Health questions were put in the House of Commons yesterday.
The situation at Mid Staffordshire NHS Foundation Trust, which has been slammed by the Healthcare Commission for "appalling" emergency care at Stafford Hospital, stood out. Between 2005 and 2008 about 400 more people died there than would ordinarily have been expected.
Stone MP Bill Cash expressed his profound concern:
"Mr. William Cash (Stone) (Con): Will the Secretary of State take account of the fact that I am repeating my call for an inquiry into this whole matter under the Inquiries Act 2005? Will he also make it clear that all those in that trust who are culpable, as set out in the Healthcare Commission report—that includes other senior management besides the chairman and the chief executive at the time—must be removed and not merely suspended on full pay?
Alan Johnson: As I just said, the investigation will involve everyone who has any position of authority within that trust—the whole board and all the executive directors. It will be a proper investigation and it will be fair, and the action taken will result from that inquiry, not from any knee-jerk reaction by me or anyone else."
Shadow Health Secretary Andrew Lansley (above right) went on the same topic:
“we should be spotting these issues much earlier and getting rid of incompetent chief executives or chairpersons who, fortunately, are in the minority, rather than waiting for a report such as this, by which time, frankly, most of the damage has been done.”—[ Official Report, 15 October 2007; Vol. 464, c. 571.]
The Secretary of State knew about the failings at Stafford in May 2008, so why did he not intervene then and there?
Alan Johnson: I ask the hon. Gentleman to look at the Healthcare Commission’s report carefully. The difference between what happened in Stafford and in Maidstone and Tunbridge Wells, and the fact that the Healthcare Commission took into account those words and what others said at the time, is that as soon as commission staff went into Stafford and saw the problems—in May 2008—they immediately called the chief executive to a meeting, put their concerns to him, and started to see the process of improvement. That is the job of the Healthcare Commission while it carries out its inquiry. The staff cannot say at that stage that they have come to any conclusions, and it would be unfair, one day into an inquiry, to reach conclusions and say that heads must roll and recommendations must be made. We made that specific point to the Healthcare Commission at the time of Maidstone and Tunbridge Wells, so in Stafford staff immediately introduced measures to put things right, rather than wait for the end of the process and the report to be published—as I said they should do in that quote.
Mr. Lansley: I put it to the Secretary of State that he should look at the appendix to the Healthcare Commission’s report and the letter of 23 May 2008 that was received by his Department. If he meant anything by saying that incompetent chief executives should be got rid of at the point at which one becomes aware of them, it should have been done then, but the Department failed to do it. The Secretary of State has to understand that there was a failure, not just within the trust, but within the agencies charged with commissioning, performance management and performance assessment, up to and including the Department itself.
The Secretary of State’s proposed reviews—he now has three—do not have the scope, the powers or the independence to investigate those failures fully and, therefore, to restore public confidence. Will he agree today to institute an independent inquiry in the terms in respect of which I have written to him today?
Alan Johnson: We discussed this last week and there was no mention of an independent inquiry by the Opposition. The hon. Gentleman refers me to the appendix: let me refer him to the powers that the House gave to the Healthcare Commission. The commission could have immediately put that hospital into special measures. Its decision—as an independent regulator—was not to do so. It would have been quite wrong of Ministers to rush immediately to dismiss or discipline a chief executive when we did not even have any evidence from the Healthcare Commission. It had not reached any conclusion because it had spent only one day in the hospital.
Imagine a giant quango, the independent NHS board, trying to tackle these problems. The whole basis of the Opposition’s policy is to try to remove politicians from these issues. That is quite wrong, and we are right to deal with these issues in the way that we have."
Sir Nicholas Winterton asked about nurses:
"I know that the Minister is aware that a reception was held in the House earlier this month that was sponsored by the Royal College of Nursing, of which the Minister was a member, and the WellChild charity, which was intended to encourage primary care trusts to employ community children’s nurses in order to help not only children with long-term complex health needs, but their families. Will the Minister tell me what steps the Government are taking to ensure that these nurses are employed, as they will help children and their families to co-ordinate packages of not only medical but local care, which might help them to spend more time at home rather than commuting to hospital on a regular basis, as this is often painful to them?
Ann Keen: I congratulate the Royal College of Nursing and WellChild on holding that reception, which highlighted some very important issues; as the hon. Gentleman said, we were both present. Government funding of £340 million established through our recent child health strategy will help local areas to support the development of more care packages in the location preferred by the child and family. To provide the safe, comprehensive and sometimes highly complex packages of care that these children need takes time to co-ordinate. There are no quick fixes, as was highlighted at the reception. In many cases, delays are caused by the time taken to resolve issues such as housing and adaptations rather than the lack of community nurses, but we are committed to the work force and to the planning of community children’s services. I believe that this area will be addressed in the Prime Minister’s commission on the future of nursing and midwifery."
Henley MP John Howell was worried about the impact of the recession:
"What assessment he has made of the likely effect on demand for NHS services of the economic downturn; and if he will make a statement. 
The Minister of State, Department of Health (Mr. Ben Bradshaw): The evidence from Britain and other countries is that demand for health services increases in an economic downturn. However, thanks to funding already agreed for the period to 2011, we believe that the NHS is in a strong position to manage this well.
John Howell: As more and more families pull out of private health care, what pressure is the Minister seeing on primary care providers, and what assessment has he made of how well they are able to cope?
Mr. Bradshaw: It is quite difficult to get reliable figures on how many people withdraw from private health care, as it is obviously a matter for the private sector itself. A few months ago, Laing and Buisson said—the hon. Gentleman may have picked it up—that there has been a 10 per cent. reduction in people deciding to pay privately for their operations, but that actually preceded the economic downturn. Laing and Buisson believes that it has more to do with the very short waiting times on the NHS: there is now almost no difference at all between waiting times in the NHS and waiting times in the private sector. We are confident that, given the increase in investment that the NHS will receive over the next two years, even if all the people in this country choose to use NHS care—I hope that they would like to do so, given the short waiting times—the NHS will be able to cope very well."
The minister's point about withdrawal from private healthcare being a matter for the private sector is slightly troubling. I would hope the Government has a good estimate of current trends, given the inevitable burden it will place on the NHS.
Beckenham MP Jacqui Lait asked when the national dementia strategy will be implemented in England:
"The Minister of State, Department of Health (Phil Hope): The first national dementia strategy was published on 3 February this year, and will be implemented over a five-year period. Improving services for people with dementia is a Government priority, and we have already identified it as a priority for the national health service in the operating framework. That will help to ensure that dementia is prioritised locally where further improvement may be needed.
Mrs. Lait: The London borough of Bromley contains the highest percentage of retired people in London. What can I tell my constituents about the quality of the services that they can expect, and whether those services will be delivered through GP centres?
Phil Hope: The national dementia strategy covers a range of services, but it emphasises the importance of early diagnosis. We intend every area in the country—including the hon. Lady’s constituency—to contain memory clinics, to which suitably trained GPs will refer people who show early symptoms of dementia. There they can be given an accurate diagnosis and assessment—as there are different forms of dementia—and then receive the specialist help and intervention that they require. We know that early intervention enables us to help people with dementia and their carers, and to ensure that people live much better with their dementia and stay in their own homes for longer."
Congleton MP Ann Winterton was interested in childcare:
"While I welcome the child health strategy, what plans do the Government have to increase the number of health visitors to assist children with long-term, complex needs? I understand that the numbers of health visitors have been cut over the past four years, so when will they be back to 2005 levels? What plans does the Minister have to provide adequate respite care for parents and other children in the family?
Dawn Primarolo: I know that the hon. Lady follows these considerations very closely, and I commend her for that. She will know that the Government have committed extra finance, to a total of some £340 million over this spending cycle, through both the Department for Children, Schools and Families and the Department of Health. We have also made clear the future priorities for both the operating framework and the present structure. First, we need to address the issues of palliative care and short breaks. Secondly, we need to look at the clinical pathways and put in place individual care plans. That addresses precisely the point that the hon. Lady made about health visitors, for instance, and the complex needs of these young people. Finally, we must address the question of managing medicines in schools. Those three sets of priorities have been identified by parents, people in the voluntary sector and the young people themselves. [ Interruption. ] If the hon. Member for South Cambridgeshire (Mr. Lansley) would just stop talking from a sedentary position, I would be able to answer the question. The day that the Conservative party provides answers to anything will truly be a damascene conversion.
I return to the final point made by the hon. Member for Congleton (Ann Winterton) about health visitors. I can confirm that the work being taken forward by the Government in the spring of this year will concentrate on the valuable role that health visitors play in meeting the complex needs of these young people."
Buckingham MP John Bercow is also engaged with the issue:
"One group of children and young people with complex health needs consists of those who require high-tech, expensive communication aids to express their hopes, needs, fears and interests. I welcome the proposed joint commissioning pathfinders, to which the Government have sensibly committed. Will the right hon. Lady confirm that they will be taken forward with all due haste, and that the Government will look at other aspects of joint commissioning, and models for the provision of alternative and augmentative communication for children who are desperately in need of it?
Dawn Primarolo: I commend the hon. Gentleman on his excellent report, the recommendations of which the Government accepted. I can confirm that we will act on the specific points relating to the individual, and the very important support and care that individuals may need. We will also look at his recommendations on wider issues to do with speech, language and communication, and so at the collaboration that needs to take place beyond the health service, particularly through local area agreements, to make sure that we deliver on the recommendations that he rightly made."
Shadow Health Minister Stephen O'Brien chipped in:
"The Secretary of State pledged in his first speech as Health Secretary to meet the care needs of people with a learning disability, but in the light of today’s shocking findings by the ombudsman on the NHS’s failures in long-term care for young people with learning disabilities, when will the
Minister of State and the Secretary of State convert the words of January’s strategy—itself an admission of the failure of the Government’s 2001 “Valuing People” document—into the action that is so urgently needed if we are to avoid a repeat of the shocking discrimination and damage suffered by those with learning disabilities?
Dawn Primarolo: I absolutely agree with the hon. Gentleman; the report is shocking. The Government are determined to make progress by accepting recommendations previously made to us, by concentrating specifically on care plans, and by working with GPs on identifying issues, early intervention and providing the correct support. The Minister of State, my hon. Friend the Member for Corby (Phil Hope), has today clearly indicated our determination to make sure that the very highest standards are available to all those who access our health services."
Another Shadow Health Minister, Anne Milton, asked about self-harm:
"Figures show that the number of people admitted to hospital for intentional self-harm has increased by a third in the past five years, from 74,000 to 97,000. More than 4,000 of those admissions were of children under the age of 14. One in eight women admitted to self-harm in 2007, an 80 per cent. increase since 2000. Figures released by the National Society for the Prevention of Cruelty to Children yesterday show that the number of suicidal children ringing the helpline ChildLine has tripled in the past five years. Is the Minister not ashamed of these appalling figures and the Government’s failure to turn the tide on the country’s deteriorating mental health?
Phil Hope: I understand the hon. Lady’s concerns. It just surprises me sometimes when Opposition Front-Bench spokespersons reel off a list of statistics without asking questions and, more importantly, without acknowledging the substantial extra investment that this Labour Government have put in place and which her party voted against in every Budget since 1997. The issues that she highlights are serious and need to be addressed. I am pleased that the suicide rate in England continues to fall. It is now at its lowest since records began in 1861, and is among the lowest in Europe. I am also pleased that the World Health Organisation said:
“The ambition and pace of change in England has been remarkable over the last 10 years, and mental health services here are increasingly being seen across Europe as a model to follow.”
Another member of the team, Mike Penning, asked about dentists:
"The 90,000 extra places for patients that the Minister has just announced will go part of the way to addressing the issue of the 1.1 million people who would like an NHS dentist. Professor Steele is currently doing his review. Will his report be published in full, and will the Government accept all his recommendations?
Ann Keen: No, it will be published in full; all of us on this side of the House are humble enough to say when we have made an error. I only wish that the hon. Gentleman would be as honest when Conservative Members do. Like any sensible Government, we will look at the review when it is published."
Sir Nicholas Winterton popped back up to ask about diabetes and other conditions:
"What assessment have the Government made of the future impact of cardiovascular and kidney disease and diabetes on NHS resources, and what plans are being put in place to deal with what will clearly be an additional burden on the NHS?
Alan Johnson: There are a number of bits of analysis on this. The one that struck home more than any other was the Foresight report conducted by some of the world’s most eminent scientists and epidemiologists about the effect of obesity, which is a major driving factor in type 2 diabetes, cardiovascular disease and, indeed, cancer. They said that if we do nothing about this, by 2050 not only will there be an enormous burden in terms of disease but enormous costs—they estimate the cost will be around £50 billion to the NHS and to society more generally. That is why we are introducing the abdominal aortic aneurysm ultrasound check from this year, the vascular check for every adult between 40 and 73, call and recall, and many other initiatives to deal with prevention. The hon. Gentleman raises a crucial point about what we have to do now to prevent this disease burden in future."
Shadow Minister for Communities and Local Government Stewart Jackson asked about midwifery:
"We know that the increase in the number of live births has outstripped the increase in the number of midwives by a ratio of 3:1 in the period since 2001. The impact of that is particularly acute in areas of high population growth, such as my constituency. The Royal College of Midwives states that 3,600 new midwives are needed in such areas. Two weeks ago, six expectant mothers were turned away by the maternity unit at Peterborough district hospital and forced to travel 35 miles to King’s Lynn. What is the Minister going to do about that?
The Parliamentary Under-Secretary of State for Health (Ann Keen): We are actively recruiting midwives, and working very closely with the Royal College of Midwives. If an expectant mother were turned away from a unit it would be for reasons of safety—for the mother and the birth—because there was not enough capacity. We have an escalating birth rate and an active recruitment programme of midwives. We are also encouraging return to practise. I am sure that the hon. Gentleman would agree that the safety of the mother, and the circumstances of the birth, is paramount and it is better for a mother to travel elsewhere than for her to be admitted and made unsafe. It is unfortunate when a woman has to travel further to give birth, but it is a matter of safe practice."
Bracknell MP Andrew Mackay (Senior Parliamentary and Political Adviser to David Cameron) indicated his dismay at the suggestion that the price of alcohol should be subjected to a hefty rise:
"While Sir Liam Donaldson’s comments about tackling alcohol abuse might have been well meaning, does the Secretary of State accept that for many of my constituents—perfectly ordinary people struggling in this recession—the idea of a huge tax increase on relatively cheap bottles of wine is quite unreasonable?
Alan Johnson: I share the right hon. Gentleman’s view on that. For 150 years, the chief medical officer has been producing such reports—not the same person, of course—that have made a huge contribution to public health in this country, sometimes years after a report has been published. I respect the integrity of the chief medical officer, as I am sure the right hon. Gentleman does, but I just happen to disagree with that solution."