Awesome timing was on show by whoever leaked the NHS Bill transition risk register and the business case to Dr Phil Hammond, who put them up on his website.
The risk register was also sent to Roy Lilley, who published it at his NHS Managers website.
Click here for details of 'From Bill-Killing to blamestorming - how the Health And Social Care Act 2012 will define the three main Westminster parties for a decade', the new issue of subscription-based Health Policy Intelligence.
As well as these, you may want to catch up on the latest Health questions in Parliament, via Hansard
The Secretary of State was asked—
1. Andrew Bridgen (North West Leicestershire) (Con): What plans he has to improve individual choice and standards for end-of-life care. 
The Secretary of State for Health (Mr Andrew Lansley): We are developing a new patient funding system for all providers of palliative care. It will be fair and transparent and deliver better outcomes for patients and better value for the NHS. Just last week, I announced that we are investing £1.8 million in eight pilot sites to help us in that work. Marie Curie Cancer Care is also providing £2.5 million of funding to support those pilots. The new system will be in place by 2015.
Andrew Bridgen: I thank the Secretary of State. Does he agree that current state funding for end-of-life and palliative care provision is at best patchy across the country and needs to be improved? Will he outline the role that he sees for voluntary and charitable organisations in the delivery of improved palliative and end-of-life care in future?
Mr Lansley: My hon. Friend will know very well of the vital role that the voluntary sector already plays, whether through the hospice movement or through Marie Curie and other voluntary organisations. As he implies, we not only want to secure more consistent, high-quality end-of-life care, to which effect we are already implementing the end-of-life care strategy and the National Institute for Health and Clinical Excellence quality standard for end-of-life care, but through the implementation of the palliative care funding review pilot schemes we want to ensure that the voluntary sector and other providers are equally able to provide the services that patients and their families desire.
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Barbara Keeley (Worsley and Eccles South) (Lab): For both end-of-life care and social care more generally, the Budget was a real missed opportunity, in that the Government did not signal what they were going to do about the future funding of social care. Will the Secretary of State now update us on the discussions that he has had with the Treasury about what will be done about the gap in the future funding of social care?
Mr Lansley: On the contrary, the Chancellor set out very clearly his intention that a White Paper on the reform of social care would be published in the spring. The hon. Lady may wish to know that we are in direct discussions with the Opposition to seek consensus about the long-term reform of social care funding.
NHS Reorganisation (Costs)
2. Mr David Crausby (Bolton North East) (Lab): What his most recent estimate is of the cost of NHS reorganisation. 
7. Gavin Shuker (Luton South) (Lab/Co-op): What his most recent estimate is of the cost of NHS reorganisation. 
The Minister of State, Department of Health (Mr Simon Burns): The cost of the NHS modernisation is estimated to be between £1.2 billion and £1.3 billion. It will save £4.5 billion over the rest of this Parliament and £1.5 billion a year to 2020. We will reinvest every penny saved in the NHS in front-line services.
Mr Crausby: The Bolton clinical commissioning group estimates that its budget will be about £25 per Bolton resident, or £100 for a couple with two children. Is that not too much, considering that they will get no medical treatment at all from that money, just administration money paid to doctors who should really be treating patients and not sat in the back office?
Mr Burns: No, I do not believe it is. The administration figure that has been announced for CCGs throughout the country is £25 a patient, but if a CCG is more effective and efficient in providing administration and bureaucracy and makes savings, those savings can be transferred and reinvested in funding the care of their patients. That is an incentive for them to be streamlined and to ensure that that happens.
Gavin Shuker: The Minister speaks of reinvesting every single penny in the NHS budget. How does that fit with the £500 million raid on the NHS budget spoken of this week?
Mr Burns: If I could explain this to the hon. Gentleman, the £500 million that he is talking about was part of the savings made through renegotiating the IT contract. It is a perfectly normal procedure, because as the right hon. Member for Leigh (Andy Burnham) will know, the average figure for previous years was £850 million, and one year when he was a Minister at the Department of Health, it was £2.3 billion.
David Tredinnick (Bosworth) (Con): As part of the reorganisation, my right hon. Friend the Secretary of State has decided—rightly in my view—that the Health
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Professions Council will regulate Chinese medical practitioners, but there is widespread concern in the community that these practitioners will not have protection of title. Will he please ensure that they do when he finishes his consultation?
Mr Burns: I am extremely grateful to my hon. Friend and, as his question suggested, there is a consultation process. I can give him an assurance that the point that he has made will be fully considered as part of that consultation process.
Robert Halfon (Harlow) (Con): Is my hon. Friend aware that the NHS reorganisation will abolish the strategic health authority in the eastern region, which will save £46 million a year—money that will be spent on front-line services in Harlow and elsewhere?
Mr Burns: I am extremely grateful to my hon. Friend for pointing that out. It is crucial that we slim down the bureaucracy and management of the NHS so that we can make savings, so that they can go where they should—to provide more care for patients in the NHS.
Andy Burnham (Leigh) (Lab): Last week in the emergency debate, the Secretary of State said:
“Risk registers…are not a prediction of the future. They set out a worst-case scenario”.—[Official Report, 20 March 2012; Vol. 542, c. 676.]
I now have an early version of the risk register that civil servants gave him in September 2010. Risk No. 7 of his reorganisation was that “Financial control is lost.” That was red rated and, according to the document, likely to happen with major consequences. Is it not clear that last week the Secretary of State gave an inaccurate description of the risk registers he saw, and should he not now come to the Dispatch Box to correct the record?
Mr Burns: May I reassure you, Mr Speaker, if not so much the right hon. Gentleman, that my right hon. Friend did not mislead anyone? The answer to the right hon. Gentleman’s question is the same as he and his predecessors pursued under the last Labour Government—and was pursued under the Thatcher and Major Governments—which is that Ministers do not comment on leaked documents.
Andy Burnham: The rest of the world is, and we would be interested to hear the Government’s views on it. Here we have it in full colour. It is not the worst-case scenario, as the Secretary of State claimed, but 43 very real and predictable risks, 21 of which are red rated and 14 likely to happen with major consequences. They include:
“Emergencies…less well managed…more failures…GP consortia go bust or have to cut services…performance dips and key staff lost”.
Is it not now clear for all to see that the Secretary of State and his Ministers have knowingly taken major risks with the national health service, ignored warnings from civil servants and kept those risks secret from Parliament in order to get their unnecessary Bill through?
Mr Burns: I am not quite sure which word in my last answer the right hon. Gentleman did not understand, so I will repeat it. Like previous Governments, we do not comment on leaked documents. Instead of coming
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to the Dispatch Box and talking down the fantastic work that nurses and doctors do day in and day out, why does he not read
, the latest copy of which is full of facts about how the NHS is improving its performance and delivering better quality care for patients throughout England?
3. Mr Virendra Sharma (Ealing, Southall) (Lab): What assessment he has made of progress in tackling tuberculosis in England. 
The Minister of State, Department of Health (Paul Burstow): Provisional numbers of tuberculosis cases in England in 2011 increased by 556 compared with 2010, although the number of cases is lower than in 2009. This may indicate that TB is stabilising, but it is too early to draw firm conclusions. We expect local NHS organisations, in partnership with other agencies, to sustain their efforts to control TB. On 23 March, the National Institute for Health and Clinical Excellence published new guidance to help the NHS manage TB in hard-to-reach groups, including collaborative commissioning.
Mr Sharma: I thank the Minister for his answer. London has the highest rate of TB of any city in western Europe, with more than 3,000 cases a year. When faced with the same problem in Paris and New York, respective Governments committed to increasing resources and a clear model of care. Given the scale of the problem here, and the growing concern about drug-resistant TB, will the Secretary of State commit to implementing the London model of care for TB services that was developed by TB health professionals and advocacy groups to stop this ever-worsening problem?
Paul Burstow: I know that the hon. Gentleman takes a close interest in this matter. He is a member of the all-party group on tuberculosis, and I believe he is meeting the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton) to discuss these matters further. He is right that this is a big issue in London as well as a global issue. The Department is working closely with TB Alert, the tuberculosis charity, which is running a series of programmes to raise awareness. It is working with the NHS and the voluntary sector, particularly in communities with higher risk populations, and we are working with the Royal College of General Practitioners to develop an online resource to promote the better detection and treatment of TB in primary care. I hope that he can explore these issues further, but the Government take them very seriously and are working with other agencies to make progress.
Tony Baldry (Banbury) (Con): It was 50 years ago that my dad moved on from being research secretary at the British Tuberculosis Association at Harefield because, in the 1950s, TB had ceased to be a killer in the UK. It is a tragedy that it has now come back, largely as a consequence of people with infectivity from overseas bringing TB into the country. What more can be done to enhance the screening of travellers from high-infection
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areas entering the UK so that those infected with TB can be identified and treated before they infect others in the population here?
Paul Burstow: My hon. Friend makes an important point about one aspect of the better control of TB and its spread. The Home Office has been running a pilot programme for some years. It continues to evaluate the effectiveness of that programme with a view to establishing whether it is more widely applicable. We know that this disease has moved from the general population to specific high-risk groups, which is why the targeted approach I mentioned in my initial answer is the key to controlling it.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab): The Minister has heard that TB is a particular problem in London—there was an 8% rise last year—and he will be aware that the current difficulties concern delays in detection and referral and the variability of commissioning and service provision. Given that the Health and Social Care Bill will necessarily lead to further fragmentation, separating health protection and public health from commissioning, how will he ensure that the Bill does not make a bad situation, in respect of TB in London, worse?
Paul Burstow: The Bill will not lead to fragmentation. It actually supports greater integration of health, social care and public health and, at a local level, it allows health and wellbeing boards to become the means by which to co-ordinate all the agencies that have a part to play when it comes to tackling TB, not least in ensuring that the advice of public health officials benefits not just the NHS but wider public services that also have a role to play in raising awareness of the disease and ensuring that it is properly tackled.
Defective Breast Implants
4. Ian Lucas (Wrexham) (Lab): What discussions he has had with Ministers in the Welsh Government on the treatment by the NHS of patients with defective breast implants. 
The Secretary of State for Health (Mr Andrew Lansley): My officials have kept colleagues in the Welsh Government closely informed about the advice of Sir Bruce Keogh’s expert group and about our plans for the NHS treatment of patients with PIP breast implants.
Ian Lucas: The Secretary of State has said that private providers have a moral duty to replace faulty implants for free. Will he tell the House how many private providers have carried out that moral duty?
Mr Lansley: I will write to the hon. Gentleman with the latest figures and place a copy of the letter in the Library. Overall, however, I am aware of 5,232 referrals to private providers, as a result of which 2,704 scans have been conducted. Consequently, the decision to explant breast implants has been taken in 298 cases. Some 75 such operations have been completed.
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6. Dr Phillip Lee (Bracknell) (Con): What the average cost has been of a consultation at an NHS walk-in centre since 2008. 
The Minister of State, Department of Health (Paul Burstow): The average cost of an attendance at an NHS walk-in centre was £36 in 2008-09; £42 in 2009-10; and £39 in 2010-11.
Dr Lee: I thank the Minister for his detailed answer. Does he agree that in the future new commissioning groups, such as those that will serve my constituency in Bracknell, might choose not to fund walk-in centres—whether ones already established or those in the future—based on clinical justification terms? I, for one, remain to be convinced—indeed, I am far from convinced—of the long-term financial justification for, or clinical benefit of, walk-in centres.
Paul Burstow: There is not a nationally mandated programme of walk-in centres; rather, it will be for local commissioners to make decisions based on the evidence and their evaluation, and ensuring that they fulfil their contractual obligations.
Mr Kevin Barron (Rother Valley) (Lab): Is it not the case that the walk-in centre that opened in Rotherham a few years ago has given communities that are higher on bad health indices access to health care 12 hours a day, seven days a week? Getting rid of it—it was opposed by some local doctors, because it threatened their business—would be a backwards step. Can we expect the new commissioning groups to start commissioning GPs in areas such as mine, which are higher on bad health indices and do not have enough general practitioners?
Paul Burstow: I am grateful to the right hon. Gentleman for his question, because he outlines the need to reduce health inequalities—something that the party of which he is a member failed to do in government. I can assure him that the Bill, which has now gone through all its parliamentary stages, will place a duty on clinical commissioning groups to seek to reduce health inequalities —something that his Government never did.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op): Is the Minister aware that when walk-in centres fail—or when any aspect of the national health service fails—it is because of poor management? Does he realise that good managers up and down the country are leaving the national health service? Doctors are not trained as managers. The Institute of Management has said that 43% of our managers are not up to the job, and we are not training our managers in the national health service because they are GPs.
Paul Burstow: This Government respect the contribution that NHS managers make, and we respect the contribution that the NHS Confederation makes as well. However, we also want to ensure that clinicians are at the heart of commissioning services. They are the people who understand patients most, and they are the people we are giving that responsibility to, because we think that is the way to drive improvement in the NHS.
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Private Finance Initiatives (North-East)
8. Guy Opperman (Hexham) (Con): What his policy is on the rationalisation of PFI deals in the north-east for the purposes of making savings on long-standing PFI hospitals; and if he will make a statement. [R] 
The Secretary of State for Health (Mr Andrew Lansley): Any plan to rationalise a PFI contract, such as that being considered by Northumbria Healthcare NHS Foundation Trust, would be a local decision. Any trust will need to satisfy itself of the value for money of any proposal. Northumbria Healthcare is a foundation trust, so Monitor is also considering its plans.
Guy Opperman: Many hospitals around the country are struggling under PFI debt. What plans does the Secretary of State have to ensure that other types of organisations, aside from Northumbria NHS Foundation Trust, will benefit from the new deal, just as my constituents in Hexham are?
Mr Lansley: I am grateful to my hon. Friend. We have recently made it clear that where there is unsustainable PFI debt—as is the case for seven PFI contracts—we stand ready to support those trusts in meeting some of those costs, which we inherited from the last Government. Beyond that, working with the Treasury, we have undertaken a pilot project that has demonstrated how 5%, on average, can be taken out of the cost of PFI contracts through the better management of them. I hope that will be applied across the country. I welcome, as I know my hon. Friend does, the way in which Northumbria Healthcare, with its local authorities, is looking at resolving its PFI debts, and if that represents value for money, I am sure that others across the country will benefit from the experience.
GPs (Performance Management)
9. Stephen Barclay (North East Cambridgeshire) (Con): What steps his Department is taking to develop more effective performance management of GPs. 
The Minister of State, Department of Health (Mr Simon Burns): As set out in the Health and Social Care Bill, performance management of general practice will become the responsibility of the new NHS Commissioning Board from April 2013. This will enable, for the first time, a single, consistent approach to be developed for the assessment and management of general practice.
Stephen Barclay: As with any profession, the performance of GPs varies widely. As more power is devolved to GPs, does my right hon. Friend recognise the importance of independent performance management of GPs, in order to identify outliers and improve patient care?
Mr Burns: I am extremely grateful to my hon. Friend, given his past association as a constituency MP with this subject, because of the problems in his constituency. I believe that we have a strong system of general practice in this country, but I am afraid that more can be done to address variations in aspects of the quality of provision by some general practitioners. As I have said, the NHS Commissioning Board will adopt a single,
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consistent approach, allowing an overview of performance, which is not currently possible, and ensuring that interventions occur at an early stage. I think that will go a considerable way towards helping with the problems that have been experienced.
Jim Shannon (Strangford) (DUP): As an elected representative for a great many years, I have often been made aware of issues relating to GPs and patient lists. Does the Minister agree that there should be greater co-operation between the Health Department and GPs with regard to their patient lists, and specifically with regard to the transfer of patients?
Mr Burns: With regard to the transfer of patients, we are seeking to give greater choice to patients under the modernisation programme so that they can move from one GP, or one GP practice, to another in a way that they cannot do at the moment. That will help to enhance the power of patients to get the GP of their choice and preference.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con): I am sure that the Minister would agree with me about the importance of addressing alcohol misuse through the alcohol strategy announced last week. On the performance management of GPs, however, does he agree that we need to do more than just monitor how much people drink, and that we need to ensure that GPs are incentivised to tackle the problem drinkers who attend their surgeries?
Mr Burns: Yes, my hon. Friend raises an important issue. We must ensure that every contact counts, and that there is greater working between GPs and patients to help to deal with what is a significant problem among certain sections of the community.
Andrew Gwynne (Denton and Reddish) (Lab): The first step that the Government should take is to start listening to doctors. Is it not the case that some senior GPs are now spending as little as one day a week seeing patients because they are too busy working on the Government’s massive NHS upheaval? It is costing the NHS up to £124,000 a year to replace each of those GPs with a locum. That is why the Department’s leaked transition risk register warns that GP leaders are not sufficiently developed to run consortia, and that they might be drawn into managerial processes that drive clinical behaviour, rather than the other way round. The risk rating for that is that it is likely to happen, with major consequences. When is the Minister going to get his head out of the sand and start listening?
Mr Burns: Well, that interesting rant bore little relation to the facts—[ Interruption. ] If the hon. Member for Copeland (Mr Reed) would just button it for a minute, he will get the answer. The answer is that we are constantly listening to GPs, nurses, consultants and others within the NHS health economy. As we showed during the progress of the Health and Social Care Bill, we listened and we accepted a number of recommendations from the Future Forum and from a number of others, which strengthened and improved the Bill. I have to say that the hon. Member for Denton and Reddish (Andrew Gwynne) just does not get it.
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Care at Home
10. Meg Munn (Sheffield, Heeley) (Lab/Co-op): What steps he is taking to ensure that people receiving care at home funded by the NHS are involved in making the arrangements for that care. 
The Minister of State, Department of Health (Paul Burstow): Our ambition is to enable shared decision making for all NHS patients. We expect people who are eligible for NHS continuing care funding to be fully involved in discussions about their care. Subject to the results of the current personal health budget pilots, everyone eligible for NHS continuing health care, including many people receiving care at home, will have the right to ask for a personal health budget, including a direct payment, from April 2014.
Meg Munn: I have received a letter from one of my constituents who has had direct payments for 15 years under social services. Following a stay in hospital, she was moved on to health funding, and her life has changed dramatically for the worse. She says that she no longer has any choice in who cares for her and finds it hard to find the right people with whom she feels comfortable. She concludes:
“I’m tired of being bullied. I’m just miserable.”
Will the Minister do something to bring forward the measures more quickly, so that people who have been directing their own care under social services can have the same quality of life and the same choices that they have become used to?
Paul Burstow: I absolutely agree with the hon. Lady’s constituent, and with the hon. Lady. We need to ensure that, as soon as possible, the benefits and the control that direct payments give to individuals in social care are available to people in regard to their long-term health care and particularly to continuing health care. It is realistic to say that we can roll this out nationwide by 2014, but I know that the hon. Lady is having discussions with the authorities in Sheffield, and I encourage her to carry on those conversations about the way in which people can use the current arrangements to access those facilities.
Mr Stephen Dorrell (Charnwood) (Con): Does the constituency case raised by the hon. Member for Sheffield, Heeley (Meg Munn) not highlight the increasingly urgent need to achieve much more integration between health and social services, and indeed between different parts of the national health service, in order to provide joined-up care that focuses on patients’ needs and delivers better value for money to the taxpayer?
Paul Burstow: My right hon. Friend is absolutely right. I urge the hon. Lady to write to me about the matter so that I can respond in more detail, but let me say to my right hon. Friend that it is not just a question of delivering more integration within health care—which is often still too fragmented—or between health and social care; it is also a question of recognising that issues such as housing and leisure are critical to the delivery of greater well-being, and to an improvement in the health of the nation. The Health and Social Care Bill, which has now completed all its stages, gives people in every part of the system a clear duty to collaborate, integrate, and deliver better care for individuals.
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Dame Joan Ruddock (Lewisham, Deptford) (Lab): There are currently severe constraints on the availability of incontinence pads and on the bed linen laundry service, which is causing immense distress to the many poor families in my constituency. Will the Minister look into the problem? Will he recognise that it is simply impossible for people who are already in difficulties, and who are poor, to find the money for those extra things?
Paul Burstow: If the right hon. Lady sends me the details, I will look into the individual case. I agree with her that it is unacceptable for such products to be rationed. I think it essential to base their provision on an assessment of individuals’ needs, and for those individuals to receive what they need for a good quality of life.
Ian Swales (Redcar) (LD): My constituent Joyce Benbow was discharged from Redcar hospital last November, but is still there owing to a failure to agree on her care package. When will the managers of health and social care budgets be more joined up so that people receive the right provision at the right time?
Paul Burstow: My hon. Friend has raised an important point about the importance of joining up hospital care, community care and social care, which has often been overlooked. We have invested more than £300 million this year in developing more re-ablement services, and in January we invested an extra £150 million in support for them. We are also extending our plans for more tariff reform to ensure that local hospitals have the means to drive the development of such services in their communities.
111 Telephone Service
11. Miss Anne McIntosh (Thirsk and Malton) (Con): What recent representations he has received on the 111 pilot telephone service; and if he will make a statement. 
The Secretary of State for Health (Mr Andrew Lansley): I have received representations from the British Medical Association and the NHS Alliance, both of which support the NHS 111 model, requesting an extension of the roll-out deadline of April 2013. I am actively considering that, and will be discussing it with the clinical commissioning groups who are leading the development of NHS 111 in their areas.
Miss McIntosh: Will the Secretary of State accept representations from me? I have used the 111 service on behalf of a family member, and I know that it is not working as well as it might, which is quite distressing. The call time and the script do not allow a person receiving a particular type of care to be fast-tracked to a clinician. I believe that there is a case for delaying its roll-out, and that the service would be infinitely better if the Secretary of State took my representations on board.
Mr Lansley: I will of course accept representations from my hon. Friend and, indeed, from anyone else. Pilot schemes are under way in County Durham and Darlington and in Nottingham, Lincolnshire and Luton. The system is also live in Derbyshire, the Isle of Wight,
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Cumbria, parts of Lancashire and parts of London. An evaluation will be published shortly by the university of Sheffield, but an interim evaluation suggested that 93% of patients were pleased with the service that they had received, and, most important, 84% felt that it had delivered them to the right place first time.
John Healey (Wentworth and Dearne) (Lab): Will the Secretary of State confirm the provision in regulation, reinforced by his new guidance, that no GPs should use 0844 numbers for their surgeries? Some patients are having to pay over the odds to contact their GPs.
Mr Lansley: We have made it very clear that GPs should not be using 0844 numbers for that purpose and charging patients for them. One of the benefits of NHS 111 is that it will be a free service for patients, and will give them an opportunity to gain access to integrated urgent care wherever they are in the country. That is why we want to roll it out as soon as we can.
John Pugh (Southport) (LD): Given the importance of 111 contracts, should we not delay assigning them until the clinical commissioning groups are properly in place?
Mr Lansley: My hon. Friend will recall from my first answer that I am looking to discuss the timing of the roll-out with clinical commissioning groups. I do not want that to be unduly delayed, because there are clear benefits to patients in the 111 system in that it gives them a more integrated single point of access to the NHS.
Nurse to Patient Ratio
12. Mr Jim Cunningham (Coventry South) (Lab): If he will introduce proposals to require a minimum ratio of nurses to patients in hospitals. 
The Minister of State, Department of Health (Paul Burstow): Guidance on staff ratios and the proportion of registered and unregistered staff can play a useful part in supporting local decisions about setting safe and sustainable staffing levels. Both the Royal College of Nursing and the NHS Institute for Innovation and Improvement have produced such guidance. We have no plans to impose centrally determined ratios, as in our view that would undermine professional judgment.
Mr Cunningham: Is the Minister aware that the RCN says that nurses are overstretched, with too much reliance on cheaper, unqualified assistance? What impact does he think that will have on care for the elderly?
Paul Burstow: First, let me say that we greatly welcome the survey the RCN published last week, and the work it has done for many years to highlight ratios such as the ratio of nurses to beds. The hon. Gentleman will be pleased to know that the ratio has improved under this Government. We are working with the RCN and others to identify the processes and paperwork within the NHS that occupy nurses’ time and take them away from the bedside, which is the priority.
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Mr Jamie Reed (Copeland) (Lab): When I last asked the Minister from the Dispatch Box about the loss of 3,500 nursing posts, he told the House that that was “factually incorrect”. He was right, and I apologise: the actual figure, published last week, is 4,096. In what will surely be one of the Secretary of State’s final outings in his current post, before he is reshuffled to where he can do no further harm, will he tell the House how many of those nursing posts would have been secured by the £500 million spending cut he agreed with the Treasury in last week’s Budget?
Paul Burstow: Well, if the question is as put, the answer is none.
Raynaud’s Disease and Scleroderma
13. Fiona Bruce (Congleton) (Con): What steps he is taking to provide services for people diagnosed with Raynaud’s disease and scleroderma. 
The Minister of State, Department of Health (Paul Burstow): Routine commissioning is a local responsibility, which in future will be led by clinicians, who best understand patients’ needs. From April 2013, the NHS Commissioning Board will have a clear focus on commissioning services for people with rare, specialised conditions. The commissioning of those services directly through one national commissioner to a national standard should ensure better planning and co-ordination of services, which will be of benefit to patients. The scope of this commissioning, and the extent to which it will cover complex rheumatology services, is still being considered.
Fiona Bruce: I thank the Minister for that reply. I am very proud to have the headquarters of the Raynaud’s and Scleroderma Association based in my constituency. It was founded 30 years ago by a remarkable lady, Anne Mawdsley. It is still run from a terraced house in Alsager, and she has raised £12 million through undertaking some remarkable feats, including, I think, swimming with dolphins. Will the Minister commend her work and assure her that scleroderma patients will be able to access the best specialist centres for diagnosis and treatment?
Paul Burstow: I pay tribute to the work my hon. Friend does and to the work the Raynaud’s and Scleroderma Association has done over many years in raising funds, raising awareness and making sure there is a greater focus on these issues. I can assure my hon. Friend that the work we have done in establishing the NHS Commissioning Board will mean that in future, for the first time, there will be one organisation that will be able to look at issues involving specialised and complex needs that require a national focus.
Adult Congenital Cardiac Services
14. Greg Mulholland (Leeds North West) (LD): What recent progress he has made on the review of adult congenital cardiac services. 
The Secretary of State for Health (Mr Andrew Lansley): The review of adult congenital heart services is a clinically-led NHS review, independent of Government. I understand that an expert advisory group has been established and
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its first task will be to develop designation standards and a model of care that commissioners can use to help determine the future pattern of services.
Greg Mulholland: I thank the Secretary of State for that answer, but adult cardiac patients in Yorkshire are both disfranchised and extremely worried because of the review of the children’s heart unit, as if it is closed, they, too, would lose access to surgeons. Does the Secretary of State agree that it does not make sense to have two separate reviews, and that they should instead be brought together?
Mr Lansley: My hon. Friend will know that no decision has yet been taken on the location of children’s or adult congenital heart surgery centres in England. Neither the draft adult clinical standards nor the proposed standards for children’s services require services for children and adults to be collocated.
Nic Dakin (Scunthorpe) (Lab): Will the Secretary of State ensure that the relationship between adult and children’s cardiac services is properly considered as part of the review?
Mr Lansley: On both children’s and adult congenital heart services, all relevant clinical factors should be taken into account in the review, but I reiterate the point that I made to my hon. Friend the Member for Leeds North West (Greg Mulholland): the standards for those services do not require children’s and adult services to be collocated.
Vision Screening (Children)
15. Neil Carmichael (Stroud) (Con): What assessment he has made of the provision of vision screening for children. 
The Minister of State, Department of Health (Mr Simon Burns): The Department of Health has made no assessment of the provision of vision screening for children. However, the UK National Screening Committee, which advises Ministers and the NHS on all aspects of screening, has commissioned a national mapping exercise to look at how many primary care trusts offer vision screening.
Neil Carmichael: There is some evidence of variance across the country, with some PCTs not conforming to current arrangements. What thought has been given to how to improve the situation and iron out the variance?
Mr Burns: As my hon. Friend will be aware, the National Screening Committee recommends screening for visual impairment for children between the ages of four and five, and encourages all PCTs to follow those recommendations and ensure that children are screened. However, the Government are aware that, as my hon. Friend says, there are variations in the commissioning of vision screening across PCTs, and it welcomes the review that is being undertaken. We await its recommendations as regards those variations, but we hope that under the new arrangements, after the abolition of PCTs, there will be a far more uniform approach to commissioning and screening.
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Services for Older People
16. Nick Smith (Blaenau Gwent) (Lab): What recent assessment he has made of the performance of services for older people. 
The Minister of State, Department of Health (Paul Burstow): A number of inspections, reports, independent audits, and investigations have revealed long-standing and unacceptable variations in the standard of care that older people receive in the NHS, and in social care. The Government are determined to root out poor-quality care wherever it is found. We have established the national Nursing and Care Quality Forum to work with patients, carers and professionals to spread best practice.
Nick Smith: The British Geriatrics Society’s “Quest for Quality” report identified that too many people in care homes were without access to NHS services, including psychiatric, physiotherapy and continence services. What action are the Government taking to ensure that care home residents get the high-quality NHS care that they deserve?
Paul Burstow: In England, one of the things that we are doing is making sure that a programme of special inspections of care homes, conducted by the Care Quality Commission, looks at those issues to ensure that we provide the right range of support services for people in care homes. In addition, the National Institute for Health and Clinical Excellence has produced quality standards; in particular, it has been working on quality standards relating to issues affecting older people—incontinence, nutrition support for adults, patient experience, delirium, dementia, and many others. All that is critical to delivering really good-quality care in care homes.
22.  Margot James (Stourbridge) (Con): Russells Hall hospital, which serves my constituency, has reviewed recent reports, and done its own research, on dignity and care for older patients. It has elevated the qualities of care and compassion to the top of its criteria for recruiting health care assistants. Does my hon. Friend agree that the Nursing and Midwifery Council should apply similar learning to nurse training?
Paul Burstow: It is important that that is applied to all who have direct responsibility for delivering care, and hands-on care in particular. The work that Russells Hall hospital is doing on care and respect, and in its responsibility programme, is a good example of that. On issues such as dementia, we are clear that we need to ensure good advice, training and support for all nursing staff—we are working with the Royal College of Nursing on this—so that they treat people who have dementia with dignity.
Liz Kendall (Leicester West) (Lab): The Government are rightly building on Labour’s national dementia strategy, and the Minister should know that the dementia crisis cannot be addressed without tackling the crisis in care. Yet his Government have cut more than £1 billion from local council budgets for older people’s care, services are being withdrawn and care charges for dementia sufferers are soaring. The Alzheimer’s Society and Age UK say that these cuts have pushed the system to breaking point. Does the Minister agree with them, yes or no?
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Paul Burstow: The hon. Lady, of course, offers no solution, merely a problem. I say to her that this Government identified £7.2 billion of additional investment to go into social care over the life of this Parliament, and those resources are being used creatively by some local authorities to protect front-line services. I urge her to applaud the authorities that are doing that and join me in condemning those that are cutting services despite being given the resources.
Health Care (Professional Standards)
17. Caroline Dinenage (Gosport) (Con): What steps he is taking to raise the professional standards of health care workers and care assistants. 
The Minister of State, Department of Health (Paul Burstow): The Government have commissioned Skills for Health and Skills for Care to develop a code of conduct and minimum training standards for health care support workers and adult social care workers in England. That will inform the development of a system of assured voluntary registration for this group, which will be reviewed after it has been established for three years.
Caroline Dinenage: Have the Government made any assessment of the cost of rolling out mandatory regulations to health care support workers?
Paul Burstow: I will write to the hon. Lady with any specific details about the precise costs of rolling out such a register. I say to her that, for the first time, we have a Government who have decided that leaving unclarified the training requirements, standards and codes of conduct for health care assistants and care assistants is unacceptable. That is why we have commissioned this work. It will involve working with unions and other health care professionals to make sure we get those standards right, because we know that that is key to delivering dignified care.
T1.  Jo Swinson (East Dunbartonshire) (LD): If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Andrew Lansley): My responsibility is to lead the NHS in delivering improved health outcomes in England; to lead a public health service that improves the health of the nation and reduces health inequalities; and to lead the reform of adult social care, which supports and protects vulnerable people.
Jo Swinson: An estimated 50,000 people, mostly men, are misusing anabolic steroids to build muscle, which can result in liver cancer, depression, a damaged immune system, kidney problems and cardiovascular disease. Will the Secretary of State examine the public health implications of the 56% rise in steroid misuse over five years? Will he work to address its causes, such as body image anxiety, as well as just treating the problem?
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Mr Lansley: I am grateful to my hon. Friend for making a good and important point. My right hon. Friend the Home Secretary will be subjecting these drugs to greater control under the Misuse of Drugs Act 1971, restricting their illegal import into this country. Controlling supply is one part of the effort. Prevention is also important; people need to be fully aware of the risks to their health. The FRANK service, which provides advice to young people and parents about drugs misuse, will make it clear that the misuse of steroids is dangerous. I would encourage local areas to work with local businesses, such as gyms and fitness centres, to publicise those risks.
T2.  Nick Smith (Blaenau Gwent) (Lab): The Department’s latest estimate shows that alcohol misuse costs the NHS £3.5 billion every year. Will the Secretary of State now champion a 50p minimum unit price? That would save more than 3,000 lives a year, rather than 1,000 a year, which is what his public health responsibility deal is expected to secure.
Mr Lansley: The hon. Gentleman should have welcomed the alcohol strategy that my right hon. Friend the Home Secretary published last Friday. Not only did we see the Government’s intention to introduce a unit price, but on that day 35 business organisations across the country collectively, under the responsibility deal, pledged themselves to take 1 billion units of alcohol out of the UK market in the course of a year.
T7.  Simon Wright (Norwich South) (LD): Many hospitals, including the Norfolk and Norwich university hospital, have reported a dramatic increase in alcohol-related admissions over the past 10 years, so I welcome the latest alcohol strategy. But what steps is the Secretary of State taking to support the expansion of treatment and early interventions for dependent and harmful drinkers in Norfolk and elsewhere?
The Minister of State, Department of Health (Paul Burstow): I am grateful to my hon. Friend for his question, and he is absolutely right to identify the priority that this Government are now placing on dealing with the harm caused by alcohol, not least because of the 1.2 million alcohol-related hospital admissions. The strategy outlined by the Home Secretary last week is about education and raising awareness; enforcement; and treatment—making sure that the treatment services are more widely spread. It is also about recognising that this is a cross-government responsibility, not the responsibility of any one Department. That is why the proposals to use a national minimum unit pricing policy will tackle cheap booze and the binge culture.
T3.  Grahame M. Morris (Easington) (Lab): We now know that the Conservatives have received more than £8 million in donations from private health care companies since 2001. This goes beyond simply cash for access to a much more sinister issue of cash for policy influence. Ministers have said that they do not expect any increase in private sector provision in the NHS, but how will this be measured in years to come?
Mr Lansley: Nobody buys influence over the policy of the Conservative party or the coalition Government. That is in complete contrast to the situation with the right hon. Member for Leigh (Andy Burnham) and his friends on the Opposition Front Bench, who are the wholly owned subsidiaries of the trade unions.
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T8.  Jeremy Lefroy (Stafford) (Con): Could my right hon. Friend indicate how he proposes to use his welcome new duty to reduce health inequalities under the Health and Social Care Bill?
The Minister of State, Department of Health (Mr Simon Burns): I am extremely grateful to my hon. Friend for that question. As he will be aware from his time on the Bill Committee this Government have for the first time in the 64 years of the NHS put into legislation a duty to reduce health inequalities. That will be done through the NHS Commissioning Board and clinical commissioning groups, each being under a duty to have regard to the need to reduce inequalities in access to and the outcomes of health care. The Secretary of State will also have a wider duty to have regard to the need to reduce inequalities relating to the health service. That will include his duties for both the NHS and public health. It is a great step forward and I am surprised that the previous Government did not think of doing it during their 13 years.
T4.  Rosie Cooper (West Lancashire) (Lab): At a time of major upheaval in the national health service, the people of west Lancashire and other areas of Lancashire are being failed by the chief executive of the Lancashire primary care trust cluster. Living in Yorkshire and working from Lancaster, Janet Soo-Chung has failed to meet with me or other colleagues, including my hon. Friend the Member for Chorley (Mr Hoyle). Can the Secretary of State assure me that the necessary time and development is being invested in health services in west Lancashire to ensure that authorisation takes place in a timely way without conditions and that the health services provided to my constituents are good?
Mr Lansley: I will, of course, ask Janet if she will meet the hon. Lady and her colleagues, but I think the hon. Lady might have noted that the NHS is performing magnificently. The quarter document published just this morning gives details of 14 performance measures across the NHS, in five of which performance has been maintained and in nine of which there has been improvement, so there has been no deterioration in performance. When the hon. Lady gets to her feet she should say to the NHS, “Well done for improving performance.”
Stuart Andrew (Pudsey) (Con): Currently, there is a review into paediatric cardiac services going on. I recognise that that is independent of Government, but we now have the independent analysis of patient flows, which says exactly what we have been saying—that patients in south and west Yorkshire will not go to Newcastle. Does my right hon. Friend agree that this is an important development and that the options should reflect that because this is a serious problem for heart services in the north of England?
Mr Simon Burns: I congratulate my hon. Friend on his persistent championing of his constituents, but sadly I cannot be drawn into a discussion about evidence, facts and figures that might come up around this issue, because as he will appreciate it is an independent review which is divorced from Ministers.
T5.  Chris Ruane (Vale of Clwyd) (Lab): Mindfulness-based meditation techniques have been deemed by the National Institute for Health and Clinical Excellence
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to be more effective than drug-based therapy in the treatment of recurring depression in many circumstances. Will the Minister tell the House his views on mindfulness-based techniques and say what other conditions and diseases he thinks would benefit from such therapy?
Paul Burstow: The Government are committed to extending the range of NICE approved therapies when it comes to access to talking therapies. Certainly, we will look very carefully at how we extend it in the area he has suggested. I will write to him in further detail about this.
Andrew George (St Ives) (LD): What reassurance can the Secretary of State give to Members of Parliament representing areas that have received an allocation from the formula which has been significantly below their target, given the change in arrangements to clinical commissioning groups in future?
Mr Lansley: My hon. Friend will be aware that the distance from target on the existing formula for Cornwall in particular has narrowed and is only just over 2%. For the future, I hope that he and all hon. Members will take considerable reassurance from the fact that not only will the formula continue to be the subject of independent advice, but new statutory provisions will set out that it should be intended to reflect the prospective burden of disease in each area, so it should be matched as closely as possible to the need for services in each area.
T6.  Stella Creasy (Walthamstow) (Lab/Co-op): The Government say that clinicians understand patients best, but there are doctors in Walthamstow who will not provide contraceptives to local women, and we now have one of the highest rates of teen pregnancy and repeat abortions in the country. Will the Ministers agree to meet women from my constituency and help them understand who, under the new system and the new layers of bureaucracy, they can hold to account for these problems—yes or no?
Mr Lansley: The hon. Lady should first have expressed a welcome for the fact that there has been a further reduction overall in the numbers of teenage pregnancies. As she knows, in her constituency there are doctors who, as she says, do not provide contraceptives, but there are also many other practices that do—17 out 18 GP practices in Walthamstow provide contraceptive services. There was a 60% increase in a decade in the number of managers in her area and the result seems to be that she does not understand how services were managed in Walthamstow. Under local authorities and the clinical commissioning groups in the future, there will be a clearer system.
Mr Speaker: No one could accuse the Secretary of State of being other than comprehensive. We are grateful to him.
David Mowat (Warrington South) (Con): The Secretary of State will be aware that under the allocation formula a number of PCTs have built up historic deficits, which have required us in Warrington, for example, to reduce our in vitro fertilisation services. Can the Minister confirm that with the transfer to GP commissioning, those historic deficits will be written off, which will in effect inject large amounts of money into local health economies such as Warrington’s?
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Mr Simon Burns: I hope I can reassure my hon. Friend. PCTs carrying legacy debt into 2012-13 must clear it. Clinical commissioning groups will not be responsible for resolving primary care trust legacy debt that arose prior to 2011-12. It is expected that aspirant CCGs will continue to work closely with primary care trusts and primary care trust clusters in 2012-13 to ensure that no PCT ends 2012-13 in a deficit position.
Bill Esterson (Sefton Central) (Lab): One NHS consultant told me that
“NHS reorganisation could mean that you are forced to spend around 10% of your income on private health care insurance.”
Does the Secretary of State accept that the doctor is right to say that people will either wait longer for care or they will have to pay for it?
Mr Lansley: That is complete rubbish. The legislation is absolutely clear that it does not lead to privatisation, it does not promote privatisation, it does not permit privatisation and it does not allow any increase in charges in the NHS. It simply creates a level playing field so that NHS providers will not be disadvantaged compared to the private sector, as they were under a Labour Government.
Steve Baker (Wycombe) (Con): The present Wycombe hospital consultation has proceeded with a number of hiccups, not least because of the false sense of local accountability engendered by Labour’s top-down system of health management. Will the Secretary of State meet me and a small delegation of my constituents to discuss how things will improve under his reforms?
Mr Lansley: Of course. I will be glad to meet my hon. Friend and his constituents. I recall how he has been an advocate on their behalf in the past and a vocal advocate of services in Wycombe. I emphasise to my hon. Friend that we are looking towards not only the clinical commissioning groups, but the local authorities injecting further democratic accountability so that in his constituency and those across the country we see much greater local ownership and accountability for the design of services.
Mark Durkan (Foyle) (SDLP): The Chancellor’s evidence to the independent pay review body chairs last week contained curious if not dubious references to nursing pay and non-nursing pay, and possible outcome linkages of those. Does the Secretary of State understand those and can he explain them?
Mr Lansley: The hon. Gentleman will know that we have asked the pay review bodies to look at the aspects of pay related to market conditions, and I do not want to prejudice that. They will come back with their advice on that.
Mark Menzies (Fylde) (Con): I welcome the Prime Minister’s announcement yesterday on dementia care. What assurances can the Secretary of State give me that this will be an aggressive strategy, looking at matters such as new access to drugs, early diagnosis and support for carers of those with dementia?
Mr Lansley: Not only were there the announcements made yesterday, but as part of that there was the establishment of three sets of champions, including Angela Rippon and Jeremy Hughes from the Alzheimer’s Society, working together as champions to raise awareness and
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understanding, Ian Carruthers and Sarah Pickup as champions on improving treatment and care, and Dame Sally Davies, the chief medical officer, and Mark Walport from the Wellcome Trust, as champions for research. Their objective is specifically, as the Prime Minister told them, to hold our feet to the fire, not only for the ambitions we set out yesterday, but for going further and faster.
Simon Danczuk (Rochdale) (Lab): On 24 February, my constituent, Audrey Kay, died after a litany of poor treatment. Will the Minister meet her son and me to hear Audrey’s treatment story?
Paul Burstow: Of course, I will be only too pleased to have that meeting.
Chris Skidmore (Kingswood) (Con): Is the Minister aware of the publication today of the industrial action review by the London ambulance service, which details that on 30 November, the day of the public service strikes, in the afternoon and the evening, requests for front-line staff to return to front-line ambulances were made by the London ambulance service. However, of the three unions to strike, only Unison responded to say that it would not ask staff to return to work. Three hours later, after three repeated requests for help, a patient who had been unable to get an ambulance had died. The report has called—
Mr Speaker: Order. The hon. Gentleman should resume his seat. I do not wish to be unkind, but topical questions are about short questions, and that was not. I am very sorry. The Minister may give a brief reply if he wishes.
Mr Simon Burns: The industrial action to which my hon. Friend refers showed both the best and the worst sides of industrial relations in this country. On the one hand, it showed the worst excesses of union militancy and intransigence in failing to put effective contingency plans in place ahead of strike day, and then in refusing to call off the strike. On the other hand, it showed the best traditions of public services when the Metropolitan police, St John Ambulance and many out-of-hour providers came to the aid of the London ambulance service. Were it not for their help, the situation could have been even more serious.
Mr Speaker: The Minister’s power to anticipate what will be said to him is extremely impressive, and I congratulate him immensely warmly.
Valerie Vaz (Walsall South) (Lab): One year on, are the pledges under the responsibility deal working?
Mr Lansley: One year on in the responsibility deal we are seeing successes, including the elimination of artificial trans fats, further reductions in salt in manufactured foods, and over 8,000 high street outlets sharing and showing calorie information. The monitoring and evaluation of the deal is vital. We are committed to this and we are making up to £1 million available to fund an independent evaluation.
Several hon. Members rose —
Mr Speaker: Order. I thank colleagues for their co-operation. I am sorry to disappoint those who were waiting, but we must move on.
Awesome timing was on show by whoever leaked the NHS Bill transition risk register and the business case to Dr Phil Hammond, who put them up on his website.