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Volume 401: debated on Tuesday 18 March 2003

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The Secretary of State was asked

Mental Health (Barnet)


If he will make a statement on mental health services in Barnet. [103193]

Local mental health services in Barnet are making good progress against the national service framework targets, but they face considerable challenges in meeting additional demands and improving further services for patients. Public and staff are being involved in the plans for future developments.

I am grateful to my hon. Friend for that response, but I am sure that she is aware of the long waiting times for intensive out-patient care. I wish to raise in particular the matter of the Barnet psychiatric unit, which closed temporarily more than five years ago, with a view to being reopened. Nothing has happened yet and the result is that the temporary ward at Edgware hospital is under considerable strain. What will happen in terms of reproviding the Barnet psychiatric unit, and when may we expect to see some progress on the issue? The present situation is unsustainable, and perhaps the money could be found from the modernisation fund.

My hon. Friend will be aware that the outline business case to reprovide the acute in-patient service at Barnet was considered by the primary care trust in December. The acute unit will now provide 54 beds and will bring acute mental health services on to the same site as the rest of the acute services. That will be a real improvement for patients. The extra revenue costs are likely to be some £350,000 and the PCT has confirmed that it will be able to afford that. We need now to make swift progress in relocating those services to Barnet to serve people in that community.

In supporting the hon. Member for Hendon (Mr. Dismore) about the need for that acute service, may I ask the Minister to confirm that the social service inspectorate's report of May 2002 was selectively damning? It said that mental health services in Barnet had been allowed to drift, service users were losing out and carers were not being supported. May we have her assurance that the Government are addressing the matter and taking the necessary actions to put things right quickly?

The hon. Gentleman is too harsh on those local services. The area has lower than average suicide rates, admission rates and readmission rates, as well as good user involvement, a good relationship with Barnet Voice for Mental Health and good carer involvement. Local people are working hard to ensure that mental health services in the area serve the needs of patients. They are setting up new assertive out-reach and crisis intervention teams, and much good work is being done. Further improvements do need to be made, but significant progress has already been achieved.

May I first pay tribute to Lord Hunt of Kings Heath, who left the Government today? He was effective, well respected and well known to those who work in, and care about, the NHS. The child and adolescent mental health services report zero weeks waiting time—in other words, no waiting time—for first out-patient appointments—[HON. MEMBERS: "In Barnet?"] Yes, in Barnet. What does Barnet have that other areas, such as my own of Stockport, do not; or is that another case of inaccurately reported waiting times?

I thank the hon. Lady for her kind remarks about Lord Hunt. He was an able Minister and a close colleague who will be severely missed in our Department. The hon. Lady should know that we will commit £300 million to the national service framework, including £93.5 million this year. The children's national service framework will also address the issue of waiting times, which is a major priority in the planning and priorities framework for this year. Out-patient waiting times are too long, but clear action will be taken and the necessary investment made in the service to ensure that we reduce them.

Hospital Private Finance Initiative


If he will make a statement on the private finance initiative in hospitals. [103194]

:State for Health (Mr. Alan Milburn): The private finance initiative is helping to deliver the biggest hospital building programme in the history of the national health service. Of the 104 PFI hospital schemes announced since 1997, 25 are already operational and a further 23 are under construction.

I thank my right hon. Friend for that answer. Over the past few years the doctors, nurses and administrators at Tameside general have done fantastic work, despite the fact that the hospital site is spread across many buildings, many of them old Victorian workhouses, and that patients still have to be ferried between buildings by ambulance. Without PFI we would have to wait decades for another hospital. Can my right hon. Friend tell me when we can expect completion of a new hospital if Tameside is successful in the current application process?

I am aware of the problems in Tameside because my hon. Friend has been to see me to talk about them and to present me with a petition that he and other members of the local community organised. We will make progress as soon as possible, but the process takes some time. Once building begins, we may be confident that the new development will be built on time and to cost. It is worth saying that, as a consequence of PFI, major capital investment is now going into the national health service. Since 1997, capital spending in the NHS has risen by 63 per cent., partly as a result of PFI. To give hon. Members a point of reference, investment fell by more than 20 per cent. under the Conservative Government between 1992 and 1997.

As a result of the extra investment that will come on line from April, over the course of the next four years capital spending in the NHS will rise by a further 144 per cent., to give the NHS, its staff and its patients precisely the sort of modern working environment and modern facilities that they need. People will draw a clear contrast between a Labour party that is committed to investment and the Conservative party.

The Secretary of State will no doubt be aware of the bureaucratic blunders in the Paddington basin project, which resulted in a 17.5 per cent. shortfall in space. People forgot to take note of the new regulations on elderly patients in hospital. Does the Secretary of State agree that it is time to reconsider the relocation of Harefield hospital to the Paddington basin? It is time to reinvest in Harefield and so save everybody money.

I can always rely on the hon. Gentleman to accentuate the positive. On the subject of the Paddington basin, we have been through the process and, indeed, I have been to Harefield. As the hon. Gentleman knows, I met local people and members of staff, including Sir Magdi Yacoub. The decisions were difficult but I believe that they are right, not just for Harefield but for health services in the area. As a consequence of the extra investment that is now going into the NHS in the area, we will get modern hospital facilities that are long overdue.

Foster Carers


How many children are looked after by private foster carers. [103195]

Data on the number of children looked after by private foster carers are not collected centrally. The Children Act 1989 places a duty on local authorities to

"satisfy themselves that the welfare of children who are privately fostered within their area is being satisfactorily safeguarded and promoted".

The Minister will know that the social services inspectorate wrote to Departments and estimated that as many as 40,000 or 50,000 children are privately fostered. Those children are afforded less protection than children who are child-minded. She will also know that Lord Laming had little to add on safeguards for children who are privately fostered, other than the recommendations that came from the Utting inquiry on children living away from home. Will she tell us when a Green Paper will arise from the Laming inquiry into the Victoria Climbié case? Why are the Government so reluctant to introduce a registration scheme for privately fostered children, as recommended by Utting?

I pay to tribute to my hon. Friend for his continued concern about the protection of privately fostered children. Although I share his objective, I have not always shared his view on the most effective way of ensuring that protection. As he has suggested, we have taken action to ensure that the legal responsibilities that already exist for private fosterers and local authorities are taken forward. A letter from the chief inspector has outlined that, and there have been an SSI inspection and a leaflet campaign to raise awareness. As my right hon. Friend the Secretary of State made clear when we published the report of the Climbié inquiry, we will give a full response to Lord Laming's recommendation that we should review legislation in this area at the time of the children's Green Paper. I believe that that Green Paper will be published later in the spring.

Does the Minister agree that many children in foster care will go on to be adults in adult placement care? Is she aware that the number of adult placement carers is falling because of the Government's decision to have them regulated by the National Care Standards Commission? When will the Government announce the decision of their review of that matter? Does the Minister accept that adult placement carers are looking after vulnerable adults in their own homes? Those homes are not care homes and they should not be regulated by the NCSC and made subject to all manner of rules and bureaucracy that are completely unnecessary.

The hon. Gentleman raises the issue of adult placements, which has also been raised by several of my hon. Friends, and by at least one of his hon. Friends, who visited me, along with representatives of the National Association of Adult Placement Services. As a result of that meeting, we are undertaking a consultation on how to ensure that, in putting in place the necessary regulation to ensure that vulnerable people who are cared for in adult placements get the protection that they deserve, we also continue to recognise the specific circumstances of those who care for vulnerable people in their own homes. It is not true that the conditions for adult placement schemes are the same as for care homes; indeed, they never have been. What we have done is to listen to the genuine concerns of those who undertake this very important role, to undertake a consultation, and to make changes that will help to promote the work of those who care for vulnerable people in their own homes.

To return to the subject of private fostering, I well understand that my hon. Friend often has to wrestle with huge problems that require major investment, organisational change and cultural reorganisation within complex health and social care systems. Does she agree that, by contrast, private fostering would be simple to crack, would require almost no investment, and would provide great protection for children? Indeed, it is the sort of job that she could knock off before breakfast one morning. Will she therefore join me in looking forward to the blithe new morning when she will have the opportunity to do that?

Perhaps I should point out to my hon. Friend that one of the things that I am wrestling with, as he puts it, is what we need to do to ensure that the changes that we make really do make a practical difference to vulnerable children. As my right hon. Friend made clear in responding to the Climbié inquiry, our consideration of the issues arising from private foster care will be based on what will make a practical difference to the protection of those children, on how we can ensure that the considerable protection already provided in legislation is carried through properly, and—perhaps most importantly—on how we can ensure that local authorities fulfil their responsibilities to those children. We discovered that, even under the current legislative framework, Gloucestershire local authority, for example, has taken action and increased the number of notifications of private foster carers from 11 to 224 in the past three years. That is—

Nhs Dentists


What estimate he has made of the number of people in the north-west who are no longer able to get on the list of an NHS dentist. [103196]

National health service dental registrations in the north-west have been stable for several years. The region has the second highest registration rate for adults in England, at 49 per cent., which is significantly above the England average. More than 60 per cent. of children in the region are registered with a dentist. This is broadly in line with the national average.

Will my hon. Friend recognise that I get letters every week from people in Burnley who cannot get on an NHS dentist's list, and that advising them to phone NHS Direct is not the way forward? The primary care trust informs me that another dentist is transferring his patients to Denplan, and that a further one will follow shortly. An NHS dental service is no longer available to the majority of people in my constituency, and that is not acceptable.

I sympathise with the problems that some of my hon. Friend's constituents are experiencing, and I understand that there are particular recruitment problems in Burnley. However, that is why there are a number of primary dental service pilots and a new dental unit in Burnley. I am also advised that my hon. Friend's NHS managers are talking to Manchester dental school, to ensure that students want to come to Burnley to work. At the same time, my officials and I are holding discussions with the British Dental Association to ensure that we have support teams in our access problem areas. I will ensure that my hon. Friend's constituency is considered as part of that programme.

Primary Health Care


If he will make a statement on budget deficits in primary health care services. [103197]

In both of the last two financial years, the national health service has reported a break-even position, an improvement on the deficit of £459 million in 1996–97. For this financial year, discussions are currently taking place between primary care trusts and strategic health authorities on managing their end-of-year financial positions.

I thank the Minister for that reply. When the Department wrote to me recently boasting about the additional money for Stockport primary care trust, was the right hon. Gentleman aware that £5 million of that was needed for deficit reduction and that, as a result, the trust's board tells me that it is now required to make real-terms reductions of £1.3 million in the next financial year? As audiology, child psychiatry and mental health services are under real pressure in Stockport, may I encourage the right hon. Gentleman, when he writes to hon. Members boasting about increases in money, to avoid the spin and state the facts?

We always state the facts and we have done that on this occasion. I am grateful to the hon. Gentleman for pointing out the difficulties that his PCT is experiencing, and I shall certainly look into those issues on his behalf, but a certain reciprocity would be welcome. I am happy to go in for that, if the hon. Gentleman would like to welcome the 26 per cent. cash increase that Stockport PCT received over the past three years and the 29 per cent. increase to which it can look forward over the next three years.

I am not sure whether the Minister fully understands what a fact is. If he cut out the spin and actually answered the question put by the hon. Member for Hazel Grove (Mr. Stunell), he would be aware that a number of PCTs will have deficits at the end of the current financial year. For example, my PCT in Chelmsford will have a deficit of £1 million. I wrote to 50 per cent. of PCTs, and a significant number wrote back to say that they will not break even at the end of this year and will have deficits. Instead of spinning and citing figures, why does the Minister not face up to reality, answer the question straightforwardly and explain how PCTs with deficits at the beginning of the next financial year will deal with them?

I did answer the question put by the hon. Member for Hazel Grove fairly and fully, but there is a wider issue. Of course, we shall look into the end-of-year position; it is the job of SHAs and PCTs to do that. There is, however, a certain credibility gap when the hon. Member for West Chelmsford (Mr. Burns) comes to this place demanding, in effect, more resources for the NHS when his policy is to take money away from the NHS.

Community Hospitals


If he will make a statement on the Government's policy on smaller community hospitals. [103198]

We want to see a new lease of life for community hospitals. Our new guidance, "Keeping the NHS Local", issued last month, emphasises the important role that community hospitals can play in providing locally based health services.

I thank my right hon. Friend for that very encouraging reply. In the light of it, will he join me in urging the North and East Yorkshire and North Lincolnshire strategic health authority to give urgent and careful consideration to the outline business case that it will receive later this month from the Selby and York primary care trust for the complete rebuilding of Selby War Memorial hospital, not only because of the role played by the hospital in the community but also because that exciting project is one of the first to come from a PCT?

I very much enjoyed meeting my hon. Friend and representatives of his local PCT about a month ago to talk about the proposed development. As he remembers, I visited the hospital two or three years ago and was most impressed by what I saw. There is a strong case for redevelopment. Obviously that will take investment and it will need a good case, but I know that the PCT will make a good case to the SHA. Equally, I am sure that my hon. Friend will remind his constituents that such developments are possible only because of the investment that the Labour Government are making.

On the assumption that the Secretary of State will give the go-ahead to the reorganisation of health care in east Kent, and given the excellent coastal and cottage hospitals in that area, will he tell us what financial assistance he will give the PCT so that hospitals such as the Queen Victoria Memorial hospital in Herne Bay can have the minor injuries and accident and illness units and telemedicine that they need, which would help patients to be treated closer to home without having to travel at all?

As the hon. Gentleman is well aware, not least because he has been one of the protagonists in the whole sorry affair vis-á-vis east Kent, decisions have to made, and most members of the community now want a final decision so that we can make progress. What is absolutely clear across the country, not just in east Kent, however, is that community hospitals have a very important part to play. Indeed, technological change and medical advance are driving many of the treatments that were previously available only in the big tertiary centres and making them available much more locally, provided, of course, that we invest in the necessary information technology and make the necessary capital investment and resources available for staff and training. That is precisely what the Government want to do—but whether the Conservative party agrees with those proposals is a moot point.

On 10 February, I attended the official opening of the new £1 million skin care unit at Kettering general hospital, which will deal with the increasing number of problems with eczema, skin cancer and other dermatological conditions. I welcome that investment in our local health service. Does my right hon. Friend believe that smaller hospitals would benefit from that kind of investment if we adopted a policy of cutting public spending by 20 per cent., like the Conservative party has?

I take the very simple view—I think that my hon. Friend shares it—that if we want more out of the national health service, we simply have to put more in. That is what the Government are committed to; it is what the Conservative party opposes.

According to the logic of the document published by the Secretary of State's Department on 14 February and, indeed, the strategies of many local NHS trusts, services would move from district general hospitals to community hospitals; but does the Secretary of State acknowledge that, if that happens, many parts of the country are likely to have fewer district general hospitals?

No, I do not think that that is the case. Although change will always be necessary in the NHS—change is often a very positive thing because it is driven by medical advance and technological improvement and it makes more treatments available to more patients—we have to move away from the idea that the "biggest is best" philosophy will always work for NHS patients, especially in local communities.

Rather than presuming that biggest is always best and that the only way to solve a problem with local health services is to centralise those services, the new guidance rightly says that the starting point for examining what is needed in the local community should be the presumption of keeping as many services as locally based and locally accessible as possible. That is what we want to do, but it can only be done—I repeat this point—provided that we make the necessary investment in IT, technology, training, staff, buildings and equipment. We are prepared to make that investment. Of course, the hon. Gentleman's party voted against it.

Foundation Hospitals


If he will make a statement on foundation hospitals. [103199]

The Health and Social Care (Community Health and Standards) Bill published on 13 March sets out our legislative proposals for NHS foundation trusts. Subject to Parliament, I expect that, in four to five years, every NHS hospital will have the opportunity of becoming an NHS foundation hospital.

As the Secretary of State will be aware, Conservative Members strongly support foundation hospitals, so we were concerned to note that at least 115 of his Back-Bench colleagues have signed an early-day motion criticising them. Will he explain to the House why he has so singularly failed to sell his policy to them?

I suppose that I should say that I am grateful to the right hon. Gentleman for his support. However, there is a small matter of difference between him and me on foundation hospitals, as he calls them: I believe that those hospitals should be part of the NHS. They should have greater freedom, greater local control and greater local accountability, but none the less they should be subject to national inspection systems and, most importantly, to national standards. Indeed, what is very obvious every time Conservative Members talk about foundation hospitals is that they use those two words, but they fail to mention the three words that are important: national health service.

Obviously, as a person who has been treated by an NHS hospital—I received remarkable treatment at St. Thomas's—I can only congratulate the NHS on the service that it provides, and that is without foundation hospital status. If my right hon. Friend pursues the foundation hospitals policy, will he ensure that all hospitals can apply for that status and that real consultation will take place with the staff, patients and trade unions before we venture down that road?

My hon. Friend is absolutely right. Incidentally, I wish him well and I hope that the other knee survives. When he reads the Bill he will see that we set out the process of consultation in it. If proposals are to come forward from NHS trusts that want to become NHS foundation trusts, they must have the local community on board. Clearly, it will be important to consult local Members of Parliament and elected local councillors, but equally, it will be important to consult local staff and other parts of the local health community: most notably, primary care trusts.

I can give my hon. Friend the undertaking that he seeks: our ambition has always been to try to raise standards of care in every single NHS hospital. We do not want a two-tier service, and we certainly do not want to pursue a sink-or-swim policy. That is why I believe that it is necessary to provide extra help and support so that every hospital, over a four-to-five-year period, has the opportunity to become an NHS foundation hospital.

Will foundation hospitals be subject to the remorseless process of centralisation, mergers and closures being carried out by strategic health authorities across the country?

Strategic health authorities, under the proposals contained in the Bill, as the right hon. Gentleman will see when he reads it, lose their powers of direction—effectively, my powers of direction—over NHS hospitals. I believe that that is right. Although it is absolutely necessary, for equity purposes, to ensure that appropriate standards in the system apply in all parts of the country, ultimately, health care is delivered locally, not nationally. If we are to have better local health services capable of dealing with specific local problems in local communities and tackling some of the appalling local health inequalties that exist in our country, and which have been widening for decades, it is necessary to put local staff and local communities in charge of the hospitals that serve them.

In evaluating the expressions of interest in foundation status that have been received so far, what steps have been taken by the Government to establish whether there is genuine local community support at this stage for foundation trust status beyond a handful of very ambitious NHS managers?

We will do precisely that. To continue the conversation that my hon. Friend and I had in the Health Committee a week or so ago, it will be extremely important, when I assess the proposals that come forward from NHS trusts that want to become NHS foundation trusts, that they genuinely demonstrate that they have support, not just in the local hospital but in the local community, too. That will be important because, ultimately, those hospitals will become owned and controlled by the local community. I want to ensure that as wide a range of stakeholders, and as many people in the local community and among local staff as possible, are involved in this process from the outset.

In the Prime Minister's speech and subsequent article, "Where the Third Way Goes from Here", he says that we must

"set the parameters for the future partnerships we will need between tax-funding and personal contributions".
Does that mean that in foundation hospitals and elsewhere in the NHS, the Government are considering co-payment?

How very interesting, because in the next paragraph of the article, the Prime Minister says:

"We should be opening up healthcare for example to a mixed economy … and be willing to experiment with new forms of co-payment in the public sector."
Does that not entirely torpedo what the Secretary of State has just said?

No, because, unlike the hon. Gentleman, I have read the whole article, not one section of it, and what the Prime Minister was clearly talking about was our proposals in relation to tuition fees. It is the hon. Gentleman who is making proposals for co-payment. Just this weekend, he went out of his way to suggest that the future of Conservative party policy on health care is clear. He wants

"a pay-as-you-go market where patients pay for a single procedure or item of care"
. That may be the Conservative policy for the future of health care. It is not Labour's policy.

School Pupils


When he last met the Secretary of State for Education and Skills to discuss the health of school pupils. [103200]

My right hon. Friends the Secretary for State for Health and the Secretary of State for Education and Skills last met on 12 March 2003 and discussed a range of issues about the health, social care and education of children. They propose to meet regularly to continue their discussions on these issues.

Will the Minister accept that obesity among school pupils is now running at record levels and increasing year by year? Does she accept that a major reason for that is 20 years of attacks by the educational establishment on physical education and sport in schools, with the result that today's young people are less fit than their parents and grandparents were at their age? Unless urgent action is taken to make young people fitter and healthier, they will have serious mobility, breathing and heart problems at a much earlier age, which will put an extra major pressure on the national health service.

I share the hon. Gentleman's concerns, which is why physical activity is a crucial factor in the NHS plan, the cancer plan and the coronary heart disease and diabetes national service frameworks. It is also why we are working closely with the Department for Culture, Media and Sport on its £459 million programme to enhance school sport and club links. The New Opportunities Fund programme is providing £581 million to enhance school sports facilities. The issue is extremely important for the Department of Health because obesity leads to perhaps 9,000 premature deaths in this country every year.

Will my hon. Friend take more action with the Department for Education and Skills? Does she remember that my Committee, the Select Committee on Education and Skills, examined school meals only two years ago? We made some strong recommendations because it is a catastrophic situation when our children's diet and lack of exercise causes such concern. The re are action points and we have done a lot of the work, but instead of merely discussing the problem, will the Minister meet her opposite number in the DFES to produce an action programme?

I assure my hon. Friend that regular meetings are held between the Department for Culture, Media and Sport, the Department for Education and Skills and the Department of Health—that really is joined-up government. He will be aware of the food-in-schools programme. We are rolling out the national school fruit scheme so that by the end of the year, about 1 million children will receive a free piece of fruit in school every day. It is a high priority to extend the healthy schools programme to school meals, tuck shops and vending machines, and to ensure that fresh water is available in schools.

It could be said that many school children are the equivalent of couch potatoes, which hints at a lack of exercise and obesity. However, there is activity on the equivalent of the couch because the level of sexually transmitted diseases is rising at almost epidemic proportions among under-age children in certain areas of the country. It is said that there are not adequate resources to deal with the problem. Will the Minister comment on that?

The hon. Lady will know that this country has a sexual health strategy for the first time. That is backed up by £47 million of extra investment and £5 million has been invested this year in genito-urinary services to try to halt the rise of disease and to ensure that people with sexually transmitted infections receive swift treatment. She will also know about the major media campaign that was launched to try to persuade young people to change their behaviour and adopt safe-sex practices in future. That is an attempt to halt the rise of infections such as chlamydia, which are of great concern to many people in this country.

My hon. Friend is right to point out the extra investment in schools, and especially the money for school sports co-ordinators. Is she aware that, in reality, many people who did sport at school drop it after they reach 16 or 17? Obesity costs the country, and especially the health service, £2 billion. Will she ensure that her Department plays its part with Sport England, lottery money and the Department for Education and Skills to invest in the long-term future of our people by ensuring that we reduce people's obesity not only when they are at school, but throughout their lives?

My hon. Friend makes an important point and I am delighted to tell him that the Department of Health will fund nine local exercise action pilots—LEAP projects—to encourage more forms of exercise among groups ranging from older people to young parents to schoolchildren. We realise that enabling people to access sport and physical activity throughout their whole lives is key to ensuring that we reduce levels of coronary heart disease, cancer, strokes and diabetes.



What progress has been made with the establishment of centres of excellence for the treatment of endometriosis. [103201]

The Government recognise that endometriosis affects the lives of many women and their families. Some specialist clinics treating advanced endometriosis have developed locally in response to need. Officials in my Department have discussed centres of excellence with the National Endometriosis Society and other organisations, and will continue working with them to see whether further work is appropriate.

Does the Minister accept that much more is needed? What encouragement can she give to women and their families who experience long delays in diagnosis and in appropriate treatment once the diagnosis has been made?

The hon. Lady plays an important part in the all-party group on endometriosis. As she points out, it is important that endometriosis should be diagnosed early, allowing treatment with some of the less radical approaches. That is why the pilot scheme for the national electronic library for health and a virtual branch library under that will include a section on women's reproductive health. We shall ensure that endometriosis is covered in that so that general practitioners, the first and very important point at which women can be diagnosed and then referred if necessary, have the necessary information in order to be able to carry out their work.

Junior Doctors


What assessment he has made of the impact on medical staffing in acute hospitals of extending the working time directive to junior doctors. [103202]

The Department of Health has issued guidance, with the support of the medical royal colleges, that sets out a range of solutions that will enable NHS trusts to meet their statutory obligations under the working time directive. That is being supported through a programme of pilots, a strategic support fund and the increases in staff and resources announced in the NHS plan.

Does the Minister recall that the Royal College of Physicians has warned that implementation of the working time directive in August next year will lead to

"a substantial risk to the safety of many hospital in-patients"

Can he comment in particular on the fact that his Department's own pilot study suggests that smaller hospitals, those with six specialist registrars or fewer, will really struggle? Can he now give the House a pledge that if there turns out to be a conflict between the working time directive and acute care in acute hospitals, it will be the patients who are put first?

Of course that must be right, and I can certainly confirm that, and of course I am aware of the views of the Royal College of Physicians, which we take seriously. It welcomed the guidance that we issued earlier in the year and we continue to discuss its concerns with it and how we can construct the right solutions. But it is possible, working with the pilots that we have announced for the 19 trusts that are devising the cost-effective solutions to the problems that the working time directive undoubtedly poses, that we can construct effective solutions that put the patient first. It is in everyone's interests to do that, and I think that we shall be able to do precisely that. [Interruption.]

Order. There is too much conversation going on. These questions are important and we should be able to hear the answers.

Is the Minister aware that while we all welcome the reduction in junior doctor's hours, some junior doctors fear that the quality and length of their training and experience may be compromised, along with continuity of care?

Yes, I am aware of that concern. The hon. Gentleman takes a close interests in these matters and I hope that he will have seen my recent announcement about how we intend to reform medical postgraduate training in order to avoid precisely that issue. We need a more structured senior house officer training programme and that is what will come through from the foundation programme that we shall be introducing. That work is being led by the chief medical officer, who I know takes such concerns seriously, and has made it clear, as we have, that the most important thing that we must do in the circumstances is to ensure that we preserve the quality of medical training in Britain, which most people, fairly, reasonably and rightly, regard as among the best in the world.

When will that programme start and how long will it take before it is working? As additional consultants were appointed to try to relieve the pressures on junior doctors in the past, have we not succeeded?

The reforms I mentioned to postgraduate medical education will start later this year, and I hope that we will be in a position to introduce them more widely from 2004. We are doing that in full consultation with all the devolved Administrations and with the support of the chief medical officers in all four nations of the United Kingdom.

The Minister has singularly failed to answer the question asked by my hon. Friend the Member for Tunbridge Wells (Mr. Norman). Does he agree with the Royal College of Physicians that implementation of the European directive by August 2004 will be difficult or even impossible and that the level of out-of-hours medical cover in many hospitals is already worryingly thin, posing a direct and alarming threat to safe levels of patient care? Given that the number of doctors enrolling in the past five years has been worryingly low—about 350, when the Minister estimates that 7,000 to 10,000 are needed to comply with the directive—is he now prepared to put British patients' interests first by delaying implementation, or does he expect doctors to deal with even more patients in fewer hours and risk many of our hospitals collapsing, or will patients simply have to wait even longer?

I did answer his hon. Friend; the problem is that usually he does not like the answers that I give.

We ought to be clear. The idea that we should delay implementation of the working time directive is ridiculous—that is not going to happen. No, I do not agree with the Royal College of Physicians' assessment. We have published guidance setting out how the NHS can reach compliance and how we will do that, and we are backing that with significant additional investment, which will be important. The hon. Gentleman, like the rest of his rag-tag army of clapped-out, failed Front-Bench spokesmen, has absolutely no strategy other than the usual parade of doom and gloom and cutbacks in NHS spending, which will make it impossible to do what he says we should be doing.

Nhs Dentists


What progress he has made in establishing the commissioning of NHS dentistry by primary care trusts. [103204]

The Health and Social Care (Community Health and Standards) Bill was introduced on Wednesday 12 March. It proposes that each primary care trust be given a duty to secure or provide primary dental services to the extent that it considers it reasonable to do so.

Does my hon. Friend accept that previous initiatives, such as investing in dentistry and locating an NHS dentist through NHS Direct, have run their course and still many adults cannot find a dentist who will accept them as an NHS patient? Does he agree that the day cannot come too quickly when PCTs commission services so that there is a full range of NHS dentistry services available? Will he consider taking interim action to ensure that NHS dental services are boosted now?

I am grateful to my hon. Friend for his remarks. We were right to take short-term and medium-term steps to ensure that people had access to NHS dentistry through dental access centres and the NHS commitment scheme. It is now right to ensure that PCTs can commission for dentistry in their locality to meet local needs, and we have put the Bill before Parliament to do that. My hon. Friend campaigns for his constituents in Stafford, and his local PCT is keen to act in that respect.

Does the Minister recall the Prime Minister's promise that everyone would have access to an NHS dentist by September 2001? That promise was broken: fewer than half the people in this country have such access. Why was the Prime Minister's promise broken?

The hon. Gentleman asked me precisely the same question in January and today I will give him the same reply. The promise was not broken. People have access to a dentist through NHS Direct. Dentist registration numbers are up, as is the number of dentists. He will know that the number of people registered fell to 16 million under the Conservative Government, whereas it is now 23.5 million.

Is not access to NHS dentistry a particular problem in areas where the population is growing at a more rapid rate than the national average, as is true in some parts of the east midlands? Cannot some of the gaps in provision be filled by a more effective amalgam of action by the Department of Health, the British Dental Association and primary care trusts? Will my hon. Friend look into the particular problem in areas like mine?

My hon. Friend will be pleased that I am in dialogue with the British Dental Association, and we propose dental support teams to target access problems in specific areas. I will ensure that his area is considered, along with many others, to make sure that constituents get access to a dentist.

Child Mortality (Luton)


What further measures he intends to take to tackle child mortality in Luton. [103205]

A range of health initiatives are already being undertaken in Luton to contribute towards reducing child mortality. I was pleased to be able to visit the Our House project in my hon. Friend's constituency, where health visitors, other health professionals and parents are working together to safeguard their children's health and futures. In addition, we are increasing funding to Luton teaching primary care trust significantly to help tackle inequalities, of which child mortality is a particularly important one.

As my hon. Friend is aware, Luton suffers from a high level of infant mortality: 6.5 per 1,000 births, as opposed to the UK-wide average of 5.5—a tragic indicator of health deprivation. Is she aware that in terms of funding, Luton primary care trust is one of the furthest from capitation? At the end of a three-year period, it will be one of the eight PCTs furthest away from capitation. Although we are extremely grateful for the additional funding that we have received for many health projects in our area, for our Government have committed themselves to improve health care—

I understand my hon. Friend's concern. I know that she is keen to tackle health inequalities, so I am sure she welcomes the fact that Luton PCT will receive an increase of more than 32 per cent. over the next three years, of which a significant part is a rolling-over of the health inequalities adjustment. Although I recognise her point, the allocations policy will reduce the discrepancy between Luton's financial position and its distance from target. We believe that we have struck the right balance for the present allocation round, but we will consider the policy in the light of all the circumstances when we outline the next set of allocations.

Budget Deficits


What recent advice he has given to (a) strategic health authorities and (b) local health economies on dealing with projected budget deficits. [103206]

All NHS organisations have been asked to plan for financial balance. We have asked strategic health authorities and their local health economies to work together to ensure that this is achieved. Primary care trusts have an important role to play in commissioning quality and affordable services from local trusts within the resources available.

Is part of the Minister's advice that the NHS locally should sack good chief executives or encourage them to resign when there is a deficit, like the £18 million deficit at the Oxford Radcliffe hospital, where David Highton, recognised as one of the best chief executives in the country, has resigned because he has been unable to achieve financial balance and meet the Government's targets because of the millions of pounds that he has had to spend on agency nurses to create the capacity that the hon. Lady's Government have failed to achieve in the Oxford area?

The hon. Gentleman knows that management issues are a matter for the local trust, not for Ministers. He also knows that because of our ambitions for the service, there are indeed pressures on many health economies throughout the country because of our need to increase capacity and give patients more access to the service. He knows that we have the biggest increase in investment that the NHS has ever known—a 7.5 per cent. real terms increase for the next five years. I am sure the hon. Gentleman will welcome the massive investment that there has been in his community in the form of the new trauma centre, an increase in prescribing budgets, an increase in money for coronary heart disease and a range of other services in his local area. [Interruption.] There are challenges for the PCTs to face, but the investment is without question the largest that the NHS has ever known.

Order. May I once again appeal to the House to be much quieter? I can hardly hear the questions and answers and it is unfair if hon. Members cannot hear what the Minister is saying or if the Minister cannot hear the questioner.

When we visited the Minister recently to talk to her about the deficit of the Kennet and North Wiltshire primary care trust, she expressed what can best be described as indifference to its indebtedness. That means that there is now a threat to the local hospitals in Malmesbury and Devizes, just outside my constituency. Does she regret that indifference and does she believe that there is anything that can she do about the issue? What will she do to save Malmesbury hospital?

I had an extremely constructive meeting, not with the hon. Gentleman, but with his colleague, the right hon. Member for Devizes (Mr. Ancram), and the chairman and chief executive of the local primary care trust, who showed me that they were determined to ensure that they could improve services for that local community. They are under financial pressure, but they have had an extra £45 million of investment in their local health services. I say to him that the comments that he has made in his local press about my alleged remarks are entirely untrue and a travesty of the meeting that I held with him. I am always willing to help local Members of Parliament, but in this case, he has not shown the necessary support to his local health community.

Community Pharmacies


If he will make a statement on the implications for his Department of the Office of Fair Trading report on community pharmacies. [103207]

We have so far received about 1,000 responses to the OFT report on community pharmacies. It is the Government's intention to respond to the report within the next few weeks. We are working with my right hon. Friend the Secretary of State for Trade and Industry to ensure that our response properly reflects the interests of NHS patients in providing access and choice for improved local pharmacy services.

I fully support the viion of my hon. Friend's Department for the future role and development of community pharmacies, but can I tell him that the OFT's recommendations on scrapping control of entry regulations threaten to drive a coach and horses through his Department's policy? I represent an area of small towns with high chronic illness and low car ownership. Those towns have already lost banks and post offices. May I urge him to ask his DTI colleagues to reject the OFT's recommendations?

My hon. Friend will appreciate that one cannot go through the Lobby as Minister with responsibility for pharmacy services at the moment without being lobbied by almost every MP about this important issue. That is a testimony to the work that community pharmacies do in all our areas. They provide valuable services in deprived communities and rural and suburban communities alike. It is right that we consider the proposals against our wider policy objectives in the Department of Health for community pharmacies.

Is the Minister not aware that, as things stand, he will be known as the man who shut down the rural pharmacies? Something should be done about that. Would he not be much better off ensuring that pharmacies in the countryside provide a range of complementary therapies?

What would shut down the pharmacies is a 20 per cent. cut across the board. We have 90 days to consider the report and we are doing so very carefully.

Free Fruit Scheme


If he will make a statement on the operation of he free fruit scheme in schools. [103208]

We are committed to introducing a national school fruit scheme that will entitle four to six-year-olds to free fruit daily from 2004. The scheme is currently being rolled out region by region with funding from the New Opportunities Fund. By July, the scheme will be reaching about 1 million children.

I thank my hon. Friend for that reply. When I was an Agriculture Minister, I helped to launch the scheme and was delighted by the enthusiasm for it in some inner-city schools. Given that the House is so full, I am glad that so many people are present to hear me express my hope that the scheme will be extended to Gateshead, Sunderland and the north-east as soon as possible.

My right hon. Friend is absolutely right that the scheme is hugely popular. About 88 per cent. of eligible schools have already taken it up and we are looking to roll it out to other regions over the next few school terms. I have visited school fruit projects in Newham and Runcorn, where children have hugely welcomed the apples, pears, bananas and oranges that they are getting every day. The scheme is making a real impact not only on their health, but on the curriculum. We are using it as a way of engaging children in improving their health and nutrition, and extending to their families ideas about getting school fruit, a healthy diet and the best possible start in life—something that should be available to all our children.

Nhs Dentists


If he will make a statement on the availability of NHS dentistry in the town of Berwick-upon-Tweed. [103209]

The Government are aware that the Northumberland care trust has been concerned about access to NHS dentistry in Berwick-upon-Tweed. As a result, we have recently approved funding for the trust to appoint a part-time salaried dental practitioner to work in Berwick royal infirmary. That will address the issues in the short term while longer-term solutions are considered.

While that appointment has yet to be filled and there are no vacancies in NHS dental practices in the area, what can the Under-Secretary say to my constituents who have been told that the only way in which to get NHS dental treatment is to travel 65 miles to the Newcastle dental hospital?

I hope that the right hon. Gentleman will encourage his constituents to support the Bill, which is currently being considered, and will give primary care trusts the leverage to ensure local commissioning. I am in discussion with the British Dental Association to ensure that we have dental support teams in areas where access is a specific problem.