagship pledge to deliver cancer test results within one week in the next Parliament. I hope that the hon. Gentleman will persuade his Front Benchers to back those commitments.
Confidential Settlements
12. David T. C. Davies (Monmouth) (Con): How much the NHS spent on confidential settlements with members of NHS staff in the last three years. [324917]
The Minister of State, Department of Health (Gillian Merron): It is not possible to separate out confidential severance payments within the NHS account. However, NHS expenditure in England, excluding foundation trusts, in the relevant category-ex gratia payments, other-was £4 million in 2006-07, £8.2 million in 2007-08 and £5.4 million in 2008-09.
David T. C. Davies: I thank the Minister for that helpful answer. I have recently been dealing with the case of a Dr. Lucy Dawson in my constituency, who was offered a confidentiality payment to keep quiet about a complicated matter. That worries me. Does it worry the Minister that, apparently, millions of pounds are being handed over to people simply to persuade them to keep their mouths shut when they see wrongdoing in the NHS? Will she commit to doing something about it?
Gillian Merron: That is not a culture in the NHS that I recognise. It is important to say that those payments relate to all staff groups-for example, a termination payment made out of compassion, perhaps to a seriously ill nurse, could be included in the figures. Another example would be where a payment represents best value for money-for example, if legal advice suggests that a case would be lost at an employment tribunal. Any proposed payment is not permitted to reward failure, dishonesty or inappropriate behaviour. Indeed, such a payment would not be approved. It is worth saying that the Audit Commission also acknowledged extremely rigorous processes that we have in the NHS for approving such payments.
Paediatric Cardiac Surgery
13. Sandra Gidley (Romsey) (LD): What progress has been made on the national review of paediatric cardiac surgery; and if he will make a statement. [324918]
The Parliamentary Under-Secretary of State for Health (Ann Keen): The review of paediatric cardiac surgery is making good progress. Centres offering those services will shortly be asked to submit their proposals for meeting the requirements to be a surgical centre in the future.
Sandra Gidley: There are concerns that the national specialised commissioning group has already decided to reduce the number of units to five and that certain arbitrary assumptions mean that the slightly smaller units will be at risk of closure. Southampton general hospital is internationally respected for its work in this field, so will the Minister assure me that safety outcomes and quality will be the main criteria used in making the decision, not merely the number of procedures a year?
Ann Keen: The criteria were defined to secure safe and sustainable paediatric cardiac surgery services. Southampton University Hospitals NHS Trust's outcomes show that it is consistently either at the top or very near the top of all performance tables.
Community Health Services (Worcestershire)
14. Peter Luff (Mid-Worcestershire) (Con): What assessment he has made of the likely effects on patients and staff of the reorganisation of community health services in Worcestershire; and if he will make a statement. [324919]
The Minister of State, Department of Health (Gillian Merron): This is a matter for the local NHS, which is proposing changes to improve the quality of services to patients. That will be thoroughly tested against national criteria.
Peter Luff: I think that the Government are probably right to insist on the purchaser-provider split, but does the Minister understand that the timetable the Government are insisting on for the reorganisation of community services in Worcestershire could lead to the wrong decisions being taken about the future of those services, contrary to the interests of patients and staff, and probably to the need for a further reorganisation, which would be damaging and disruptive to the organisation, all too quickly?
Gillian Merron: I spoke to the chief executive of Worcestershire PCT just this morning, and the need for improving services has been worked on since January 2009. The Department's deadline for achieving substantial implementation is April next year. The local NHS does not see this as a forced or a hastened change, and it has worked closely with staff, patients and others to improve services. What I believe would prove disruptive and disconcerting for staff and patients is delaying this improvement in services.
National Dementia Strategy
15. Richard Ottaway (Croydon, South) (Con): What mechanism will be used to audit spending on the national dementia strategy. [324920]
The Minister of State, Department of Health (Phil Hope):
Dementia is a national priority and we are already spending over £8 billion a year on dementia in health and social care. The mechanism for the audit of the first ever national dementia strategy, which I published last year, is under development. We will consider how
money is spent as a whole in health and social care for people with dementia, and that will form part of a wider review of dementia services.
Richard Ottaway: The strategy contains an outline of a proposal that employers should look for signs of dementia among employees. In the event that that happens, will he assure me that there will be training for employers in that process, and safeguards against discrimination against older employees?
Phil Hope: Yes, employers will certainly not be able to discriminate against older people, but it is important that we have raised general public awareness of dementia. For too long, dementia has been ignored or not recognised, and people therefore do not come forward for diagnosis by their GP or specialist memory clinic. As a result, they do not get a diagnosis for two or even, on average, three years, when the dementia has progressed. That means that we do not intervene early enough, and that means that we do not help people live with dementia well enough or hold back the progression of the disease. I hope that the wider public, as well as professionals in the health and social care system, will be able to identify early signs and refer people to appropriate specialists, and so ensure that people get the early intervention that they need.
Mr. David Drew (Stroud) (Lab/Co-op): Will my hon. Friend ensure that as part of the audit we look at the cost and value of day centres? Too often nowadays it appears that local authorities, in particular, are trying to run down day centre services when those are often the only means by which people with dementia can get out of their homes. That is surely a retrograde step.
Phil Hope: I understand my hon. Friend's concerns. One of the directions of travel that we wish to pursue is the idea that individuals might have a personal budget so that they can take more control over the care that is provided to them. Carers and the person with dementia will then be able to use their resources to ensure that they have the services that they need. We wish to ensure that services for people with dementia, possibly through peer support and other aspects of effective dementia care that we are demonstrating in this the first year of the strategy, are made available more widely throughout the country.
Jeremy Wright (Rugby and Kenilworth) (Con): Has the Minister had the opportunity to look at the latest report of the all-party group on dementia on what has happened to money allocated for the implementation of the national dementia strategy? If so, does he share my concern that very few of the PCTs that were asked could tell us what they had done with their share of the £60 million allocated for the first year of the strategy, or at least explain how what they had done with it related specifically to dementia? Can we do better for next year?
Phil Hope:
The hon. Gentleman is chair of the all-party parliamentary group, which has done sterling work under his leadership during the past year to raise the profile of the needs of people with dementia and the need to provide better services for them. I congratulate him and his colleagues from all parties. The audit that I described earlier is designed to track progress in
implementation of the strategy's objectives. We will be looking at a whole range of factors, such as the number of dementia leads in hospitals, which is a key part of the strategy, the number of established memory services, and the use of anti-psychotic drugs, another issue that he and I share a concern about and on which we wish to see rapid progress.
Topical Questions
T1. [324929] Peter Luff (Mid-Worcestershire) (Con): If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Andy Burnham): The Government have today published a White Paper on the reform of social care in England. It proposes a national care service providing quality care and support for all adults in England free for people when they need it. It represents one of the biggest changes to the welfare state since the creation of the NHS. It sets out three stages of reform. First, the Personal Care at Home Bill helps the most vulnerable, enabling us to provide free personal care in their own homes for those with the highest needs. In the second stage, we will end the local lottery in care and establish national standards and entitlements. From 2014, care will be provided free to anyone staying in residential care for more than two years. At the start of the next Parliament, we will establish a commission to help reach consensus on the fairest and most sustainable way for people to contribute to the new system. As people live longer, we need to act to give them peace of mind and the ability to protect what they have worked for. Reform will work only if those benefits are secured for everybody.
Peter Luff: That sounded a bit like a statement to me.
The Government may be aware of the threat to the acquired brain injury education service in Evesham, which helps the rehabilitation of stroke victims, in particular, and other brain injury victims. The threat has been caused by the changing priorities of the Learning and Skills Council in relation to adult education. Will the relevant Minister talk to the Further Education Minister to satisfy themselves that the unit is either truly just an education service or actually, as it used to be, co-funded by the Department for Health and the education Department?
The Minister of State, Department of Health (Gillian Merron): I am advised that Worcestershire primary care trust is looking at NHS-funded services for people with acquired brain injuries, and it is the PCT's responsibility to commission services to meet the needs of the population. The trust has had an increase over two years of some £83.8 million and given a public commitment to ensure that the services that the acquired brain injury unit provides will be considered as part of the review. I certainly take the point that educational opportunities are an important part of the rehabilitation process.
T3. [324931] Hazel Blears (Salford) (Lab):
Last Friday in Salford we opened the Humphrey Booth resource centre, which is a national demonstration project for those with dementia and Alzheimer's. It is an uplifting and inspiring place, so in developing the national care service will my hon. Friend ensure that such services
are absolutely driven and shaped by users and carers? That is how we will secure services that really meet the needs of people with complex conditions such as Alzheimer's and dementia.
The Minister of State, Department of Health (Phil Hope): My right hon. Friend is right to applaud the work of agencies such as those in her constituency. There are many others like that throughout the country, and our job in creating a national care service is to ensure that we design and develop services with not only users but carers at the very heart of how we respond to people's needs. The new national care service will be free for people when they need it, and we will support families, carers and communities as a basic principle of the way in which a new national care service delivers help for people throughout the country.
Mr. Speaker: Order. We have a lot to get through in topical questions, so the exchanges need to be very short and sharp.
Mr. Andrew Lansley (South Cambridgeshire) (Con): Why did the Secretary of State not make an oral statement? Will he now rule out a death tax to pay for the Government's national care service-yes or no?
Andy Burnham: We are debating the Personal Care at Home Bill later today, on a crowded parliamentary day, and we will have the opportunity to debate it as the first stage in our three-stage reform plan to fund social care. We will propose for social care a system that is similar to the rest of the welfare state-organised on a population basis, whereby everyone makes a contribution and everyone has a choice about how they make that contribution. We will establish a commission to advise the Government on those payment options, and the commission will be able to consider all options.
T5. [324933] Dr. Doug Naysmith (Bristol, North-West) (Lab/Co-op): I know that the Secretary of State is aware that there are two separate electronic surveillance systems for tuberculosis in England: one for London, one for the rest of the country. Does he agree that it would be more sensible to have one system for the whole country, enabling more effective control and treatment of that troublingly persistent disease, and, perhaps, a national treatment plan, as in many other countries?
Gillian Merron: I agree, and a new national system will be up and running early next year.
Norman Lamb (North Norfolk) (LD): The Princess Royal Trust for Carers and Crossroads Care have revealed that for the next financial year PCTs have allocated to carers only 26 per cent. of the £100 million intended for respite care. Is not the Government's promise of respite care, followed by a total failure to deliver that care, tantamount to a fraud on some very vulnerable people? Surely it is now time to give a guaranteed right to a week's break for the 1 million carers who work the longest hours.
Andy Burnham: This Government recognised the need to support carers better when we came into office in 1997. Before then, the recognition of, and support for, carers was absolutely pitiful. Ever since then, the Government have invested £1.7 billion through the carer's grant to support carers, and locally people can allocate that funding flexibly. However, the hon. Gentleman is right to say that we allocated further spending to PCTs so that they could provide respite care for carers. The Minister of State, Department of Health, my hon. Friend the Member for Corby (Phil Hope) has asked strategic health authorities to identify the level at which PCTs use that funding, so that we can take further action where sufficient priority is not being given to spending resources on respite care for carers.
T10. [324938] Lynne Jones (Birmingham, Selly Oak) (Lab): According to the Government's excellent carers strategy, the provision of accurate and timely information is vital for carers, yet according to Rethink, the mental health charity, 33 per cent. of mental health carers do not receive basic information such as the diagnosis of the person they are caring for, and only 20 per cent. of trusts have information-sharing policies. What action will the Government take to remedy this deficiency?
Phil Hope: I know that my hon. Friend takes a keen and active interest in issues surrounding support for mental health service users and has campaigned on these issues for many years. I would like to make it clear that we do believe that service users should be fully informed about and engaged with arrangements for their own care. That is why the Department issued revised care programme approach guidelines as recently as 2008. Under those guidelines, each mental health service user should have, wherever possible, an opportunity to be actively involved in agreeing their treatment plans with their care co-ordinator. That would allow patients some say in determining what information is then made available about their condition to other parties, including carers and family members.
Mr. Speaker: These exchanges are taking too long: I want to get lots more colleagues in.
T2. [324930] James Duddridge (Rochford and Southend, East) (Con): Southend primary care trust relatively recently merged into South East Essex primary care trust, and there are now discussions-I think abortive-about merging into Mid Essex primary care trust. If this does go ahead in order to make efficiency gains, how will we ensure accountability between local government and larger NHS trusts?
The Minister of State, Department of Health (Mr. Mike O'Brien): We need to ensure that PCTs and trusts are accountable to local people-that is the whole basis on which we have introduced the system of decentralisation in the NHS. Improving the quality of that accountability is therefore crucial. If we have learned anything from the Mid Staffordshire debacle, it is that trusts need to be in contact with local people.
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