Health Questions

21st March 2017

Philip Dunne answers MPs’ questions on healthcare.

NHS: Export of Procedures


4. What assessment he has made of the effectiveness of the export of procedures developed by NHS professionals. [909357]


Many NHS bodies work with their international peers, and each makes its own assessment about the effectiveness of intended collaboration, rather than any determination being made at a national level. Trusts should only pursue opportunities that deliver value for money and do not impair their ability to deliver NHS services.


A team of clinicians at Southmead hospital in my constituency, led by Professor Tim Draycott, have developed and are now exporting internationally a system of maternity healthcare that is transforming maternity safety and childbirth. What is the Department doing to provide further support and ensure that the evidence base the team have developed is embedded and incorporated in policy making in this place?


My hon. Friend will be aware that the professor to whom she refers has presented his findings to the Secretary of State. Partly in response to that, we have set up an £8 million innovation fund to help to take such initiatives forward and to spread best practice throughout the country.


May I endorse what the hon. Member for Bristol North West (Charlotte Leslie) said? In the area of diabetes, for example, our country has some of the best clinicians in the world. Will the Minister ensure that the next time the Prime Minister goes on an official delegation she takes one of these professors with her to show the rest of the world what we are able to do for conditions such as diabetes?


The right hon. Gentleman is an acknowledged expert on diabetes. I have visited facilities around the world, including in Abu Dhabi, where Imperial College London has a joint venture with the diabetes centre there. The UK is an acknowledged expert, and we are launching the national diabetes prevention programme, which will roll out across 10 pilot sites for type 2 diabetes prevention work. I shall encourage the Prime Minister to consider the right hon. Gentleman’s proposal that we expand that work on other trade visits, certainly those for health, around the world.

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Enriched Culture Medium Test


10. If his Department will take steps to introduce the enriched culture medium test for group B streptococcus for pregnant women; and if he will make a statement. [909363]


My right hon. Friend will be aware that Public Health England published a paper in June 2015 precisely on this subject, but it concluded that within the currently accepted clinical guidelines there are no clinical indicators for testing women using enriched culture medium methods. This test is not, therefore, recommended for routine use at present.


My hon. Friend will be aware from his reading of the British Paediatric Surveillance Unit report that the incidence of group B strep has increased by 30% over the last 15 years. Does he agree that this matter has gone on for far too long, and that the Government must come to a conclusion to prevent further tragedies?


As my right hon. Friend will be aware, the UK National Screening Committee is reviewing the evidence for antenatal screening, including the use of enriched culture medium tests for group B streptococcus, following a public consultation. I understand that its recommendation will be published very soon, and I assure him that I will consider the recommendation very carefully and write to him with my view.

Heart Disease and Paediatric Services


12. Which hospitals providing congenital heart disease services do not meet the standard for the co-location of paediatric services; and what plans his Department has to stop providing congenital heart disease surgery at those hospitals. [909365]


Standards for paediatric co-location for congenital heart disease services are not currently met by the Royal Brompton, Leicester and Newcastle hospitals. NHS England is consulting on proposals to cease commissioning level 1 surgical services from the Royal Brompton and Leicester. No final decisions have been made on the proposed changes. Public consultation continues until 5 June 2017, and I encourage my hon. Friend to participate in that consultation.


I doubt the hon. Lady will require any encouragement.


Mr Speaker, you are absolutely correct in your comment.

Does the Minister agree that the standards review found that not all clinicians are in agreement about how essential the co-location of paediatric services is, bearing in mind that a child being treated right now at the Royal Brompton will have 24-hour access to all necessary medical specialties? Will he tell us what improvements co-location at the world-class Royal Brompton hospital would achieve?


My hon. Friend has considerable expertise, but I am advised that having all relevant children’s specialties on the same site is the optimal model of care for the most critically ill children. It promotes closer, more integrated ways of working between specialist teams, and ensures rapid access to key services, such as paediatric surgery, at the most critical times when they are needed.


Mortality rates for the treatment of congenital heart disease fell from 14% in 1991 to 2% last year. The Royal Brompton, where the service is threatened with closure, does better even than this. What evidence is there that the closure programme will produce any further improvement, and if there is none, why is it being pursued?


The hon. Gentleman is right to point out that we have some world-leading out-patient outcomes for congenital heart disease, and I recognise the statistics that he read out. This is being driven entirely by seeking to improve patient outcomes across the country—improving them even on that very good performance—and to ensure greater resilience of service in some areas where there are relatively low volumes and an over-reliance on locums. I accept that that is not the case at the Royal Brompton, but it is in some of the others.


The Leeds heart unit is performing very well, and is free from the threat that it was facing, unfairly, a few years ago. Will lessons be learned, however, from the disastrous Safe and Sustainable review process, which pitted hospital against hospital and clinician against clinician? Can we find a much better way—I hope the Minister will tell us that this is happening now—to reconfigure such services?


I recognise that when the proposal was put forward back in 2012, it led to a process that we felt was wrong, and we therefore stopped it. This process, we hope, is being conducted in a more rigorous and fairer way, and will lead to outcomes driven, as I say, by improving patient experience.

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PFI Liabilities


13. What the estimated cost of private finance initiative liabilities to the NHS is in (a) 2016-17 and (b) the subsequent three financial years. [909366]


Labour’s legacy cost from the 103 hospital PFI schemes entered into between 1997 and 2010 was a public sector liability of £77 billion. The estimated total NHS PFI payments for the financial year ending at the end of this month is £1.97 billion, and the totals for the next three financial years are £2.04 billion, £2.11 billion and £2.16 billion.


Those are alarming figures, so what are the Government doing to support the trusts affected by those expensive and inflexible PFI and other deals reached under the previous Labour Government? What assessment has the Minister made of what the funds could be buying in the NHS now if it was not saddled by this Labour debt legacy?


My hon. Friend is right to point out that the Opposition constantly complain about the cost of the PFI programmes that they themselves initiated. The Government are making large efforts to support trusts in dealing with the PFI legacy. We are giving the seven trusts worst affected by PFI schemes access to a £1.5 billion support fund over a 25-year period. In 2014 alone, trusts negotiated savings worth over £250 million on their contracts.


21. On the subject of financial liabilities, what assessment has the Department made of the potential effect of changes to the discount rate on the amount of compensation paid out by the NHS Litigation Authority? [909374]


The Department is urgently undertaking work to understand what the impact on the NHS will be. There have been regular meetings with the NHS Litigation Authority since the announcement. The Government will adjust the NHSLA’s budget to meet the additional costs associated with the change in the discount rate.


The hon. Member for Southport (John Pugh) shoehorned Question 21, which we did not reach, into a Question that we did reach. He blurted it out so quickly that it took us a while to notice that it had absolutely nothing whatsoever to do with the private finance initiative. Very naughty boy!


PFI always was idiotic. It carried on under the coalition Government and has left a huge financial hangover. Will the Minister have a word with his colleagues in the Treasury, because the Treasury figures on hospital liabilities are different from the figures that some of the hospitals themselves produce? As there is a discrepancy, we do not even know what the liabilities are.


The hon. Gentleman has been assiduous, as is his wont, in trying to get to the bottom of the costs of the PFI impact on the hospital in his area. If he has a discrepancy, it would be very helpful if he pointed it out to me in writing. I will then respond to him.

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Topical Questions


T9. As the Secretary of State knows, we have a crisis in GP recruitment in rural north Lincolnshire. Does he agree that the best way to enable doctors to get to know our glorious county would be to establish a medical school at Lincoln University, and will he join our campaign to make that possibility come true? [909352]


As my hon. Friend will have heard from the Secretary of State earlier, a number of areas are competing to secure a new medical facility. One of our criteria will involve encouraging doctors to be trained in areas where there are shortages, and I am sure that Lincoln University will take that factor into consideration.

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I welcome the new nursing associates role that is currently being piloted. Will other areas, such as Portsmouth, be able to offer the same opportunities in the future, and will the new role be open to older people wishing to return to the workplace?


As my hon. Friend knows, we are launching a second wave of nursing associates at the beginning of April. I am pleased to be able to confirm that Southern Health NHS Foundation Trust, which manages Portsmouth Hospitals NHS Trust, is one of the trusts that will receive nursing associates, and that the system is partly designed to give social care workers opportunities to upskill.

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