41 min read

Editorial Tuesday 23 October 2012: Jeremy 'Bellflinger' Hunt - the Norman Puddifoot of Health Secretaries

At the risk of making myself persona numquam grata among the elite of the health policy universe, I must confess that today, I felt slightly sorry for Jeremy 'Bellflinger' Hunt.

I am beginning to think that he may be the Norman Puddifoot of Health Secretaries.


Click here for details of 'Lansleyshambles - game over, as Jeremy ‘Bellflnger’ Hunt does the reconfiguration hokey-cokey', the new issue of subscription-based Health Policy Intelligence.


I must explain that remark.

And the explanation starts with a confession, which is that as a child I was a 'Doctor Who' fan.

Full disclosure: I was not just someone who liked watching Dr Who a bit.

No, I was a tragically obsessive, scarf-owning, merchandise-buying borderline autistic about the charmingly wobbly-setted sci-fi-fest. (I can almost hear readers going 'ah ... that explains a lot', which is not a wholly reassuring feeling. But there we are.)

When I started watching, 'my' Doctor was the brilliantly manic, manically brilliant Tom Baker.

And my Dad, probably and understandably bored and irritated by my incessant rambling about a TV show,  devised a highly effective winding-me-up strategy.

This was to announce that he'd heard on the news that Tom Baker was going to move on from Dr Who, and that he was going to be replaced by Norman Puddifoot.

I didn't know who Norman Puddifoot was. To save you the time and RSI of Googling him, Norman Puddifoot does not in fact exist (although I did once deploy him in an editorial when I ran British Journal of Healthcare Management. Don't believe everything you read in the media.)

All I knew about Norman Puddifoot was that he was not required, and that the world (i.e. me) neither wanted nor needed him as the next Doctor Who.

Which is how I fear it may prove to be for The Bellflinger.

I think the world may neither want nor need Jeremy Hunt as Secretary Of State For Health. His first session of health questions was far from compelling.

Let us start with the modest positives: it is not as if The Bellflinger has no sense of humour whatsoever. Indeed, taking a question from NHS-loathing Commons dullard Peter Bone, The Bellflinger namechecked the axiomatic Mrs Peter Bone ("I am very pleased that my hon. Friend has an urgent care centre, and am sure that Mrs Bone will appreciate it even more than he does").

No, it is more a sense that the brief does not engage him much.

Now, there is arguably a cautionary tale to be learned from the extent to which his predecessor Andrew Lansley (ex-saviour and former-liberator) was engaged - if not actually subsumed - by the health brief.

But there is probably a valid mid-point between Lansleyite obsessive-compulsive health uber-geekery, and the sense of being a man facing the pleasure and wonder of two fillings without anaesthetic that so far emanates from The Bellflinger.

I don't think you have to love the health brief, but you have to like it a bit and find the challenges and problems interesting.

It's far from clear that Hunt finds health that engaging. This is a shame, because the health portfolio is going to be a bit of a ballache over coming years.

The 2012 Act means that he has lost the jolly interventionist powers (short of going nuclear and over-riding the NHSCB); yet the NHS will be financially pressured until, oh, about 2023. At an upbeat estimate.

Pressure tends to inflict pressure sores.

Andy Burnham, The Mascara Kid, was reasonable effective, getting in his blows around the higher-than-anticipated-if-scarcely-surprising figures that "the previous Secretary of State gave the budget a real-terms cut for two years running. Let me give the exact figures, which the Secretary of State did not give the House. The costs of the reorganisation are up by 33% or £400 million, making the total £1.6 billion and rising".

Labour's Tom Blenkinsop also scored with a question on ambulance waiting times over 30 minutes, forcing Hunt to reveal that "the number of ambulance handovers delayed by longer than half an hour was 63,892 between 1 November 2010 and 24 February 2011 and 77,543 between 1 November 2011 and l March 2012". Andrew Gwynne amplified this, using FOI data to state that "under this Government, 100,000 additional patients are being left waiting in ambulances outside accident and emergency departments for more than half an hour when they need urgent treatment".

Regional pay reared its ugly head, with Dr Daniel 'D-100' Poulter stating "it is important that we support national pay bargaining where we can. There is an agreement in principle, endorsed by NHS employers, that national pay bargaining is supported throughout the NHS".

Jamie Reed is fast becoming not only Labour's Twitter-Surrealist-In-Chief, but quite handy with a one-liner, dubbing Poulter's physical proximity to The Bellflinger "the Ghost of Christmas Past sitting next to the Invisible Man". Poulter countered that Reed's points about the risks of regional pay were "fatuous", although his reason for this seemed to be London weighting. Which probably isn't uppermost in the minds of the South West pay consortium.

The Health Select Committee member Dr Sarah Woolaston asked about the registration of all clinical trials - the Ben Goldacre question. Lovely Norman Lamb read out rather a long answer; the Speaker told him off; and #SimonBurns4SOS's ex-bag carrier-turned health minister Anna Soubry chid Mr Bercow in her ex-boss's finest tradition.

The Soub-Chef rose to a question from her backbench colleague David Mowat about the allocation formula to reveal "We will soon publish the final recommendations of the independent advisory committee on resource allocation ... fairness is imperative when it comes to distributing money and deciding where it goes. One reason the Government are keen to make the formula fair is our determination to reduce health inequalities, especially given the last Administration’s legacy of increased inequalities".

Liz Kendall skewered the Soub-Chef with a deadly question: "Cancer networks have played a crucial role in improving patient care, including by earlier diagnosis. The former Health Secretary promised this House that their funding would be guaranteed in 2011, but the South East London Cancer Network now says its budget was cut by 40% between 2009 and 2011. This year, it has been slashed by a further 55% and its staff have been cut from 15 to eight. Will the Minister now admit that her Government have cut funding for vital front-line cancer experts and have broken their explicit promises on cancer care?

The reply - "my information is that any 40% reduction is a result of cuts in administration—and that, if I may say so, seems the right way to go about things. This Government are determined to make sure that when we make cuts of that nature, they are not actually cuts—[Interruption.] It is about moving money around so that it goes to front-line services. This Government are determined to reduce bureaucracy in the NHS and to make sure that patients get the benefit of our spending—unlike under the last Administration, who had it round the other way" - was spectacularly underwhelming. The Soub-Chef's line here wasn't just undercooked; it was still in the fridge.

Her assertion that "when we make cuts of that nature, they are not actually cuts" deserved a place in The Thick Of It. Norman Lamb refused to answer a question about cuts in mental health, probably mindful that his predecessor, anonymity-prone Paul 'Who?' Burstow had admitted them to the HSJ

Full text of the session below comes courtesy of the ever-fabulous Hansard.

The Secretary of State was asked—

NHS Cost

Mr Peter Bone (Wellingborough) (Con):
What his latest estimate is of the likely cost of the NHS in 2012-13.[124134]

The Secretary of State for Health (Mr Jeremy Hunt):
The latest estimates of NHS spending are those published in the 2012 Budget. The planned NHS spending for 2012-13 is £108.8 billion.

Mr Bone:
The Conservative-led coalition Government are increasing spending on the NHS, unlike what Labour would do. In my constituency, we will get an urgent care centre in a few months as a result of Tory health reforms. People in Corby already have an urgent care centre as a result of Tory reforms. Does the Secretary of State agree that, while Labour talks about the NHS, Conservatives deliver on the NHS?

Mr Hunt:
I absolutely agree with my hon. Friend. Indeed, last week we announced that waiting times are at near-record lows. The number of hospital-acquired infections continues to go down and mixed-sex wards have been virtually eliminated. I am very pleased that my hon. Friend has an urgent care centre, and am sure that Mrs Bone will appreciate it even more than he does.

Grahame M. Morris (Easington) (Lab):
Does the Secretary of State recognise that the Office for National Statistics survey shows that the mortality rate in north-east England is 12% higher than that in the rest of the UK? Does he recognise the need to invest in more advanced radiotherapy equipment, bearing in mind that 70 of the 212 systems will need to be replaced by 2015?

Mr Hunt:
I would not necessarily expect the hon. Gentleman to follow announcements that are made at the Conservative party conference, but we did make the big announcement that access to radiotherapy will be transformed, making it available to everyone for whom it is clinically necessary and cost-effective. Improving mortality rates is extremely important. As I have set out, one of my key priorities is to transform the NHS so that we have the best mortality rates in Europe. I hope that that is welcome news for his constituents.

Charlie Elphicke (Dover) (Con):
Does my right hon. Friend agree that there will be less budget pressure on the NHS if we do better with long-term conditions, get better at integrated care and use data better to predict ill health? To that end, will he come and see the work of the Kent Health Commission on those issues?

Mr Hunt:
I would be delighted to see the innovative things that are happening at the Kent Health Commission. Looking at how we deal with people with long-term conditions—that is 30% of the population, and the proportion is growing with the ageing population—will be a vital priority for the NHS over the coming years.

Andy Burnham (Leigh) (Lab):
May I welcome the Secretary of State and his new team to their positions? As the only other person to have made the jump from Culture to Health, I am sure that he will find me a constant source of useful advice.

The Secretary of State has not said much since his appointment, but he did set out his mission in The Spectator:

“I would like to be the person who safeguards Andrew Lansley’s legacy”.

Let us talk about that legacy. Just last week, the Secretary of State slipped out figures on the latest costs of NHS reorganisation. Would he care to update the House on the current estimates?

Mr Hunt:
Let me tell the right hon. Gentleman that Andrew Lansley’s legacy is—

Mr Speaker:
Order. The Secretary of State has been in the House for seven and a half years. I think he knows that we refer to Members by constituency, not by Christian name. It is not difficult.

Mr Hunt:
First, may I say how delighted I am that the right hon. Gentleman and I once again have the same brief? I look forward to having a constructive relationship with him, not with total optimism, but I will try my best.

The right hon. Gentleman talked about my predecessor’s reforms and legacy. One of the finest things about my predecessor’s legacy is that he safeguarded the NHS budget—indeed, he increased it during this Parliament by £12 billion—when the right hon. Gentleman said that it would be irresponsible to increase it.

Andy Burnham:
Look at the figures: the previous Secretary of State gave the budget a real-terms cut for two years running. Let me give the exact figures, which the Secretary of State did not give the House. The costs of the reorganisation are up by 33% or £400 million, making the total £1.6 billion and rising. And what is that money being spent on? A full £1 billion is being spent on redundancy packages for managers: 1,300 have got six-figure pay-offs and there are 173 pay-offs of more than £200,000. Scandalously, that news comes as we learn today that the number of nurse redundancies has risen to more than 6,100. Six-figure pay-outs for managers, P45s for nurses and the NHS in chaos—is that the legacy that the Secretary of State is so proud of?

Mr Hunt:
Let us look at some of the facts. The number of clinical staff in the NHS has gone up since the coalition came to power. The right hon. Gentleman talked about the cost of the reforms, which is about £1.6 billion. Thanks to those reforms, we will save £1.5 billion every single year from 2014 and the total savings in this Parliament will be £5.5 billion. Let me remind him that he left the NHS with £73 billion of private finance initiative debt, which costs the NHS £1.6 billion every single year. That money cannot be spent on patient care. He should be ashamed of that.

Mr Philip Hollobone (Kettering) (Con):
Will the Secretary of State confirm that NHS spending will increase in real terms during the lifetime of this Government, and that there are no plans from anyone to close the accident and emergency department and the maternity unit at Kettering general hospital? Will he condemn those who say that the Government want to close the hospital, when nobody is going to do that at all?

Mr Hunt:
My hon. Friend is absolutely right: that is a mendacious scare story that is being put out on the ground. Real-terms spending on the NHS has increased across the country, which has not been possible across all Government Departments. Because of that, we are able to invest more in patient care, cancer drugs, doctors and facilities across the country, and indeed in Kettering.

Ambulance Waiting Times

Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab):
How many patients waited longer than half an hour in an ambulance to be transferred to accident and emergency in each year since 2009-10.[124135]

The Secretary of State for Health (Mr Jeremy Hunt):
The Department’s records date back to 2010-11. The number of ambulance handovers delayed by longer than half an hour was 63,892 between 1 November 2010 and 24 February 2011 and 77,543 between 1 November 2011 and l March 2012.

Tom Blenkinsop:
On 27 September, patients and paramedics were left waiting outside James Cook university hospital in Middlesbrough for two and a half hours before being handed over. Dr Clifford of the college of emergency medicine described such delays as being due to an unacceptable mismatch in demand and supply. Does the Secretary of State agree with Dr Clifford, and what steps will he take to ensure that those problems do not recur for my constituents?

Mr Hunt:
I am extremely concerned about what happened on 27 September. I can confirm to the hon. Gentleman that all the red 1 calls on that day were met within the target time of eight minutes, but the delays were completely unacceptable. I know that the trust is taking measures to ensure that the problems are not repeated, particularly looking forward to the winter time when there is likely to be extra pressure on ambulance services. I will follow the matter very closely, and I expect the trust to come up with measures to ensure that his constituents are properly safeguarded.

Andrew Bridgen (North West Leicestershire) (Con):
In the summer, I spent an interesting and thought-provoking day observing the work of a crew of the East Midlands ambulance service. Can my right hon. Friend confirm that ambulance trusts across the country, including the East Midlands ambulance service, are performing well in meeting their response time targets?

Mr Hunt:
I can absolutely confirm that. In fact, I was extremely pleased to see last week that all the standards are being met for both eight-minute category A calls—red 1 and red 2 calls—and 19-minute calls. That is as it should be, but it is no grounds for complacency. Although that is a country-wide picture, there are parts of the country where those standards are not being met in the way that we would like. We will continue to monitor the situation closely.

Andrew Gwynne (Denton and Reddish) (Lab):
I will be charitable to the Secretary of State, but he brushed over the figures in his answer to my hon. Friend the Member for Middlesbrough South and East Cleveland (Tom Blenkinsop). I have got the actual figures through a freedom of information request. They show that under this Government, 100,000 additional patients are being left waiting in ambulances outside accident and emergency departments for more than half an hour when they need urgent treatment—a totally unacceptable situation. What more evidence does the Secretary of State need of the chaos engulfing the national health service under his Government? It shows that the focus has slipped off patient care and that our accident and emergency units are struggling to cope.

Mr Hunt:
The hon. Gentleman speaks as though the problem of ambulance waits never happened for 13 years under Labour, but he knows that we actually had some appalling problems, with ambulances circling hospitals because hospitals did not want to breach their four-hour A and E wait targets. We are tackling the problem, and as I mentioned, if he looks at the figures published last week he will see that we are meeting the standards for ambulance waits that his party’s Government put in place. However, we are not complacent, and we are monitoring the figures closely. Particularly with the winter coming up, we want to ensure that the ambulance service performs exactly as the British public would want.

Mr James Gray (North Wiltshire) (Con):
Many ambulance trusts are indeed doing extremely well, as the Secretary of State indicated. Does he agree that that is at least partly due to localism in the ambulance service, which may be undermined if, for example, the Great Western ambulance service becomes an amalgamated regional service? Now it has been announced that the call centre in Devizes will be closed in favour of one in Bristol. Does he agree that there is at least a risk that the local service for people in Wiltshire will be reduced if such regionalisation is allowed?

Mr Hunt:
I agree with my hon. Friend that the purpose of the changes that the coalition Government have brought to the NHS is to tap into local innovation, ideas and ambitions to transform services, and it is important that no changes undermine that. He should take comfort from the fact that my predecessor introduced clear tests for any major reconfigurations, including that they should be strongly supported by local doctors, that the public should be involved in any consultation, that the changes should improve patient choice and that there should be clear evidence of benefits to patients. I hope that that gives him and his constituents some reassurance.

National Pay Arrangements

Mrs Mary Glindon (North Tyneside) (Lab):
What his policy is on upholding national pay arrangements in the NHS.[124136]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter):
NHS trusts and foundation trusts have the freedom to determine the terms and conditions of the staff they employ. As the hon. Lady will be aware, the “Agenda for Change” was negotiated and brought in during 2004 by the then Secretary of State, John Reid, to agree a national framework for pay in the NHS. In general, most trusts support the agreed pay framework and the “Agenda for Change”, and they are likely to continue to use national terms, provided they remain affordable and fit for purpose.

Mrs Glindon:
In fairness, a truly national health service demands a national pay scheme, and the British Medical Association has warned that the move to regional pay undermines the ethos of “national” in our national health service. How does the Minister intend to act on that warning?

Dr Poulter:
I remind the hon. Lady that it was the previous Government who set up the current national pay framework in 2004, and that framework has been amended 20 times to support employers over that period. The previous Government gave foundation trusts the freedom to amend those pay terms and conditions. Regional pay does exist in the NHS. On the basis of what she has said, does the hon. Lady wish to remove the London weighting for those workers who live in London? I am sure she would not want to do that because we recognise that it is more expensive to live in certain parts of the country, and workers should be rewarded for that.

John Pugh (Southport) (LD):
The Lib Dem conference rejected regional pay entirely, but not the London weighting, and 25 honourable colleagues endorsed a submission to the pay review body. With that in mind, is it not odd that the south-west consortium remains part of national pay bargaining?

Dr Poulter:
My hon. Friend makes a good point and it is important that we support national pay bargaining where we can. There is an agreement in principle, endorsed by NHS employers, that national pay bargaining is supported throughout the NHS. It was supported throughout the NHS under the previous Government, who set up the “Agenda for Change”, and during their tenure, that agenda remained fit for purpose. Twenty changes during the previous Government’s tenure benefited employees in the NHS, and rightly so. The current Government believe that we must continue to ensure that the system is fit for purpose.

Mr Jamie Reed (Copeland) (Lab):
It is most unusual to find the ghost of Christmas past sitting next to the invisible man. The truth is that in May this year, the Deputy Prime Minister stated:

“There is going to be no regional pay system. That is not going to happen.”

Regional pay will strip millions from local NHS services; it will hit the poorest areas of the country hardest, damage front-line NHS care, and there can be no justification for it. Will the Minister categorically rule out continuing with these ruinous proposals—yes or no?

Dr Poulter:
The arguments presented by the hon. Gentleman are fatuous, and the previous Government endorsed regional bandings for London workers. If today he is saying that he does not agree—[Interruption.] You might learn something if you listen. If he is saying that he does not agree with London weighting for London workers, which is a form of regional pay—[Interruption.]

Mr Speaker:
Order. The Minister is entitled to be heard.

Dr Poulter:
If the hon. Gentleman listens, he may well learn something about what his Government did when they were in power. They endorsed the fact that in the NHS it is important to recognise that we need inducements in some parts of the country to encourage workers to work there. That is why we have central London and outer London weighting. If it was good enough under the previous Government, it should be good enough now.

Mr Speaker:
Order. We are immensely grateful to the Minister, but we have a lot to get through and we really must press on with rather greater dispatch from now on.

Clinical Trials

Dr Sarah Wollaston (Totnes) (Con):
What his policy is on making available all information about the results of clinical trials to patients, doctors and medicine approval bodies.[124137]

The Minister of State, Department of Health (Norman Lamb):
The Government support transparency in publishing results of clinical trials, and they recognise that more can, and should, be done. In future, greater transparency and the disclosure of trial results will be achieved via the development of the European Union clinical trials register, which will make the summary results of trials conducted in the EU publicly available. Greater transparency can only serve to further public confidence in the safety of medicines, which is already robustly assured in the UK by the Medicines and Healthcare products Regulatory Agency. By law, the outcomes of clinical trials undertaken by companies must be reported to that regulator, including negative results.

Mr Speaker:
Order. We are grateful to the Minister but some of these answers are simply too long. If they are drafted by officials, Ministers are responsible—[Interruption.] Order. I require no assistance at all from the Under-Secretary of State for Health (Anna Soubry). She should stick to her own duties, which I am sure she will discharge with great effect.

Dr Wollaston:
I thank the Minister for his answer and for recognising that missing data from clinical trials distorts the evidence and prevents patients and their doctors from making informed decisions about treatment. Will the Minister meet a delegation of leading academics and doctors who remain concerned that not enough is being done to see how we can ensure that all historic and future data are released into the public domain?

Norman Lamb:
My hon. Friend raises absolutely legitimate concerns, which have been raised by others, including Ben Goldacre. I am happy for my noble Friend Lord Howe or me to meet her and experts to discuss this important issue further.

Mr Speaker:
I call Catherine McKinnell.

Catherine McKinnell (Newcastle upon Tyne North) (Lab):
I did not have a question on this.

Mr Speaker:
The hon. Lady does not want to come in. Fair enough.

Diabetes and Asthma

Christopher Pincher (Tamworth) (Con):
What steps the Government are taking to help people cope with conditions such as diabetes and asthma.[124138]

The Secretary of State for Health (Mr Jeremy Hunt):
We are working on an outcomes strategy for long-term conditions such as diabetes and asthma structured around six shared goals, early diagnosis, integrated care, promoting independence, and steps to support those with long-term conditions to live as well as possible.

Christopher Pincher:
Given that type 1 diabetes in under-fives is growing at 5% each year, what can my right hon. Friend do with the innovative Secretary of State for Education to ensure that nursery and primary school staff have the right skills and knowledge to ensure that they can help young children to cope with type 1?

Mr Hunt:
The answer is that we are doing quite a lot—a good booklet, “Managing Medicines in Schools and Early Years Settings”, goes around schools, and there are other resources for schools—but we need to do more. We will be announcing a diabetes action plan, a long-term conditions outcomes strategy and a cardiovascular disease outcomes strategy, which will go further to address the issues that my hon. Friend raises.

Keith Vaz (Leicester East) (Lab):
I declare my interest as someone who has type 2 diabetes and welcome what the Secretary of State says. However, according to the latest report, another 700,000 people will contract the disease by 2020, and 80% of amputations are avoidable. Could he ensure that this very important subject is on the agenda of local clinical commissioning groups?

Mr Hunt:
I certainly can. The number of diabetes sufferers overall will go up from about 3.7 million, which is already 5% of the population, to 4.4 million. We need to do a lot better in how we look after people with long-term conditions if the NHS is to be sustainable. We can also do a lot to transfer the individual care of people who have diabetes through things such as technology, which I will look into carefully.

Mr Stephen Dorrell (Charnwood) (Con):
Does my right hon. Friend agree that the effective delivery of care to people with long-term conditions relies on breaking down the silos within the health service, and between the health service, social care and social housing? Will he encourage the new health and wellbeing boards to follow through that agenda with a serious purpose?

Mr Hunt:
My right hon. Friend is absolutely right. By 2018, nearly 3 million people will have not one but three long-term conditions. All too often, the system treats them on a disease or condition basis, and not as a human being who needs an integrated care plan. That is the route to lower costs, but it is also the route to transformed care.

Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op):
The Public Accounts Committee has heard that, of 20 trusts that needed to improve their diabetes care, only three took the accepted help. How will the Secretary of State ensure that care through health providers meets the grand targets he has set for himself?

Mr Hunt:
The hon. Lady is absolutely right to point out that the consistency of provision is not good, but we will be publishing a diabetes action plan that will try to ensure more consistent provision throughout the NHS. We also need to raise our sights as to what is possible, because as I have mentioned, a third of the population have long-term conditions, and we can do much better at helping people to live with those conditions in a way that promotes their independence.

Community Hospitals

Mr Nick Gibb (Bognor Regis and Littlehampton) (Con):
What assessment he has made of the role of community hospitals in the range of local health care and hospital provision.[124139]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter):
My hon. Friend is right to highlight the importance of community hospitals in his constituency and elsewhere. They can provide high-quality care close to home, particularly for people with long-term conditions and the frail and elderly.

Mr Gibb:
I am grateful to my hon. Friend for that answer. If there is a conflict between local health officials and local people as to the desirability of a community hospital, as there is in Littlehampton in relation to the Littlehampton community hospital, which most people in the town want to see rebuilt, whose views should prevail—the NHS employees or the local residents of Littlehampton?

Dr Poulter:
I thank my hon. Friend for his question. As he is well aware, it is down to local commissioners—local doctors—in Littlehampton to decide, in consultation with local communities, what is good health care. Of course, we must not get fixated on buildings in the NHS. I know there is a local campaign to support the re-establishment of Littlehampton district hospital, and although that may be a very desirable end, there may be many other ways in which high-quality health care can be provided for his constituents closer to home.

Graham Jones (Hyndburn) (Lab):
From April, my local health centre will be transferred to a national property company, a quango, in Whitehall. How can local people in Hyndburn regain some influence over this health centre and its use after April?

Dr Poulter:
Part of reorganising services and delivering good health care is about clinical leadership—I hope that is supported across the House—and local doctors, nurses and health care professionals saying what is important for their patients and what local health care priorities are. Obviously, local communities need to be engaged in that process, but what really matters is what is good for patients and delivers high-quality care for them. We need to deliver more care in the community, and in doing so we have to recognise that some of the ways we have delivered care in the past—picking up the pieces in hospitals when people are broken—need to change. We have to do more to keep people well at home and in their own communities.

Sir Alan Beith (Berwick-upon-Tweed) (LD):
Given that the maternity unit at Berwick infirmary has been suspended since the beginning of August for safety reasons, with births being referred to a hospital 50 miles away, will the Minister take into account the urgent need to provide the necessary clinical support for community hospitals in remote areas so that they can provide local essential services to the highest standards?

Dr Poulter:
I thank my right hon. Friend for that question. We discussed this issue in the Adjournment debate before the autumn recess. He is a strong advocate for his local maternity services. The concern was that only 13 births take place at his local maternity unit every year, and whether staff can continue to deliver high-quality care with such a low number of births. Of course, his local providers will want to consider the rurality of the area and the potential, as outlined in the Birthplace study, of rotating staff in and out of the hospital to support his local unit.

Domiciliary Care

Barbara Keeley (Worsley and Eccles South) (Lab):
What steps he plans to take to ensure that providers of domiciliary care employ staff who are properly qualified and security checked.[124140]

The Minister of State, Department of Health (Norman Lamb):
Providers of services are responsible for the safety and quality of the care they provide. All staff must be properly qualified and vetted, and the Care Quality Commission can and must take action against providers who fail in that regard. Action can range from a warning notice to, ultimately, cancelling a provider’s registration. The commission must be willing to take that action if necessary.

Barbara Keeley:
But the Minister knows that a recent BBC programme showed that 217 providers of care at home use staff who are not properly qualified, and that dozens of people with criminal records have not been vetted and are working unsupervised in people’s homes. The Care Quality Commission has reached only just over one in four of its target inspections, with 40% of care at home providers never having been inspected by it. What will the Minister do to ensure that we can have more confidence in care provided at home to vulnerable people and that it is up to a better and safer standard?

Norman Lamb:
I absolutely share the hon. Lady’s concern about this. It is intolerable that people receiving domiciliary care do not get high-quality care and that in some cases people are inappropriately employed. The Care Quality Commission must take action where there is evidence of employers not taking sufficient action to guarantee the quality of their staff. It is essential that the people who run those services are held to account if they fail in that regard.

Mark Pawsey (Rugby) (Con):
Will the Minister also consider the matter of the uniforms worn by staff in this sector? I understand that on occasions there has been confusion in members of the general public between such staff and qualified nurses.

Norman Lamb:
It is absolutely essential that users of services know exactly who the staff are who are caring for them, and the issue of uniform is something that I would be happy to discuss further with the hon. Gentleman.

Health Allocation Formula

David Mowat (Warrington South) (Con):
What plans he has to review the health allocation formula.[124141]

The Parliamentary Under-Secretary of State for Health (Anna Soubry):
We will soon publish the final recommendations of the independent advisory committee on resource allocation. That committee reviews the approach and the formula under which money is allocated to clinical commissioning groups and local authorities so that they can fulfil their public health duties.

David Mowat:
There have been two problems with how the formula has worked over the past few years. First, it has not placed enough emphasis on ageing as a criterion, and secondly the Department of Health has not implemented it properly, in so far as flat-rate increases have been given to primary care trusts, meaning that there has been no impact from changes. Both these things have worked to the detriment of Warrington. Will the Minister resolve these issues?

Anna Soubry:
I am glad to assist my hon. Friend and assure him that fairness is imperative when it comes to distributing money and deciding where it goes. One reason the Government are keen to make the formula fair is our determination to reduce health inequalities, especially given the last Administration’s legacy of increased inequalities.

Jenny Chapman (Darlington) (Lab):
The former Secretary of State wanted to make age the only factor in the formula, which would have totally ignored poverty and the local cost of care—[Interruption.] He said it. It would have taken £295 per head away from the north-east. Will the Minister confirm that the local cost of care and poverty will be included in the formula allocation?

Anna Soubry:
That was not my understanding of the former Secretary of State’s comments, but I can say that we are absolutely determined to ensure that fairness is achieved, and all the factors she mentions are important in ensuring that fairness.


Mary Macleod (Brentford and Isleworth) (Con):
What steps the Government are taking to improve care for people with dementia.[124142]

The Secretary of State for Health (Mr Jeremy Hunt):
Tackling dementia—particularly the shockingly low diagnosis rates—is a key priority for me and the Prime Minister.

Mary Macleod:
I welcome the Government’s steps to support carers and the work they have done, especially on the £400 million to give carers’ breaks from their important responsibilities. Will my right hon. Friend explain what is being done to increase awareness and understanding of carers’ health care needs?

Mr Hunt:
My hon. Friend is right to highlight this point. In the draft Care and Support Bill, local authorities will be required to meet the eligible needs of carers. That is a particular concern with dementia, because, all too often, someone looking after a partner with dementia gets to a tipping point where there is no alternative to residential care, but, if we can give them better support, they will have a better chance of remaining at home, which, in the vast majority of cases, is where they want to be.

Kate Green (Stretford and Urmston) (Lab):
Many elderly people with dementia remain trapped in hospital, because there is not adequate provision in the community for them to be looked after at home. How does the Secretary of State intend funds to be extracted from hospitals to be spent in the community, particularly at a time when local authority funding cuts mean that many of the voluntary agencies providing that support are actually losing posts in my borough?

Mr Hunt:
The hon. Lady is right to highlight this growing issue. One million people will have dementia by 2020, so we have to take it very seriously. It is not an either/or situation, though, because about 25% of patients in hospitals have dementia, and hospitals would like them placed in the community or at home, where they can be better looked after. This is one of those examples where, under the new reforms, we need much greater integration of services to ensure that those people are treated in the way they need to be.

Pancreatic Cancer

Mark Durkan (Foyle) (SDLP):
What recent progress he has made on improving early diagnosis of pancreatic cancer.[124143]

The Parliamentary Under-Secretary of State for Health (Anna Soubry):
We are providing more than £450 million during this spending review period to help diagnose cancer earlier. In January, we are planning to pilot a general symptom awareness campaign that will be relevant to a range of cancers, including pancreatic cancer. Unfortunately, however, pancreatic cancer is often very difficult to detect in the early stages.

Mark Durkan:
Has the Minister considered the early diagnosis summit report from Pancreatic Cancer UK highlighting that currently half of diagnoses are emergency diagnoses? It also makes strong cases for new referral pathways, risk assessment tools, direct access for GPs to investigative and diagnostic tools and the development of a National Institute for Health and Clinical Excellence quality standard for pancreatic cancer. Can we expect progress on any of these before the 2013 cancer awareness campaign?

Anna Soubry:
I thank the hon. Gentleman for his work. I am aware of the campaign that he has been running effectively in his constituency, based on the experiences of one of his constituents. As I say, however, and as he will know, pancreatic cancer is, by its nature, a particularly difficult cancer to diagnose early. We will all, of course, remember the untimely death of Sir Stuart Bell. Unfortunately, he was diagnosed only very shortly before his death. I wish that were not as common as it is, but we are doing everything we can to improve screening. I thank the hon. Gentleman again for his campaign, and I would be happy to meet him to discuss it further.

Liz Kendall (Leicester West) (Lab):
Cancer networks have played a crucial role in improving patient care, including by earlier diagnosis. The former Health Secretary promised this House that their funding would be guaranteed in 2011, but the South East London Cancer Network now says its budget was cut by 40% between 2009 and 2011. This year, it has been slashed by a further 55% and its staff have been cut from 15 to eight. Will the Minister now admit that her Government have cut funding for vital front-line cancer experts and have broken their explicit promises on cancer care?

Anna Soubry:
My information is that any 40% reduction is a result of cuts in administration—and that, if I may say so, seems the right way to go about things. This Government are determined to make sure that when we make cuts of that nature, they are not actually cuts—[Interruption.] It is about moving money around so that it goes to front-line services. This Government are determined to reduce bureaucracy in the NHS and to make sure that patients get the benefit of our spending—unlike under the last Administration, who had it round the other way.

Mental Health Services

Tim Loughton (East Worthing and Shoreham) (Con):
What steps he is taking to deliver better access to mental health services for school-age children.[124144]

The Minister of State, Department of Health (Norman Lamb):
The children and young people’s improving access to psychological therapies project, which we introduced in 2011, is about transforming mental health services for children and young people with mental health conditions. The Government’s mental health strategy implementation framework, published in July, suggests actions that schools, colleges and children’s services can take to provide better support.

Tim Loughton:
The Government should be congratulated on tackling the stigma of mental health by their “No health without mental health” policy, but the growing problem of mental illness among school-age children is a concern and with the demise of the early intervention grant, which included the targeted mental health in schools funding, there is a worry that too many schoolchildren will be neglected. Will the Minister liaise with the Department for Education and with school nurses to make sure that appropriate and timely access to talking therapies and others are available for school age children rather than having to rely on the belated chemical cosh of powerful drugs?

Norman Lamb:
May I first pay tribute to my hon. Friend’s work in this area? He has been really impressive and dedicated in his work. I absolutely agree with him about the importance of ensuring access to mental health services for children and adolescents. In fact, the Government are investing over £50 million over a four-year period through the children and young people’s improving access to psychological therapies programme and, critically, involving schools and colleges in that work. I would be very happy to work with my hon. Friend to improve access for children and young people.

Phil Wilson (Sedgefield) (Lab):
Will the Minister confirm that funding for children’s mental health services has actually been cut?

Norman Lamb:
I repeat the point that we are actually investing more in a transformation of children’s and adolescents’ mental health services—and it is making a real difference. People within the service can see the benefits that it is bringing.

Regional Pay

Mr William Bain (Glasgow North East) (Lab):
What recent representations he has received on regional pay in the NHS.[124145]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter):
I refer the hon. Gentleman to an answer I gave earlier today.

Mr Bain:
Has the Minister had an opportunity to study the research done by the New Economics Foundation a few months ago, which reveals that fully regionalised public sector pay could strip up to £9.7 billion a year from local economies, put 110,000 jobs at risk and hit women twice as hard as men? Given that, what possible justification could this Government have for such a crazy policy?

Dr Poulter:
Let me bring the hon. Gentleman back to planet earth for a while—[Interruption.] He should have listened to the answer I gave a little earlier about allowing for flexibility in pay frameworks. Some degree of regional pay was introduced by the previous Government in “Agenda for Change”. On principle, then, the previous Government, the hon. Gentleman and his colleagues, including the former Secretary of State, were supportive of regional pay. However, on the current negotiations and discussions, we would like to see a collaborative relationship between employers, unions and employees in the NHS at the NHS Staff Council to make sure that we maintain national pay frameworks as long as they remain fit for purpose.

Sir Tony Baldry (Banbury) (Con):
Why should there be an assumption that local pay will lead to lower pay in the public sector? In a constituency such as mine, where the unemployment rate is below 2%, local pay could quite possibly lead to higher pay in the public sector so that people are attracted to it.

Dr Poulter:
My hon. Friend makes an excellent point. It was the previous Government who, through the “Agenda for Change”, gave flexibility to NHS trusts to allow some employers to pay a 30% premium in areas with workplace shortages.


Lilian Greenwood (Nottingham South) (Lab):
At a time when NHS budgets are under exceptional pressure, my constituents simply do not understand why the Government are so intent on pushing trusts to divert money away from patient care and into wasteful local pay bargaining. Is there not a risk that Nottingham’s excellent NHS hospitals and community services will be unable to recruit and retain the best staff if regional pay results in cuts to their salary scales?

Dr Poulter:
The Government are supportive of the idea, endorsed by the previous Government, that local pay flexibility allows additional rewards to be paid to staff in areas with workplace shortages, as my hon. Friend the Member for Banbury (Sir Tony Baldry) just made clear. The Government are supporting the unions, employers and employees, as the NHS Staff Council, in coming together to try to agree how we need to modify the “Agenda for Change” and other agreements to ensure that they remain fit for their purpose of protecting employees.

Intensity-modulated Radiotherapy

Dr Julian Huppert (Cambridge) (LD):
What assessment his Department has made of the extent to which the cancer radiotherapy innovation fund will increase access to intensity-modulated radiotherapy.[124146]

The Parliamentary Under-Secretary of State for Health (Anna Soubry):
The £15 million radiotherapy innovation fund is designed to ensure that from April 2013 radiotherapy centres will be ready to deliver intensity-modulated radiotherapy to all patients who need it. We are working with professional bodies and Cancer Research UK to develop a programme, including support visits, training and criteria for allocating the fund.

Dr Huppert:
I thank the Minister for that answer and she will know that the UK’s first clinical trials of IMRT were carried out at Addenbrooke’s hospital in Cambridge, funded by the Breast Cancer Campaign, and showed reduced side effects and improved cosmetic outcomes. How many breast cancer patients a year does she think could benefit from IMRT and how will she ensure that they all manage to do so?

Anna Soubry:
We know that 9% of all radical radiotherapy treatment should be delivered using forward-planned IMRT and that that should be used for and will benefit breast cancer patients. A survey of radiotherapy centres was carried out in preparation for the launch of the new fund that showed that 26% of radical activity was being delivered using forward-planned IMRT. The hon. Gentleman might say that that does not exactly answer his question and I am more than happy to make further inquiries and, if necessary, to write to him in full detail.

Andrew Miller (Ellesmere Port and Neston) (Lab):
What is the Minister doing to ensure that such investments are equally accessible to people across the UK?

Anna Soubry:
That is important. I have recognised in the short time in which I have been in my post that there is often disparity across the country and in certain areas, frankly, the service is not as good as that in others. One of our aims is to ensure that regardless of where someone lives they will get good treatment from the NHS.

Multiple Learning Difficulties (School Provision)

Chi Onwurah (Newcastle upon Tyne Central) (Lab):
What steps he has taken to ensure that children with profound multiple learning difficulties have their health care needs met while at school.[124148]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter):
We are working with the Department for Education to introduce integrated commissioning of education, health and social care for children and young people with special educational needs and disabilities. This will ensure that children with profound multiple learning difficulties can get the care they need while at school.

Chi Onwurah:
I recently visited Hadrian school in my constituency, which caters for children with severe learning difficulties and profound and multiple learning difficulties. I saw fantastic teachers and carers doing fantastic work with fantastic children, but I also saw in the reception classes that more children with more severe health needs were entering the school. What guarantees can the Minister offer that funding will be in place for those children in five or 10 years so that Hadrian school can plan now for their needs?

Dr Poulter:
The hon. Lady makes a good point. We know that the Government are putting more money into the NHS. However, this not just about putting in more money, but about how we deliver care in a more joined-up way. At the moment, education works too much in its own silo and the NHS works in another. The Government’s new commissioning arrangements will follow the more joined-up approach that we need to take properly to meet the needs of children with learning disabilities in the round. That must be a good way forward in properly joining up education and health care.

Topical Questions

Mr Mark Spencer (Sherwood) (Con):
If he will make a statement on his departmental responsibilities.

The Secretary of State for Health (Mr Jeremy Hunt):
It is my privilege to serve as Health Secretary responsible for the national health service. I have identified four priority areas where I hope over the next two years to make the most progress. They are improving mortality rates for the major killer diseases so that we are among the best in Europe, which we are not at the moment; improving the way we look after people with long-term conditions such as diabetes and asthma; improving the way we deal with dementia, both as a national health service and as a society; and, perhaps most important of all, transforming the attitude to care throughout the NHS and social care systems so that the quality of care is seen to be as important as the quality of treatment.

Mr Spencer:
What assistance can the Secretary of State give to the newly appointed chairman of the Sherwood Forest Hospitals Trust as he begins to wrestle with the private finance initiative signed under the previous Government and attempts to find repayments in excess of £40 million a year?

Mr Hunt:
The first thing I would say to my hon. Friend about Sherwood Forest is that I know everyone in the House will join me in saying that our hearts go out to the families of the women who were misdiagnosed for breast cancer. We expect the local NHS to come up with a serious package of measures to make sure that that kind of thing cannot happen again.

My hon. Friend is right to talk about PFI. We inherited an appalling scandal. In order to tackle the PFI debts of just seven institutions, we are having to put aside £1.5 billion over the next 25 years, but we are working with all institutions to deal with this appalling debt overhang.

Ms Diane Abbott (Hackney North and Stoke Newington) (Lab):
We know that the Secretary of State’s views on abortion do not have a religious basis, so does he care to share with the House the scientific evidence to support his view that abortion time limits should come all the way down to 12 weeks?

Mr Hunt:
Four years ago I voted with my conscience, as I am sure she voted with hers, but I did so as a Back-Bench Member of Parliament and we have made it clear that it is not the policy of the Government to change the abortion law. My job as Health Secretary is to implement the elected will of the House, which voted in 2008 not to reduce the abortion time limits.


Annette Brooke (Mid Dorset and North Poole) (LD):
What steps is the Department taking to tackle the growing incidence of drug-resistant cases of TB, which increased by more than a quarter in the past year?

The Parliamentary Under-Secretary of State for Health (Anna Soubry):
We are funding TB Alert to raise public and professional awareness of TB. We also expect the NHS organisations and their partners to ensure early detection, treatment completion and co-ordinated action to prevent and control TB. The Health Protection Agency maintains diligent monitoring of all types of TB and the National Institute for Health and Clinical Excellence also includes specific guidance on treatment and rapid contact tracing of people in contact with any type of drug-resistant TB.


Helen Jones (Warrington North) (Lab):
Before the last election, the Prime Minister promised a “bare knuckle fight” to save district general hospitals and promised that they would be enhanced. Now that we know that the board of St Helens and Knowsley hospitals is looking at a merger with Warrington and Halton to solve its problems, can the Minister give the House an unconditional assurance that no services at Warrington will be downgraded or removed, whether that merger goes ahead or not?

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter):
There was an option to discuss this issue at the board meeting on 29 August—not of her hospital trust but of the Halton hospital trust—because the Halton trust is looking to achieve foundation status. So I can reassure her that the services at Warrington hospital are safe.


Mr John Redwood (Wokingham) (Con):
What is the administration overhead cost to the NHS and the Department this year and how does it compare with 2009-10?

Mr Jeremy Hunt:
I will get back to my right hon. Friend with the exact details, but the impact of the reforms that the Government have introduced will cut administration costs by a third across the whole NHS, leading to net savings of £4 billion during this Parliament.


Jack Dromey (Birmingham, Erdington) (Lab):
Last Wednesday, the Prime Minister told the House that Kettering hospital was safe. The following day—Thursday—evidence in a document leaked to the Corby Telegraph said that 515 of the 658 beds in the hospital could be lost. Will the Secretary of State ask the Prime Minister to come before the House to put right the statement he made to the House, but will the people of Corby not conclude that whatever the Prime Minister says, the national health service will never be safe in Tory hands?

Mr Hunt:
What a disgraceful comment. We do not need the Prime Minister to come before the House because I can tell the hon. Gentleman that Kettering hospital is safe, and that it is totally irresponsible scaremongering by the Labour party in the run-up to a by-election to suggest anything else.


Rehman Chishti (Gillingham and Rainham) (Con):
Will the Secretary of State join me in welcoming the progress that has been made to reduce mixed-sex wards and improve patient privacy at Medway Maritime hospital in my constituency?

Dr Poulter:
My hon. Friend is absolutely right to highlight the Government’s success in reducing mixed-sex wards not just in his hospital but throughout the NHS—we inherited a very different situation from the previous Government. Medway has been a pioneer in that area and my hon. Friend is right to commend the hospital and I put on record my thanks for all that it is doing.


Paul Goggins (Wythenshawe and Sale East) (Lab):
Will the Secretary of State take a close personal interest in the proposed changes to the NHS in Trafford? Given the uncertainty about alternative accident and emergency provision, and indeed the delays in commissioning community services, will he ensure that any final decisions are deferred so that they can be considered as part of the wider review planned for NHS services across Greater Manchester?

Mr Jeremy Hunt:
I should like to reassure the right hon. Gentleman that I take a close personal interest in all reconfigurations because they tend to end up on my desk. In this case, I encourage him to take part in the consultation for Trafford general, which will go on until the end of the month, but I remind him that the Government have put in place four important tests for any major reconfiguration, and we must be satisfied that those tests are passed before we approve any reconfiguration.


Nick de Bois (Enfield North) (Con):
As breast cancer action month comes to an end, recent research by Breast Cancer Campaign has shown that 76% of women would like more information about breast cancer signs and symptoms. What steps are the Government taking to encourage early diagnosis of breast cancer?

Anna Soubry:
Achieving early diagnosis of symptomatic cancer is key to our ambition to save an additional 5,000 lives a year by 2014-15. As I explained in an earlier answer, we are providing more than £450 million in funding over the spending review period to support early diagnosis. From January to mid March 2013, we will be running a regional pilot of our previously tested local campaign on breast cancer symptoms in women over 70. We are targeting those women because that is an area where, unfortunately, survival rates are particularly poor.

John Healey (Wentworth and Dearne) (Lab):
Since his promotion, the Secretary of State has said little and, I assume, read a lot. Did his starter pack include details of the Prime Minister’s promise:

“This year, and the year after, and the year after that, the money going into the NHS will actually increase in real terms.”?

Did it include Treasury figures that show there has been a real terms cut each year since the election? What is he saying to NHS staff and patients who see the cuts and see the Prime Minister’s big NHS promise being broken?

Mr Jeremy Hunt:
May I just remind the right hon. Gentleman that there has been a real terms increase in NHS spending? That contrasts rather starkly with what was said by the Health Secretary under the previous Government. He said it would be irresponsible to increase health spending in this Parliament. We ignored that advice and NHS patients are benefiting.


John Stevenson (Carlisle) (Con):
The food labelling consultation closed in August. Could the Minister indicate when the Government response is likely to be issued and confirm that the Government will not bring in unnecessary burdens on the food industry over and above those set out in European regulation?

Anna Soubry:
This is an area that is important to the Government’s work. At this stage it is important to make sure that we do not over-regulate but that we work with industry and manufacturers. The four Governments across the United Kingdom will shortly issue a statement about front-of-pack nutrition labelling, and we expect to publish the formal response to this year’s consultation within the next few weeks.

Mr Andy Slaughter (Hammersmith) (Lab):
The excellent children’s heart surgery unit at the Royal Brompton hospital will be pleased that a full review has been announced. Why does it have to report within four months, including the Christmas period, and why were previous referrals by both Brompton and Leeds refused? Will the review be full and impartial or not?

Mr Jeremy Hunt:
It will be a totally impartial and very thorough review. This is an extremely important decision, and that is why I asked the Independent Reconfiguration Panel to take the time that it needs to do the review properly; that is the least that the hon. Gentleman’s constituents would want.

Andrew George (St Ives) (LD):
In order to get the Health and Social Care Act 2012 through this House, the Government gave explicit assurances that private companies could not cherry-pick the easiest procedures and patients, yet a recent letter from David Flory, the deputy chief executive of the NHS, back-pedals on the Government’s position, and shows that the Government are dependent purely on guidance. What can the Government do to put a bit of backbone back into that important policy?

Mr Hunt:
May I reassure my hon. Friend that we are absolutely committed to the “no cherry-picking” provisions of the Act? We think that we have found the right way to achieve that in the NHS, and I will write to him to explain exactly how we will do that.

Valerie Vaz (Walsall South) (Lab):
Given the apparent increase in spending in the NHS and the £4 billion surplus, will the Secretary of State look at lifting the pay restraint for lower-paid workers, to increase morale and boost productivity?

Mr Hunt:
The £12 billion increase in spending on the NHS under this Government, which the right hon. Member for Leigh (Andy Burnham) thought was irresponsible, means that we will be able to do a lot more for patients, but there is also rising demand. If we do not have that pay restraint, we will not be able to meet the needs of an ageing population.

Justin Tomlinson (North Swindon) (Con):
What specific consideration is being given to matching the annual growth funding uplift to actual changes in population? That is essential to my constituency, which has high population growth.

Anna Soubry:
It is my understanding that that is already part of the formula, but my hon. Friend makes a good point, and I am sure that he joins me in wanting to make sure that the formulas are fair, so that we reduce health inequalities. I am happy to discuss the issue with him further.

Nick Smith (Blaenau Gwent) (Lab):
The Public Accounts Committee says that 11 of the 144 foundation trusts across England are now in serious financial difficulty. What contingency funding is in place for those trusts, to protect patients?

Mr Jeremy Hunt:
We have a clearly set out programme for all those trusts, to make sure that they get back to the proper financial controls and proper governance structures that they need. We do not want to get into the business of bailing them out; we want them to stand on their own two feet. That is the vision of the Health and Social Care (Community Health and Standards) Act 2003, passed by the hon. Gentleman’s party when it was in government.

David Tredinnick (Bosworth) (Con):
Will my right hon. Friend extend the scope of personal budgets? They help not only patients, giving them wider choice, but carers, allowing them to leave their post.

The Minister of State, Department of Health (Norman Lamb):
My hon. Friend makes an extremely good point. This is all about giving power to patients. Personal budgets have already been very successful in social care, and there are pilots under way in health care; the indications are that they are proving very successful.

Jim Shannon (Strangford) (DUP):
The NHS has a responsibility for all patients in ill health, especially those who are elderly. Is the Minister aware of the information released last week that 3,000 general practitioners have drawn up a list of 7,000 patients who have less than a year to live—in other words, whose level of care is in question? Will the Minister condemn that list and take every possible step to ensure that every patient gets NHS care, irrespective of age?

Norman Lamb:
The whole purpose of that approach is to ensure that patients get appropriate care at the end of their life. There is very strong consensus supporting that approach, including on the part of Marie Curie Cancer Care and Age UK. It is really important that all GPs and others involved in the care of people at the end of their life engage fully with the patient and the patient’s loved ones. That is the right approach.

Mel Stride (Central Devon) (Con):
My right hon. Friend will know that in this country, over 1,000 people a year die as a consequence of asthma. We have one of the highest prevalences of asthma in the world. Will he outline to the House what action we will take to get those mortality rates down?

Mr Jeremy Hunt:
We are doing a lot of work on the outcomes strategy that will directly impact on asthma sufferers. As part of that work—we are as concerned as my hon. Friend is about this—we are looking at every single asthma death in a 12-month period, starting from this February, to try to understand better the causes of mortality, because we need to make very rapid progress.

Steve McCabe (Birmingham, Selly Oak) (Lab):
Further to the answer that the Minister of State gave to my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), why do the Government not makeit a criminal offence for those who recruit staff on the cheap not to bother checking employees’ employment records, qualifications or criminal records? Surely they are putting people’s lives at risk.

Norman Lamb:
I absolutely share the hon. Gentleman’s concern. I am looking at the whole issue very closely. It seems to me that the fundamental point is to ensure that the people in charge at the corporate level are held to account for failures of care. We are very serious about ensuring that that happens.

Several hon. Members

Mr Speaker:
I am sorry to disappoint colleagues, but we must move on.

David Tredinnick:
On a point of order, Mr Speaker.

Mr Speaker:
The hon. Gentleman has been in the House since 1987; he knows perfectly well that points of order come after statements, not before them. I feel certain that he was just teasing the House and me.