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Health

Volume 408: debated on Tuesday 1 July 2003

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The Secretary of State was asked

Kidderminster Hospital

1.

If he will make a visit to inspect the new diagnostic and treatment centre at Kidderminster hospital when it is completed next year.␣[122416]

Phase 1 of the Kidderminster diagnostic and treatment centre will open in December 2003 and it is scheduled to be fully operational by April 2004. I can certainly promise to visit the centre, because I want to thank the delivery team for the excellent work that it is doing on this important project.

May I thank the Minister for his reply and welcome him to his seat, as well as the whole team for their first session of Health questions?

Given the threat to hospitals throughout the country from the European working time directive and the struggle that hospital staff now have to maintain continuity of care, will the Minister ensure that the diagnostic and treatment centre at Kidderminster, which, like others, is distant from the acute general hospital that serves it, can provide medical cover through a reasonable selection of intermediate elective surgery to meet the needs of the local community and tackle waiting list problems in the wider area?

I am grateful to the hon. Gentleman for welcoming me to the Dispatch Box.

Yes, I can assure the hon. Gentleman that we shall take a keen interest in the way in which that particular diagnostic centre works. We shall take on board the issues that he raises about the challenges posed by the working time directive. I think that he can be reasonably confident that the centre will be very popular locally. Past experience suggests a 98 per cent. rate of satisfaction with such centres, and I have no reason to believe that his centre will be any less successful.

I welcome the Minister to his duties.

Will the diagnostic and treatment centre at Kidderminster have a system for ensuring that the profits of the operator are returned to the NHS and shared with it, and that there will be a cap on the number of private patients that it takes? Will that be the practice generally for all other diagnostic and treatment centres?

I am grateful to my hon. Friend for his welcome.

The Kidderminster diagnostic centre is an NHS centre, so the issues that my hon. Friend raised will not be of concern there. On the general issue that he raised, I shall certainly reflect on his comments. If he wishes to talk to me about his concerns, I shall be happy to discuss them with him.

May I, too, welcome the Minister to the Dispatch Box?

Will the Minister reflect carefully on the wise words of the hon. Member for Wyre Forest (Dr. Taylor)? The previous Secretary of State for Health told me that there was a capacity problem in the Worcestershire health economy. That is certainly the case, and it means long waiting lists and lots of problems for patients. The centre at Kidderminster is a very important part of the solution to that problem and I hope that he will reflect carefully on what the hon. Gentleman said.

The hon. Gentleman is right; the diagnostic centre will be a very important part of building that capacity and getting waiting lists down. I welcome the interest that he has taken in this matter and in the general issues of the local health economy. However, if we are to tackle the issues that he raises, we must do so by getting investment into the national health service, and not cutting it.

May I add my congratulations to the Minister?

Will the Government use a standard tariff for treatments carried out at centres such as Kidderminster and other centres around the country, or will privately run centres be able to charge the NHS more for the same procedures?

I am grateful to the hon. Gentleman for his welcome.

I am afraid that I have to admit that I have no idea about that matter, but I shall look at it very carefully in the coming days, and I shall certainly respond to the hon. Gentleman. What I can tell him is that the Kidderminster centre is being set up with the full cooperation of the local primary care trust and strategic health authority. We expect it to have a strong impact on local waiting times and we have no reason to believe that in the fullness of time it will not prove to be an extremely successful operation.

Primary Care Trusts (Funding)

2.

What assessment he has undertaken of the funding of different primary care trusts in relation to funding targets. [122417]

We consider our allocations policy for each round of allocations in the light of all the circumstances at the time. Allocations for the period 2003–06 were announced last December and took account of the position of all primary care trusts in relation to their target share. The allocations made were the biggest three-year increases to go into the national health service in its history.

Why do the Government persistently fund some PCTs at way below their own national formula for determining the health needs of an area, while funding others consistently above it? In my area, the Bedfordshire PCTs are £22 million below the Government's formula target, yet two PCTs in the same health authority are funded at £25 million above that target. When will the Government bring about a fair allocation of health resources?

First, I welcome any support from Conservative MPs for the idea of targets, as they are not always so supportive of them. Secondly, the hon. Gentleman will remember that we have to strike a balance between the amounts that we spread across all the PCTs, given the infinite demand for them and the limited resources. Thirdly, those resources are vastly increased over anything that the Conservative party, or anyone else, ever put in.

I am going to answer the question specifically in relation to Bedfordshire. [Interruption.] I am glad that Conservative Members are so keen to get the answer, because it is as follows: Bedford PCT's allocation will increase by no less than 32 per cent.; Bedfordshire Heartlands PCT's allocation will increase by 31.7 per cent.; and Luton PCT's allocation will increase by 32.74 per cent. Those are staggering increases. The truth of the matter is that by comparison with the 30 per cent. increases under this Government, Conservative Members would take 20 per cent. away.

Is my right hon. Friend aware that my local PCT, Barnsley, which is one of the biggest in the country, is moving further away from its target funding because of the deficit that exists and is about £6 million behind its budget position? Given that Barnsley is one of the areas of greatest need, yet one of those with the lowest funding, will he look again at that situation?

I am always prepared to look particularly at areas of need, because that is one of the elements that form the criteria by which we allocate money, so I shall do so. However, I think that my hon. Friend would be the first to admit that, both historically and in terms of what any of our international competitors are doing, the amount of investment that is going into the national health service is unprecedented—£45 billion for 2003–04, £49.3 billion for 2004–05 and £53.9 billion for 2005–06. Those are staggering amounts of money. Even in my first couple of weeks in the job, I have been absolutely staggered by the amount of investment. I can tell my hon. Friend that the three-year announcements on 11 December represented the biggest ever investment handout by the state in this country since the dissolution of the monasteries.

The dissolution of the monasteries was an early version of invest and reform. The investment is staggering in its historical context.

I am delighted to hear the Secretary of State say that he is prepared to look at specific areas of need. While he is considering the funding requirements of different primary care trusts, will he look specifically at the retinal laser treatment known as photodynamic therapy? Two of my constituents, a Mrs. Scott and a Mrs. Brooks, are expected by the brand new flagship Norfolk and Norwich University hospital to travel to Liverpool for that treatment, though they are elderly and find it difficult to see, because the local PCTs have not yet given their approval to have the treatment locally. Does he agree that it is unfair to expect elderly people to fund the costs of travelling so far, from Norwich to Liverpool, and will he look into it?

Obviously, I am not aware of the specific case that the hon. Gentleman raises, but yes, I will look into it.

On distance from targets, my right hon. Friend knows that I was part of a delegation of all Bedfordshire and Luton Members of Parliament who recently met his predecessor. While we acknowledge the considerable increase, year on year, in resources for the national health service throughout the country, including Bedfordshire, we highlighted three issues at the meeting. First, Bedfordshire health services have been below target for 25 years or so—indeed, they are near the bottom of the national league table. Secondly, that has contributed to weakness over the years in building decent primary and community care services. Thirdly, although the Government acknowledge that there is a gap and that it needs to be closed, on current figures, the pace of change means that it will take almost 20 years. Does my right hon. Friend accept that the needs of my constituents and residents in Bedfordshire and Luton, and the challenge of the NHS plan to modernise and improve require the gap to be closed much more quickly?

I know that my hon. Friend is a stalwart fighter for his constituents. I would expect nothing other than that. Of course, we pay great attention to need, which exists not only in Bedfordshire but throughout the country, especially after two decades of starvation of investment in the NHS. However, the allocation policy must take account of several factors, including the overall resources available and the priorities for their use. Although my hon. Friend finds Bedford's allocation unsatisfactory, it will increase by £34.7 million, or 32.1 per cent., in the next three years. As I said earlier, Bedfordshire Heartlands' allocation will be increased by 31.7 per cent., which is £52.1 million, over three years. Although my hon. Friend, like many others, does not find his allocation satisfactory, I believe that he would be the first to agree that, by historical and international standards, the increases are staggering in proportion and amount.

I welcome the Secretary of State to his latest challenge. He has held down the post for two weeks, which is good going, and he has clearly already discovered his predecessor's collection of scratched old records at the bottom of his desk.

My hon. Friend the Member for South-West Bedfordshire (Andrew Selous) asked how the relative funding problems in Bedfordshire have been affected by the Department's age-sex standardisation technique. Does the right hon. Gentleman have any plans to revise that formula?

I thank the hon. Gentleman for his overgenerous welcome. I have been here only two weeks—

As I look at the standard of the Opposition, I believe that I shall be here for much longer.

Of course, I shall continually review the criteria for allocating resources. Allocation is based on several criteria, including need, population and the start level of resources. I shall bear the hon. Gentleman's comments in mind.

Cancer Fund Distribution

3.

What plans he has to continue the exceptional tracking exercise carried out recently for cancer fund distribution. [122418]

This was an exceptional tracking exercise. The NHS is receiving £12.7 billion extra from 2003–04 to 2005–06. It is for primary care trusts in partnership with strategic health authorities and other local stakeholders to determine how best to use their funds to meet national priorities, including cancer targets.

I thank the Under-Secretary for her reply. I welcome the openness and transparency represented by that exercise to find where the cancer money went. Will we ensure in future that all the money—not only 60 per cent., which some authorities spend—will be spent on cancer, as should happen?

I know that my hon. Friend is aware that, apart from some central funding, the money is principally routed through the primary care trusts. The research and the report that the national cancer director published on 22 May show that, after some initial problems, there has been additional major spending on new cancer drugs and significant investment in other important aspects, such as expanding the cancer work force and extending services such as radiotherapy and screening. There is clear evidence that the money is getting through and making a difference, but it is up to local decision making.

Is it not a fact that many cancer patients need nutritional supplements? Given that the Lords rejected the food supplements regulations last night and that 300 nutrients are about to be taken off the shelves, does that not mean that the Government have failed to bat for Britain in Europe? The Minister claims that in the light of the so-called dossier, those nutrients can go back on the market, but is it not true that only 15 supplements have been put forward for that dossier, and that 280 odd will therefore not be put forward? What does the Minister have to say about that?

I am not entirely clear as to the direct relevance of those questions, but as you are allowing them, Mr. Speaker, I shall do my best to respond. The point is that we have negotiated the best possible deal with other European member states, and we have a long lead-in for some of the changes. Many issues have yet to be decided, and I think that we all agree that the only reason to ban any supplements is, effectively, that they are unsafe—[HON. MEMBERS: "No."] Well, that is the Government's ground for taking action, and on the basis of evidence. I trust that we can work with the industry to secure the best possible outcome for UK consumers. That is our main objective, and I believe that our best interests are served by working together.

My hon. Friend is right to say that the tracking exercise has been incredibly useful. I have seen its effect on my network, allowing those concerned and me, as a Member of Parliament, to understand where the money is going. Visiting the United States also made clear just how well we are doing in terms of cancer treatment. Does she agree that this exercise is one way in which central Government can keep an eye on the money spent and ensure that local teams are spending it where they should? It also allows Members of Parliament to have confidence in the process.

I agree with my hon. Friend that it has been a useful exercise. Some differences in experience have clearly been encountered throughout the country, in terms of the money going to where we hoped it would go. But I hope that she and other Members will understand that it is quite difficult permanently to track in detail the money going into cancer services. Much of the money may go to specialisms, in which case only some of the money relates to cancer treatment. Given the ongoing bureaucracy, form filling and returns required to get a detailed picture, such a process is not sensible. However, we have overall targets and we are doing well on all of them, which is evidence that the money is getting to where it needs to be. I trust that Members will continue to take a lively interest in this issue.

Does the Minister accept that, ultimately, all cancer services in the community and in hospital outstations are underpinned by the regional cancer centres? When will the Government publish the independent review panel report on the future of acute health services in east Kent and, in particular, of the joint cancer centre at the Kent and Canterbury hospital? In practice, will we see a vital and excellent cancer centre eroded and ultimately closed by stealth?

We are looking at all of these issues carefully in the light of the panel's recommendations, but I can assure the hon. Gentleman that the report will be published shortly. He will have to wait to see what is in it, but the Government are of course totally committed to having a very high standard of care in excellent centres throughout the country. I am sure that he will join me in working towards that objective.

Nhs Patients (Wales)

4.

What the Government's policy is towards the treatment of NHS patients from Wales in England. [122420]

It is the responsibility of local commissioning bodies to ensure proper access to NHS services for their local populations. NHS trusts in England will continue to provide a range of services to patients from Wales in accordance with these arrangements.

I am grateful to my right hon. Friend for that reply. Is he aware that many of my constituents and others in north-east Wales currently receive much of their medical treatment from hospitals in England, such as those in Chester, Gobowen, Liverpool and Manchester? My concern is that the Health and Social Care (Community Health and Standards) Bill does not place an obligation on foundation hospitals to continue to treat patients from Wales. Will my right hon. Friend therefore consider an amendment to ensure that hospitals in England continue to have an obligation to treat patients from Wales?

I do not think that we will be considering an amendment to do what my hon. Friend suggests. However, there was some argument in the Standing Committee about the Bill's provision in connection with the treatment of patients from Wales by NHS foundation trusts in England. It was always argued that NHS foundation trusts in England were fully able, and legally empowered, to treat patients from Wales. We have tabled some further amendments in Committee to make that perfectly clear. To put the matter beyond doubt for my hon. Friend, I assure him that there is nothing in the Bill, if it is approved by this House, to prevent NHS foundation trusts, once they are established, to treat patients from his constituency. I think that that is the right way to deal with this matter.

Will the Minister confirm that the Bill means that English hospitals that treat Welsh patients will be subject to two separate inspection regimes by two sets of inspectors in the same year?

We have made it clear that we want the new audit and inspection arrangements to be as minimally invasive and bureaucratic as possible. It is perfectly possible for the National Assembly for Wales and the commission for health care audit and inspection to co-ordinate and co-operate to determine how the investigations and monitoring arrangements work in practice. That is the sensible way to proceed, but the fundamental problem for Opposition Members is that they do not accept the devolution settlement. They do not accept that it is perfectly possible for the National Assembly for Wales to exercise those functions in a devolved way. Yes, there will be two inspection bodies, but that is no reason to argue that there cannot be proper co-ordination between them. That is the right way to proceed. It reflects the constitutional settlement agreed by this House, which is working well in the interests of the people of Wales and England.

My hon. Friend the Minister uncharacteristically misunderstands the question asked by my hon. Friend the Member for Wrexham (Ian Lucas). The point is not that English foundation hospitals will not have the ability to treat Welsh patients but that, although the Bill as constructed gives them a legal responsibility to treat English patients, it does not give them a similar responsibility to treat Welsh patients. Will the Minister carefully consider whether the Bill could be amended so that patients in Wales and in England enjoy equal rights?

With the very greatest respect to my hon. Friend, I must tell him that he is wrong on that point. The Bill makes it evident beyond any reasonable doubt that NHS foundation trusts in England will be perfectly able, legally, to treat NHS patients from Wales. The point that my hon. Friend has not understood is that whether an English hospital treats patients from Wales is a matter for the commissioning bodies and the trust to negotiate. Once the agreements are in place, there is nothing in the Bill to make it impossible for an NHS foundation trust—or any other NHS acute service provider in England—to provide services to patients from Wales.

Water Fluoridation

5.

What recent representations he has received regarding the extension of fluoridation in the public water supply. [122421]

7.

We have received representations from the water industry requesting that the legislation on fluoridation be amended to make strategic health authorities solely responsible for deciding, where their populations are in favour, that a new fluoridation scheme should be introduced. We will table a relevant amendment to the Water Bill tomorrow, for debate on 9 July before Third Reading of the Bill in another place.

I am grateful to the Minister for that reply. I welcome the new team in the Department of Health to their remaining duties in Wales and Scotland.

Fluoridation is one such matter. In my constituency, 69 per cent. of people do not have access to an NHS dentist. The incidence of lip and mouth cancer is among the highest in western Europe, and we have an above-average incidence of decay in children's teeth. My constituents tell me that they do not want fluoride in the water as a matter of compulsion; they want to be able to opt to take fluoride as a supplement. Will the Minister give them the guarantee that the NHS will deal with the dentistry that needs to be performed, but that fluoridation will be a matter of personal choice for the consumer?

We are enabling local communities to decide what they want to do on this matter. I appreciate the hon. Gentleman's points about dental services, but those are a matter for the National Assembly for Wales and I cannot comment on them. I hope that hon. Members accept that we are looking to give local communities the decision-making power. I am sure that the hon. Gentleman, who believes strongly in devolution, accepts that that is the right way to go on these matters.

Has not Parliament spoken in favour of water fluoridation but mistakenly left the final decision in the hands of plcs, not the people? I thank my hon. Friend—and her predecessor, my hon. Friend the Member for Salford (Ms Blears)—for ignoring the bluster of the flat earth society and agreeing to table an amendment that will help us to improve children's health. Will she give a firm assurance that, regardless of what happens down the Corridor, this House will get a chance to vote on the issue and clear it up once and for all?

I am grateful for my hon. Friend's support for the proposal. I emphasise that no fluoridation scheme will take place unless there has been wide-ranging consultation in which both the proponents and opponents of fluoridation have been encouraged to participate and in which the majority of the population have indicated that they are in favour. Ultimately, this matter should be decided locally, but we recognise the difficulties that water companies have faced and are proposing to table the amendment in accordance with suggestions put to us on many fronts over recent months.

Countries as diverse as Finland, Cuba, Canada and Germany are now abandoning water fluoridation, but are not finding that tooth decay has increased or decreased. Why should we consider bucking that trend in this country by introducing this illiberal measure?

I have said that the amendment is enabling and will not necessarily lead to any more fluoridation schemes, which will depend on what people decide locally. There is a strong correlation between fluoridation and reducing tooth decay; that is an important fact. Large chunks of England down the east side—roughly from Hartlepool to Essex—have fluoridation occurring naturally at the sort of levels that might be put into matter, and 5 million other consumers already receive fluoridated water in Birmingham and other areas.

A very long time ago, the people of Bolton voted in a referendum against fluoridation, but it was a very long time ago. Bolton metropolitan council also voted against fluoridation, but that was some time ago as well. Will my hon. Friend give consistent guidance to all councils and people across the country so that everyone can have a say in this emotive matter, the guidance is upheld and up-to-date consultations are carried out if and when Parliament decides on the issue?

The detailed guidance will be a matter for regulations. At the moment, we are only at the stage of tabling an amendment to the Bill in another place. Local people will decide how they engage with the options covered by the regulations, which will be a matter for them.

Does the Under-Secretary understand the concern of many that there is already too much interference in what we eat and drink? Fluoridation is one concern, but there is concern also about far too many colourings and additives and the effect that they have on children's behaviour, about the reduction of basic vitamins and minerals in food, and about GM food. I accept that there is a positive dental benefit from fluoridation, but should not the Government concentrate on the real cause of the problems: the amount of sugar consumed by children?

We are doing things to improve diet and decrease the intake of sugar and salt. I reiterate to the hon. Member for Wealden (Mr. Hendry) that 5 million people already receive fluoridated water at one part per million, the proposed level of any scheme, and large chunks of the population receive it naturally through the water supply. The idea that it is purely an artificial additive is clearly wrong.

Digital Hearing Aids

6.

What the take-up of NHS digital hearing aids is. [122422]

By the end of May 2003, 98,540 digital hearing aids had been fitted to 62,865 people as part of the modernising hearing aid services project. We have recently announced that an additional £94 million will be made available over this and the next financial year to support national roll-out of a modernised hearing aid service providing digital hearing aids.

I welcome my hon. Friend to her new post and wish her well in it. I also welcome what the Government are doing on digital hearing aids, but I must tell her that it is not happening quickly enough in North Staffordshire. Does she agree that there is an unsung hero in North Staffordshire—my constituent, Mr. Longstaff—who will not be satisfied until everyone who needs a digital hearing aid can get one? He does not want people to have to wait until 2005. Could the Minister contact the Treasury and ask whether it could free up the £10 million or so in balances that existed under the old health authority? If we could free up that money and get it moving over to the new primary care trusts more quickly, we could roll out the digital hearing aid programme that much more quickly for constituents in North Staffordshire.

I thank my hon. Friend for her kind comments and welcome, and I understand the point that her constituent makes. The programme that we have set in train on digital hearing aids has been widely welcomed. I understand that the North Stoke primary care trust is commissioning this work on behalf of the other four PCTs in the area, working with the local service provider—the University hospital of North Staffordshire—and the project team. Funding is being examined and they are trying to establish how best to provide those services as quickly as possible. In fact, we look to PCTs to provide only about 25 per cent. of the funding; in a typical area, that will amount to about £6,000 per PCT. In view of the increase in PCT funding, we believe that they should try to match the 75 per cent. provided centrally to help introduce the service.

I too congratulate the hon. Lady on her appointment and I am sure that she will add sparkle to the Front-Bench team and do very well. She will be aware that digital hearing aids can help people to stay in work and revolutionise people's lives. Is she aware of the disappointment in west Norfolk that the Queen Elizabeth hospital was not part of either the first or the second pilot scheme? Can she give us any idea of when my constituents will be able to get these worthwhile and important aids?

I thank the hon. Gentleman for his kind comments. Digital hearing aids will be in place by March 2005. It has been done in waves, with different trusts signing up to the programme at different times, but it obviously takes time because various things have to take place. The proper equipment must be installed and audiologists must be trained. We need to ensure that, once the service goes out, it is able to deal with people's individual needs. I hope that the hon. Gentleman's constituents will accept that we are moving as quickly as we can. No one would be happier than we if it could be done more quickly, but real practical problems must be addressed. Nevertheless, the service should be rolled out nationally by April 2005.

I welcome my hon. Friend to her new position and I also welcome the fact that, as a result of the Government's investment in the health service on an unprecedented scale, this technology has been made available. However, is she aware of age-based discrimination in certain areas where older people who have old-style analogue hearing aids are not receiving the new digital aids? Will she make it clear that the Government will not tolerate that sort of discrimination in any NHS trust, and that the service should be freely available at the point of use so that older people can have access to digital aids?

I thank my hon. Friend for his comments. I completely agree that there should be no discrimination. The approach taken has been that people who require new hearing aids or are obtaining them for the first time have been prioritised for digital hearing aids. Provision is then worked through so that people who have had hearing aids longest get the new ones, and that may be people who have had them four years, then three years, then two. We are renewing the oldest analogue hearing aids by replacing them with digital hearing aids. That may be why my hon. Friend's constituent believes there is discrimination, but that is not the case. We are simply working through the system to deal first with those who have had hearing aids longest before we move on to others.

I add my welcome to the Minister, but while she has a fresh pair of eyes, will she look again at the facts behind her brief? Her words will sound hollow to people like my constituent Tony Warner, who is 83 and who had to wait 23 months to have a digital hearing aid fitted because of the lack of audiological technicians in the area. Does she realise that it is no good making digital hearing aids available if there is no one available to fit them? The hearing aids must be fitted by technically qualified people, but the number of audiological technicians qualifying last year was half the number in the previous year. The gap between supply and demand is widening, and the waiting lists will lengthen, not shorten.

I thank the hon. Gentleman for his welcome. I understand his constituent's frustration at any delay. As I have said, we are moving as quickly as we can to institute proper training and to put equipment in different areas. The hon. Gentleman has certainly drawn attention to a real problem in the training of audiologists. We have instituted new training programmes in recognition of the fact that there is a difficulty, and we are working with other sectors to see whether more can be done to train people. There is a difficulty, but we are working hard to redress it. I hope that that will give some comfort to the hon. Gentleman's constituent.

Does my hon. Friend accept that many people who are partially deaf, as I am, have stopped using the analogue hearing aids issued by the national health service because they pick up too much noise that we do not want to hear, meaning that we cannot hear what we do want to hear? We want the new generation of digital hearing aids to be introduced as soon as possible because they make a great difference to what people hear.

Yes, I am well aware of the differences between analogue and digital, although it might be quite handy in this place to hear some things and not others. My hon. Friend has hit the nail on the head. It is absolutely true that the new digital hearing aids allow much greater personalised tuning to serve the problem of the person concerned. Through computerisation, people are better able to adjust the hearing aids to deal with particular problems. My hon. Friend is right to say that we need to have systems in place as soon as possible, and I assure him that that is what we are working to do.

I too welcome the Minister to her post. She has had a remarkable first outing. By the way, the jacket that I am wearing is not a hospital jacket, so she need not worry too much about that.

May I press the Minister on the timing of the roll-out programme? Will Queen Mary's hospital in Sidcup, which has its service provided by Lewisham, be dealt with at an early stage of that programme? The hospital feels that it is getting postcode treatment and facilities at the moment, and I hope that it will be dealt with early rather than at the tail end in 2005.

I thank the hon. Gentleman for his kind comments; I assure him that he has no need to apologise for his white coat.

I understand that there will be concerns about the roll-out in different areas, but as I said, we have worked closely with primary care trusts in different areas to ensure that the programme can be properly met by 2005. We are encouraging other areas to come forward; we shall then work closely with them to ensure that they have the proper training and equipment so that, once the service is up and running, they can deal with people quickly and ensure that they have the benefits of digital hearing aids.

Foundation Hospitals

8.

If he will make a statement on the accountability of foundation hospitals. [122425]

NHS foundation trusts will be fully part of the national health service and run locally, not nationally. The Health and Social Care (Community Health and Standards) Bill sets out various strands of accountability for NHS foundation trusts.

As currently drafted, the Bill provides for foundation hospitals to appoint their own auditor, with no public auditor—neither the Audit Commission nor the National Audit Office—and no public scrutiny of the annual audit reports. Given that foundation hospitals will be spending billions of pounds of public money, voted by the House, should not they be ultimately accountable to Parliament rather than to an amorphous group of local worthies? Does not the Secretary of State share my concern that, when things go wrong, as they always do from time to time, no one will be to blame and no one will be held accountable to Parliament for the billions of pounds of taxpayers' money that is being spent?

I am surprised, because the whole tenor of what has been said from the Opposition Benches is that foundation hospitals do not have sufficient freedoms and are over-burdened. I believe that is wrong, but it is interesting that some Conservative MPs are saying that the hospitals should have extra burdens and that there should be more intervention. The truth is that we have a fair balance; NHS foundation trusts will have more freedom to take their own decisions locally, while nevertheless being fully part of the national health service and accountable not only to those who commission health provision—mainly the local primary care trusts—but also to their members, to those in the area who use them, to the NHS foundation trust through the board of governors and, of course, to the new independent regulator. In addition, they will be accountable to the new Commission for Healthcare Audit and Inspection. That is a balance between the desire to have a diverse form of supply inside the NHS and maximising freedom. There is plenty of surveillance, oversight and transparency and we should not go further by interfering and inflicting more obligations on the freedoms of the NHS foundation trusts.

If Christie hospital in my constituency becomes a foundation trust, what will be the electorate for its governance?

I do not know specific details about my right hon. Friend's local hospital, but I can tell him that the electorate will include not only the locality but the patients who use the hospital.

Should not foundation hospitals be accountable to the rest of the NHS for their borrowing powers? In the Standing Committee, the hon. Member for Birmingham, Hall Green (Mr. McCabe) put that point well. He said that we needed to know

"whether the extra that the trusts can borrow comes off the NHS total. If it does, it suggests that there could be a preference for those trusts at the expense of other parts of the NHS. That is a pretty central anxiety for a great many of us".—[Official Report, Standing Committee E, 22 May 2003; c. 367–68.]
Even those of us on the Liberal Democrat Benches who support the principle of alternative providers for hospital services do not think that that should be at the expense of existing providers. Is not it unfair and unjustifiable for there—

Setting priorities is not a new phenomenon inside the national health service, or any other expenditure portfolio, and when priority is given to one subject, one area, one person or one operation, it can be argued that it has therefore been taken from another area or person. There is nothing new in that, but we have tried to ensure—I think, successfully—that foundation trusts will represent a new form of publicly accountable health service. They will be truly part of the NHS, but, alternatively, they will have freedoms that have not previously existed to meet the different needs, ambitions and expectations of today's working people.

We will have centrally provided resources and standards. We will have local decision making and, as far as we can, we will give patient power and choice to individuals, so that they can exercise it among the plethora of diverse suppliers of services. We have done so to get national standards, more capacity than has been provided in the NHS ever before and a range of diversity and choice for individuals because, at the end of the day, while every hon. Member so far has concentrated on the suppliers of health care, the benchmark for all our decisions should be the receivers of health care—the patients—and they should come first.

I warmly welcome my right hon. Friend to his new post, but may I ask him to cast a new pair of eyes on the views of the Public Audit Forum, which is made up of the Comptroller and Auditor General and the Auditors General for Wales, Scotland and Northern Ireland, who say that the proposed arrangements for auditors in foundation hospitals are, in fact, inconsistent with Lord Sharman's guidelines for public accountability and that the appointment of auditors should be independent of the foundation trusts, so that auditing is consistent and comparable across the NHS? As a minimum, will my right hon. Friend allow foundation hospitals to consider bids from public sector auditors, not just private firms, so that there is transparency and accountability for the taxpayer and no danger that the focus will be on presenting the accounts in the best light?

I will certainly look again at my hon. Friend's request, but as of today, I am satisfied that there is in place sufficient oversight, which balances the need for transparency and accountability to the public sector. For example, the foundation trusts will be overseen, among other bodies, by the Commission for Healthcare Audit and Inspection. Given the 14 days that I have been in my new job, I am not truly versed in the minutiae and every detail of Lord Sharman's advice. Why not? Perhaps it has been laggardly of me not to put that at the top of the pile, but I have been trying to deal with a number of other issues, such as people who are sick. They come at the top of our priorities, but I will certainly look at the issues raised by my hon. Friend.

How much will it cost to elect foundation hospital boards and to maintain foundation hospital membership? Will that money be top sliced or come from individual trust budgets?

It will be a lot less costly than either reducing the NHS budgets by 20 per cent. or adopting a policy of providing health care in this country largely through the private sector. We will not go down either of those roads, and we will make sufficient financial provision to ensure that the NHS foundation trusts' freedoms are balanced by accountability, locally and nationally.

The new Secretary of State will have to do an awful lot better. When the previous Secretary of State did not know the answer, it was a lot less obvious. No doubt he will pick up that skill in time, but since he does not know how much his proposals will cost, let me help him. It is estimated that the cost of advertising for membership will be about £60,000, that the cost of running an initial ballot will be about £17,000, and that the cost of servicing the membership thereafter will be between £145,000 and £250,000 per trust. Those figures are based on the current estimates, by the foundation trust candidates, that it will cost between £4 and £5 a year to service each member of the trust. How does diverting £250,000 per trust square with the Government's pledge to put money into front-line care, not the bureaucracy?

Since the hon. Gentleman thinks that I am not sufficiently well versed in deception, I promise him that I will study those on the Opposition Front Bench in an attempt to improve myself; but if I have a degree of honesty about my presentation at the Dispatch Box, I do not regard that as a disadvantage. We in the Labour party do not think that a disadvantage, but perhaps those in other quarters do.

If the hon. Gentleman would stop intervening, I will try to answer his question.

The expenditure laid out in the estimates that the hon. Gentleman gives is as nothing. Some £250,000 is as nothing compared with the thousands of millions of pounds that would be taken from the NHS if Conservative Members had their way. I have to say—

Order. We cannot go into what Opposition Members would do if they were in government; they are in opposition.

Thirty-five thousand people voted in the ballot that I called on proposals to downgrade the accident and emergency department at Bassetlaw hospital. If all those 35,000 people choose to join the proposed foundation hospital as members, will they have the power to vote out the chief executive and the board if they ever come back with such ill-advised proposals in future?

Those powers will reside with the governors, who will be elected. I hope that my hon. Friend would, like me, welcome the introduction of further decentralised accountability and democracy inside the national health service. I also hope that he would support me in saying that patients are ultimately the arbiters of whether the health service works as well as we want, which is why we are committed to both decentralisation and a patient-centred health service.

Would not the most effective way to raise the quality of care in our hospitals be to make them directly accountable to patients by giving them the right to choose any NHS hospital in this country and ensuring that taxpayers' money follows patient choice by giving them a patients passport equal to the cost of the operation that they need? Therefore, why have the Government removed, for the first time in the history of the NHS, the right of patients to choose any hospital other than the one to which their local primary care trust has contracted to send them? When will the Secretary of State repeal circular—

I was almost on my way to agreeing with the right hon. Gentleman when he said that we should extend real choice to people, but he reverted to talking about the theoretical choice that is always espoused by Conservative Members: people may have the right to choose to buy a Rolls-Royce, but it is a pity if they do not have enough money to exercise that right. Labour Members want to give patients real choice by putting the necessary financial resources into the health service so that—in London, for example—if people do not have an operation of a specified type in six months, they will be able to choose to go to another national health service, or private, hospital. Indeed, if the operation is not provided in this country, people could go abroad to have it done because the patient is the centre of all our considerations. I want to roll that out. Mrs. Thatcher said several years ago that she wanted the choice to have the treatment for her family that she wanted, at the place and time that she wanted. I half agree with her, but the difference is that I want that for every family in this country.

Pharmacies

9.

What assessment he has made of the implications for health care of the proposals from the Office of Fair Trading on the regulation of pharmacies. [122426]

Pharmacy is an integral part of the NHS. We are carefully considering the OFT report in the wider context of the important part that pharmacy plays in our plans to modernise NHS services, to reduce health inequality and to improve access and choice for patients.

These principles, together with the 2,500 letters we have received on the OFT proposals, will frame our response, which my right hon. Friend the Secretary of State for Trade and Industry is co-ordinating.

I thank the Minister for what appeared to be a positive response. When the Government respond to the OFT, I hope that they will take account of the views of pharmacists and doctors, especially those in my constituency who work in small villages such as Bishopsteignton and Shaldon and fear that the pharmacy will close if the OFT proposals go ahead. Will she tell the OFT that pharmacists and doctors throughout the country are not happy with the proposals as they are at the moment?

The hon. Gentleman makes an important point about access to pharmacies, especially those in rural areas. I assure him that we take those concerns seriously. The role of pharmacists should be expanded so that they become more of a part of the primary care team. When we respond to the OFT report, we shall consider publishing a new draft framework for the national pharmacy contract. We are considering sitting down with pharmacists to decide what other services may be provided and how we may draw up a contract that takes account of their views and the need to expand their vital service as a greater part of the primary care team.

The thousands of people in my constituency who have contacted me on the issue very much welcome the fact that the Government have not just fully accepted the OFT proposals. They look forward to discovering what the Government think is the best way to recognise the importance of pharmacies in local communities. However, there is, of course, a period of uncertainty. Will my hon. Friend, whom I welcome to the Dispatch Box, ensure that we receive the Government's idea of the way forward as soon as possible?

I thank my hon. Friend for his welcome. He makes an important point. We need to respond to the report in the near future. In making that response, we also wish to take account of the Health Committee report, which was extremely helpful in explaining both the important part that pharmacists play in the wider primary health care team and the need to improve the current system, perhaps by introducing wider choice in some of the areas that pharmacists cover.