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Health

Volume 447: debated on Tuesday 20 June 2006

The Secretary of State was asked—

National Performance Targets

1. How many whole-time equivalent NHS staff are employed in monitoring and reporting on national performance targets; and how many there were in 1996. (78460)

The data are not held centrally. However, we are committed to reducing the number of national targets. That number has reduced from 28 in 1996 to 20 for the current three-year planning round.

If the Secretary of State cannot answer the question directly, does she accept that the need for constantly collecting information and reporting on targets is a significant contribution to the doubling of management staff since she took office, as opposed to a 30 per cent. increase in medical staff? Is she aware that if management staff had increased at the same pace as medical staff, there would be 12,000 fewer and the NHS would have saved about £500 million a year—a large part of its deficit?

No, I do not agree, and the hon. Gentleman is absolutely wrong. The proportion of the NHS budget that is spent on management and senior management has gone down. It was 5 per cent. and it has gone down to below 4 per cent. in the latest figures. There are 10 nurses now for every manager, as there should be. The hon. Gentleman’s implication that good health care does not require good management is nonsense. I have great respect for him and he ought to know better than to suggest that.

In respect of reducing national performance targets still further, will my right hon. Friend be cautious about reducing performance targets in relation to mental health, since there is evidence already that mental health is regarded as a rather low priority by many primary care trusts? For example, the Milton Keynes PCT is targeting mental health services in trying to get within budget.

I understand my hon. Friend’s concern about the impact of the overspending in a minority of organisations on the rest of the service, including on mental health services. The Minister of State, my hon. Friend the Member for Doncaster, Central (Ms Winterton) this morning launched a further document on the improvements that we need to continue seeing in mental health services specifically. I think she would agree that simply adding constantly to the number of national targets is not always the best way to ensure that local staff and local hospitals can respond in the best way possible to the needs of their local community, and ensure that they are delivering the best health care within the substantially increased budgets that we have given them.

How does the Secretary of State justify the Oxford Radcliffe Hospitals NHS Trust losing 600 NHS posts, including managers? She might like to reflect on the fact that on Sunday some 5,000 of my constituents, along with Labour councillors and representatives of Unison, the Transport and General Workers Union and the GMB, all gathered together to express concern about what is happening to the health service in Oxfordshire, and to the Oxford Radcliffe Hospitals NHS Trust in particular.

Of course I understand the concerns that the hon. Gentleman raises, which are reflected among his constituents and among the staff and their unions. Let me reassure him, and particularly the staff, who face a very anxious time, that the Oxford Radcliffe and any other hospital in a similar situation will do everything it can to avoid compulsory redundancies and to support staff to be redeployed, where necessary, to new jobs. Does the hon. Gentleman accept, however, that with medical technology changing, and with huge and unacceptable variations in the quality of care and the value that is given to patients by different hospitals, it must be right to expect hospitals to use new medical technology and best practice to become as effective as possible in their use of resources? That means difficult decisions in some places, but we should have the courage to take them, and he should have the honesty to support them.

At the previous Health questions, I raised a problem involving staff at NHS Direct. I was promised a meeting with a Minister, but it has not taken place and I cannot understand why. In addition, the chief executive of NHS Direct has still not responded to my correspondence. I wonder whether the Secretary of State will ensure that a meeting takes place quickly. Jobs are going down the road, which is not good enough, and it is time for the Department to be put into order.

I am extremely sorry that my hon. Friend has received neither a reply nor a meeting, although I understand that my noble Friend Lord Warner, the Minister with responsibility for health service reform, had to attend a debate in the other place when that meeting should have taken place. Another date and time that suits my hon. Friend will be organised as quickly as possible, and I will ensure that that meeting happens and that he gets a reply to his letter.

The Secretary of State will be aware that the monitoring of performance targets is undertaken not only by NHS staff, but by patients’ groups. Will she therefore urgently investigate the case of Queen Mary’s hospital in Sidcup, which has had problems with hygiene in the past and which has reportedly cancelled two inspections by its own patients’ forum—it has told the patients’ forum that it cannot investigate hygiene by using torches to look under beds? Will she investigate that refusal to participate?

Of course I will examine that specific case, of which I was not aware. The Healthcare Commission routinely inspects all health care providers to make sure that they are raising standards to the highest possible level. The hon. Gentleman has made the extremely important point that inspecting and reporting on the quality of care, which requires a certain amount of management time, is essential if we are to give patients the best possible care, which is what we all want.

I support good management in every establishment. Good management has contributed wonderfully to the stupendous improvements that we have enjoyed in our health service in recent years. [Interruption.] I am pleased that those who have not enjoyed the great care that we get in our hospitals have avoided the experience, but if they had had the great misfortune to be ill, they would have been cared for magnificently in our NHS. My local hospital trust meets its performance targets, which still need to be refined. I say that where there is bad management, it should be cured hospital by hospital. The blanket approach has resulted in my local authority paying £500,000 for a benchmarking exercise, which cannot be explained simply by the current cuts.

My hon. Friend rightly refers to the exceptional improvements in many aspects of NHS care. Indeed, he might have been thinking of the improvements in accident and emergency that have got rid of those appalling trolley waits, which was a direct result of our target. The benchmarking exercise to which my hon. Friend refers is one of many ways in which every hospital can examine its own performance to see where it can do even better and improve its care to patients. My hon. Friend supports such improvements, and we will ensure that they continue.

Anticholinesterase Drugs

2. What recent representations she has received on the prescribing of anticholinesterase drugs to people in the early stages of Alzheimer’s disease. (78461)

Ministers have received a number of representations on the availability of those drugs in the context of the drugs’ ongoing appraisal by the National Institute for Health and Clinical Excellence. I have also recently met representatives of the Alzheimer’s Society, the Royal College of Psychiatrists and the Royal College of Nursing to hear their views.

In those meetings, did the Minister note the strong feeling among patients, carers and clinicians that the early prescription of these drugs leads to a higher quality and longer life? All those people believe that early prescription slows long-term decline—what is the Minister’s view?

I am aware of those strong feelings. It is crucial that the appraisal process is carried out properly, and, as my hon. Friend knows, the process is still ongoing. Independent clinical experts should be the ultimate arbiters, but it is also right that the strength of feeling among patients throughout this country is voiced through their parliamentary representatives, which my hon. Friend has done today.

Is it not morally wrong that people with dementia are prevented from having the relatively inexpensive drugs that will prevent their dementia from getting worse? Preventing people from having those drugs is a false economy, because when dementia deepens, the cost of looking after the patient is much greater.

The National Institute for Health and Clinical Excellence was set up to take on the difficult questions that we face in judging the clinical effectiveness of treatments against their cost-effectiveness. The hon. Lady would perhaps be the first to complain if that judgment was being made by Ministers. It is important to make it clear that existing patients will not be affected and will continue to receive these treatments. However, we all want the process to be conducted fairly and, ultimately, an independent judgment to be made on the evidence.

Having been to local meetings of people concerned about the use of these drugs, I know that it is a huge benefit for people to able to have them in the early stages of Alzheimer’s disease. When my hon. Friend speaks to NICE, will he ask it to consider the contribution that the drugs make to a more independent, less stressed, and perhaps even happier life?

The NICE process has been undertaken with unprecedented thoroughness. My hon. Friend refers to the early stages of the disease, and the use of drugs at that time is precisely the issue that is being examined in depth and will be considered during the appeals process. I am sure that the strength of feeling that she represents will be heard, but ultimately it is right that an independent judgment is made by experts in that illness.

May I declare an interest in that I am patron of the east Cheshire branch of the Alzheimer’s Society and therefore take a huge and close interest in this subject? Does the Minister accept that society has a duty to enable those who suffer from Alzheimer’s, even those in the early stages of the disease, to have the best quality of life that is available to them, and that that means the use of the most advanced drugs? Will he ensure that the best drugs are available to give those with Alzheimer’s the best quality of life that this House would wish them to have?

Of course, there will be no division between Members in wanting to ensure that people get the best quality of life that they can. That is precisely what NICE is considering in terms of the difficult judgment that must be made. As a former Chair of the Health Committee, the hon. Gentleman will know that a balance must be struck between the available resources and the benefits that this treatment can offer. We have collectively asked NICE to investigate these difficult questions for us, and we all have a duty to support it through this difficult process and ultimately to consider fairly its recommendations.

Does it worry my hon. Friend that if the NICE guidance is implemented there will be less support in future for patients in the early stages of Alzheimer’s? Can he at least give assurances about the things that matter to those patients and their carers: early identification of Alzheimer’s cases; more support for the patient, the family and the carer; and more research into finding treatments that will be effective in the early stages of the disease?

I can certainly assure my hon. Friend on his last point. Research into those matters is hugely important. Of course, I am not a clinician, which is why it is important that the NICE appraisal process carefully considers questions about the early stages of Alzheimer’s and makes its judgment on whether there is evidence to support the arguments that he and other hon. Members are making. It is right that that process should be allowed to run its course, and it would be wrong for me to prejudice it. I am pleased that my hon. Friend and other hon. Members have expressed their points of view, and I am sure that they will be heard beyond this House.

Despite what the Minister says, he will have to accept that NICE has confirmed that these drugs are clinically effective but that people will now have to wait longer before receiving them. That is not only harsh but contradicts the Government’s own policy of early diagnosis and intervention. Given that, last year, the Government asked NICE to re-examine whether its model of cost-effectiveness took full account of the complexities of this case, particularly the impact that withdrawing those drugs would have on carer time and quality of life, is he completely satisfied that NICE has addressed those specific concerns; and if not, what further action does he propose to take?

The hon. Gentleman must accept that the appraisal process that NICE has gone through is extremely detailed and that it has examined all the available evidence. Indeed, the appraisal process continues—it is right that it should do so and that the questions that he identifies are properly considered. However, is it right for us to second-guess the independent experts? Is it right that we should set up NICE only to undermine—

Obese Children

The main source of data on childhood obesity is the health survey for England. According to the latest survey, 19.2 per cent. of boys and 18.5 per cent. of girls aged two to 15 were classified as obese. We are unable to provide estimates for morbid obesity in children, as there is no specific definition above which a child can be considered morbidly obese.

Does not that show that we have a virtual epidemic of obesity that affects our young children? However many positive messages parents and schools try to convey about exercise and eating healthily, the real problem is that advertisers pump out negative messages day after day about eating junk food and having drinks that are not good for children. Will my hon. Friend make representations to Ofcom to ban advertising junk food to children, not only during the day but during the programmes that they watch, including “Coronation Street”?

My hon. Friend is right to highlight concerns about obesity in children. He is also right to make the point about parents making informed choices. That is why we have worked to encourage the industry to introduce front-of-pack labelling and asked for the consultation about the promotion of high fat, high salt and high sugar foods to children. The consultation ends on 30 June, so everyone has time to make their views known. The options include a 50 per cent. reduction in the number of advertisements that promote high fat, high salt and high sugar foods and drinks to children. There is a healthy debate on the issue and I urge everyone inside and outside the House to make their views known.

Given that, over the past decade, childhood obesity in some groups has nearly doubled and that British children are getting fatter faster than children anywhere else in Europe, does the Minister share our alarm at February’s National Audit Office report, which suggests that poor co-ordination, inadequate leadership and a tendency to apply myriad initiatives that lack a credible evidence base can be blamed for the complete failure of that important aspect of Government public health policy?

Of course, the problem has been developing over the past 20 years. Children do less exercise, the Playstation is often more important than the bicycle and parents obviously have to make choices. The NAO report made some suggestions for improvement, and several matters have been improved since it carried out its first research. We now have clearer guidance to clinicians on outcomes at general practitioner surgeries, we have provided a weight loss guide and obesity care pathways to primary care clinicians and we are examining options for treatment programmes. That is happening as well as all our work with the food industry on labelling, reformulation and, of course, promotion. The hon. Gentleman would agree that the subject is complex. The Government, the health service and the food industry have a role to play but so have the public in making the right choices for children.

Alternative Medicine

Provision of complementary and alternative therapies on the NHS is a matter for primary care trusts and local NHS service providers. The Government believe that decisions on individual clinical interventions, whether conventional, complementary or alternative, are for local determination.

I hear the Minister and sympathise with his philosophical position. However, therapies such as acupuncture and Alexander technique are proven to be effective and cost-effective, but access on the NHS is difficult, with hurdles all over the place. What steps will he take to ensure that such therapies, which are proven to work, are available on the NHS to people who want to use them? Will he ensure that comparisons between conventional medicine and alternative therapies are made on the basis of sound science rather than of prejudice?

The hon. Gentleman knows that we have provided more information about the available complementary therapies. Recent figures show that around 50 per cent. of GPs are making such therapies available to patients and evidence shows that people are getting access to those services. Of course, they should always be based on the evidence available and a balance must be struck. However, locally, the matter is for clinical decision and it would be wrong to mandate such treatment or to rule it out from the top down. It is for doctors to decide.

The Minister is absolutely correct in saying that, when NHS budgets are under such severe pressure, patients, clinicians and taxpayers are best served only by treatments whose efficacy can be shown to be based on solid evidence. Is it not the case that too many homeopathic and other treatments are not subject to the rigorous testing that is routine for pharmaceutical products? As a result, they can produce known adverse effects, or show no demonstrable or discernable benefits whatever. Is not that a bit of a con?

I agree that such treatments or therapies should be prescribed or made available to patients on the advice of a clinician, and that that judgment should be made in the best interest of the patient. When there is doubt about the evidence base for a treatment, people should err on the side of caution.

There is a great deal of controversy in the health service about the benefits or otherwise of alternative therapies, but, given that some people feel strongly that they have substantial benefits, should not the Government give primary care trusts some form of guidance on this issue? Perhaps it could take the form of a code of best practice to advise on how best to provide treatments to which many people attach the greatest possible importance.

The hon. Gentleman makes a reasonable point. There are obviously strong views at either end of this argument. Some people are passionately in favour of the availability of complementary medicines, but some senior clinicians recently wrote in the newspapers that they were very much opposed to them. It seems to me that the right ground in this case is the middle ground—

The middle ground, not the third way. We should encourage people to use local clinical discretion. Although we have made more information on this subject available, not least through the Foundation for Integrated Health, we need local decision making.

Gloucestershire Strategic Health Authority

5. How much was allocated to the Gloucestershire strategic health authority in 2005-06; and if she will make a statement. (78464)

Allocations to the West Gloucestershire, Cheltenham and Tewkesbury, and Cotswold and Vale primary care trusts totalled more than £561 million in 2005-06—an increase of about 30 per cent. over the past three years.

I thank my right hon. Friend for her response, and I apologise for the typo in the question. It should of course say “Avon, Gloucestershire and Wiltshire strategic health authority”, but that somehow got lost in translation. It would, however, be much easier if we were just dealing with Gloucestershire. The letter that the Minister of State, my hon. Friend the Member for Don Valley (Caroline Flint), sent to the hon. Member for Tewkesbury (Mr. Robertson), whom I see in his place, concluded by saying:

“However, we would expect the new organisations to inherit the liabilities and obligations of predecessor organisations.”

If that is the case, would it not be appropriate to have complete transparency within a strategic health authority such as Avon, Gloucestershire and Wiltshire, so that we can understand exactly where the deficits have come from? There is a great deal of unfairness involved in offloading deficits on to areas that have not created them, and the people involved believe that they are quite within their rights to feel let down.

My hon. Friend is absolutely right about the need for transparency, but there was no such transparency in the past. Underspending areas, often in much poorer parts of the country, were constantly bailing out overspending areas of the NHS, which were often in the better off and healthier parts of the country. We are creating the transparency that my hon. Friend mentioned, as well as asking each strategic health authority to ensure that its area returns to balance. Where an organisation is overspending, and particularly if it is going to take more than a year to get back into balance, other organisations will have to hold back on the improvements that they want to make. However, that all needs to be open, transparent and understood. In particular, the organisations that are overspending need to take decisions—difficult though some of them will be—to ensure that they give their patients the best possible care within the substantially increased budgets that we are continuing to give them.

In the letter to which the hon. Member for Stroud (Mr. Drew) referred, which followed a two-hour Adjournment debate that I had last week, the Minister of State, the hon. Member for Don Valley (Caroline Flint), attempted to explain the position with regard to the recovery of the financial position. There is a great deal of confusion surrounding this issue, however. The question to which we are trying to get an answer is: do trusts have to achieve a month-by-month balance towards the end of this year, or do they have to have a full-year balance, including the historic deficits? If the Secretary of State could answer that one question, it would clear up an awful lot of confusion. The answer will determine the degree and the level of the cuts that the primary care trusts will inflict on everyone.

I had an opportunity to read the report of the two-hour debate—an extensive and excellent debate—on the health service in Gloucestershire to which the hon. Gentleman referred.

The national framework that we have set out is quite clear. We will return the NHS as a whole to financial balance by the end of March next year. Within that, we would like all overspending organisations to achieve a monthly balance between income and expenditure, again by the end of March next year. Some will not be able to do so, but overspending in one organisation will have to be matched by underspending in another.

The proposals for Gloucestershire and the wider region have not yet been finalised. Not only is local consultation taking place on the proposals that are being made, but discussions are continuing between the strategic health authority and my Department so that we can be satisfied that the proposals will achieve the best possible patient care and return the region to balance as quickly as makes sense. I know that the hon. Gentleman and other Members representing the area will continue to participate in those discussions.

Does the Secretary of State realise that primary care trusts in Gloucestershire are currently planning not only to recover deficits and restore balance this year, but to do so after having their budgets top-sliced so that Gloucestershire is contributing to deficits in Avon and Wiltshire as well? That could have substantial consequences for services in Gloucestershire. As the hon. Member for Stroud (Mr. Drew) is aware, the closure of Stroud maternity unit is being contemplated. Will the Secretary of State tell us whether she intends the PCTs to go beyond restoring financial balance and initiate a cut such as that closure?

I have made it very clear that we expect each of the regions to establish financial balance. Within that, there must be discretion for specific areas and organisations. I have spelt that out, and we repeated it most recently in the report on the financial situation that I published alongside the chief executive’s report.

What the hon. Gentleman has said reflects the fact that not only has there been overspending in Gloucestershire, despite substantial increases in the budgets, but there are even larger problems in Avon and Wiltshire—many of them deep-seated problems that have been continuing for years. For far too long, those organisations have expected other parts of the NHS to bail them out.

None of the proposals has been finalised. The plan for Stroud maternity unit needs to be considered on the basis of what will give women the best and safest maternity services within the budget that is available to that health community. I hope that instead of continuing to pretend that an unlimited sum is available and difficult decisions never have to be made, the hon. Gentleman will support the NHS in every part of the country, helping to ensure that it can provide the best possible services for patients and the best value—

Thank you, Mr. Speaker.

The Secretary of State is trying to resolve the situation in a single year. The point is that Gloucestershire is prepared to try to resolve its financial deficits; what it objects to is having to contribute this year, on top of that, to the resolution of deficits in other places some of which have been around for years, and will be around for years.

I return to the question. We have asked the Secretary of State repeatedly to avoid short-term, financially driven cuts that will be to the long-term detriment of the service. In her manifesto, she said

“By 2009 all women will have choice over where and how they have their baby”.

Thousands of women in Stroud and related areas want to be able to choose to have their antenatal care or delivery at Stroud maternity unit. Will the Secretary of State promise that in 2009 they will be able to exercise that choice?

Those are decisions that need to be made locally and on the basis that the best and safest care is provided to all patients, within the available budget. As I understand the current proposals, Gloucestershire SHA will contribute some £6.5 million to the regional reserves, with somewhat more being drawn down in that county to compensate for the overspending in its health service. In the maternity services, continuing support will be given to providing home births for those women who choose them and for whom they are safe, although midwife-led care must also be available as part of the broader service. Those difficult decisions will be made locally, in the context of the Government’s very generous national settlement.

End-of-life Care

In the White Paper that we published in January, entitled “Our Health, Our Care, Our Say”, we set out proposals for making further improvements to end-of-life care, so that many more people are able to choose where they are cared for at the end of their lives, and where they die.

I am grateful to my right hon. Friend for that answer. There is no doubt that there is good practice in the hospice movement and in some parts of the NHS, and that there are good palliative care consultants, but will she say what steps she is taking to ensure that the lessons learned, and the expertise developed, in those settings are shared with other parts of the NHS? In particular, how is that experience being used to help those dealing with patients who wish to spend their final days and weeks in their own homes?

My hon. Friend is absolutely right. Part of what we are doing is to establish everywhere end-of-life care networks that draw on the expertise available in some parts of the NHS and in the Marie Curie cancer care programme. We will continue to develop the training programme that has ensured that many more community-based staff are trained in palliative care. We must ensure that more palliative care and hospice services are available, both in the community and in people’s homes. In that way, the majority of people who would prefer to die at home or in a hospice will no longer be forced to die in hospital, which is where most people die at present. That is another example of the shift of care from hospitals into the community, which is the best care that we can offer patients.

I thank the Secretary of State for the help that the Government have given recently to plug the short-term funding gap for children’s hospices. Will she say something about how we can get together with the Association of Children’s Hospices to develop a fair, sustainable and long-term funding policy for hospices?

The hon. Gentleman raises an extremely important point, and I am delighted that we have been able to make that funding available over the next three years, beginning in this financial year. It will ensure that the children’s hospices will be able to continue their excellent work. My hon. Friend the Under-Secretary will continue to work with the children’s hospice movement to ensure that the right services are provided for terminally ill children, whether that be in a hospice or in their own home.

I also thank my right hon. Friend for the £27 million that has been announced for children’s hospices, but end-of-life care is not just about making the end of life as caring as possible. It should also be about exploring all possibilities to prolong quality of life. Will she agree to meet me as soon as possible to discuss the case of my constituent, Kath Withington, who has been denied the Tarceva drug, even though her consultant and GP recommended it? People who may be in their last months or weeks should have access to all the treatments that might prolong their lives.

I am always happy to meet my hon. Friend but, on the more general point, it must be right that we ensure that NICE evaluates drugs, and that the drugs it recommends are available right across the NHS. However, we must not try to substitute ministerial decisions for NICE’s recommendations. We played our part in establishing NICE, and in speeding up the evaluation of the growing number of new drugs now available.

The Secretary of State speaks of palliative care being provided in the community. Much of it is provided in small community hospitals, such as Steppingley hospital in my constituency but, unfortunately, many such hospitals are under threat of closure or have already closed due to NHS deficits. Is not the best way to give good, compassionate, end-of-life care in the community to make sure that the beds and nurses are there to provide it?

The greatest need is for palliative care to be available in people’s own homes, because that is where the largest number of people would choose to die if they were given the choice, as I believe they should be. In the case of community hospitals, yes, there are parts of the country where the local NHS is looking at the number of community hospitals and at whether they can be better organised. In the White Paper, we made it clear that they should not be making short-term decisions, because of current financial problems, which may have to be reversed in future years; they should look instead at how to make the best possible use of existing, and new, community facilities to ensure that they are getting the best care for patients, much of which can now be delivered outside hospitals—not only in community hospitals, but also in patients’ own homes.

Kensington and Chelsea Primary Care Trust

7. What representations she has received in respect of the management of Kensington and Chelsea primary care trust’s deficit. (78466)

Since March 2005, Health Ministers have received two letters in respect of the management of Kensington and Chelsea primary care trust’s deficit, both of which came from my hon. Friend. In addition, the chief executive of Kensington and Chelsea primary care trust met Sir Nigel Crisp, the former chief executive of the NHS, on 16 December 2005.

My hon. Friend is aware that Kensington and Chelsea PCT has an ambitious programme for recovering a deficit that is rooted—in this case—in past financial mismanagement under previous managers. My concern is that in addition to the underlying deficit the PCT is subject to the top-slicing that applies to all London PCTs. In the interests of transparency, and because that additional pressure is causing difficulty for social and mental health services, will my hon. Friend explain how much has been generated by top-slicing in London, where that fund is being held and when PCTs and others will have the opportunity to learn how that resource will be ploughed back to help authorities struggling with their deficit?

The strategic health authority was asked to come up with an appropriate plan for London, to deal with the overall situation, and it was felt right that Kensington and Chelsea contribute 3 per cent. of its budget to help tackle the deficit. My hon. Friend is right to say that the consequences of the contributions made by that PCT and others should be open and transparent. The SHA should make absolutely clear how much money it has received from the process, how it intends to spend the resources and the consequences for patient care throughout London. I urge her to engage in dialogue with the SHA about how that information can be put into the public domain as soon as possible.

Eye Examinations (Children)

8. What steps her Department is taking to ensure that children receive regular full eye examinations. (78467)

Free sight tests are available under the NHS for children under 16, and for those in full-time education aged 16 to 18. Sight tests allow the opportunity to review all aspects of eye health, including investigations for signs of disease. Information about the extensive arrangements for providing help with NHS optical services and other health costs is set out in leaflet HC11, “Are you entitled to help with health costs?”.

Last year, 2.8 million children received an NHS eye test, which is less than a quarter of the almost 12 million children who are entitled to a free eye test. How does the Minister think those figures reflect on her Department’s ability to implement its promises and ensure the good health of our children?

That does not necessarily mean that all children need an eye test. It would be a waste of money if we expected people to have eye tests when they do not need them. We provide every parent with a personal child health record, which gives them information about what to look for in terms of their child’s eyesight. The booklet “Birth to five” is provided for all first-time parents and gives advice and information. As part of the national service framework, we want to develop an orthoptist-led programme for pre-school vision screening, which ensures that eyes are working and developing normally. In those ways, we are making sure that when children have a problem, or are perceived to have a problem, they receive an eye test as required.

I accept the fact that all children may not need eye tests, but may I ask whether the Government have ever conducted any surveys to make sure that no children have fallen though the net, as they obviously will not know whether they need an eye test? In my childhood, such testing used to take place in schools.

My right hon. Friend is right about the measures that we should put in place to see whether children require a more extensive eye examination, which is why, as part of the national service framework for children, young people and maternity services, we have developed, as I said, an orthoptist-led programme of pre-school vision screening to check whether children’s eyes are developing normally and whether there are any developmental problems that require a more extensive eye test. That is a better screening procedure, but if parents have any worries, they can use the information that we give every parent after the birth of their child to make sure that they follow up any problems. If they are in doubt, they should seek an eye test, which, of course, is free.

There is a lot of talk about preventive medicine, but I do not remember a generic campaign on the need for regular eye tests ever taking place. If we wish to make an early intervention in eye disease or an early diagnosis of systemic disease, and if we are concerned about road safety or industrial safety later in life, eye tests are essential. Is it not time that the Department of Health encouraged everyone—and not just children—to have regular eye tests?

Of course we encourage them to do so. The research results of the last national campaign, I believe, did not receive a good evaluation, so we offer targeted support. As I said, every parent receives a personal health record for their child that includes information and advice so that they can find out whether there are any problems with their vision. All new parents receive a booklet, “Birth to five”, which explains problems to which they should be alert, including problems in their child’s vision. The national service framework, too, deals with pre-school screening and vision development. Our approach is targeted, and it includes a review of local optical services that gives primary care trusts a greater role in identifying people who do not take up the opportunity to have their children’s eyes tested so that they can target communities where such tests are needed. I hope that that review will give PCTs greater opportunities and flexibility to work with opticians and others to provide the service that the hon. Gentleman would like.

After an eye examination, some children may need an eye operation, but hospitals in different parts of the country are paid different rates by their PCTs for performing the same operation. Why do we need those differential rates, as costs are uniform and there are national contracts on pay and conditions for consultants, nurses and all other staff in “Agenda for Change”?

Those different rates are the primary reason why we have looked at the tariff, as we wish to make sure that there is a level playing field for health services. Clearly, we can look at the issues that my hon. Friend has raised, but may I add that we introduced free eye tests for everyone over 60? I am pleased to say that, for people of advancing years, the wait for cataract surgery is three months or less.

I have to say that that was an extraordinarily complacent answer. If we do not test children’s eyesight, how can we know the extent of the problem? There is poor take-up of eye tests among school-age children, and, after their eight-month check, only 50 per cent. of children have their eyes checked before starting school, so it is more likely that sight defects will emerge as the visual system develops up to the age of seven, which can lead to permanent visual loss and subsequent problems keeping up at school. Why, therefore, did the hon. Lady’s Government fail to support Conservative amendments to the Health Bill in another place, which would have ensured that all children receive a proper eye examination before they start school?

I am not sorry that the hon. Gentleman does not like my answer, because I would not expect him to do so. I thought that I gave a comprehensive answer, as I explained the information that we give to parents, the pre-school screening programme that we have developed, and the local services developed by PCTs based on need. We are thus meeting the needs of both children and adults in the community. I am incredibly short-sighted and use both contact lenses and glasses, and my children, too, wear glasses. As a parent, I acted when the problem emerged, and we must make sure that parents have the right information so that they can act. Pre-school screening will help, but I do not see the sense of paying for unnecessary, full eye tests if they are not required.

When I was at school, it became obvious to me, and to the teachers, when I needed to be sent for an eye test. I was sent for a test after being moved from the back of the class further and further forward, until I got right up to the chalk board; no one sent me for one before then. However, I am still disappointed in some respects. How much research has been done into the effects on young developing eyes of old-style cathode ray tubes and new LCD and plasma screens? If tests have been done showing that long exposure to such screens has a detrimental effect on young eyes, can we let parents know as quickly as possible, because many of them would like to limit exposure to that risk?

I will write to my hon. Friend with any information that I can supply on what research has been done. However, it is common sense to say that too much time spent in front of a screen is not good for anyone—not only for their eyesight but for their general well-being, given the lack of physical activity. Less is more, I would say.

Pennine Acute Hospital Trust

9. If she will make a statement on the financial position and proposed job losses at the Pennine Acute Hospitals NHS Trust. (78468)

The 2005-06 provisional out-turn figure for the Pennine Acute Hospitals NHS Trust is a £56,000 surplus. However, I am aware that the trust faces a challenging financial situation in the current financial year, and it is in discussion with the strategic health authority on how to achieve efficiency savings.

On 7 June, the Secretary of State said that

“overspending occurred in better-off areas”—[Official Report, 7 June 2006; Vol. 447, c. 254.]

Can the Minister explain why the Pennine acute trust, which covers Rochdale, Oldham and north Manchester and has huge health service needs, is predicting an overspend of £28 million, despite, as she said, having balanced its books last year?

Obviously, the trust will have benefited from the massive investment that has gone into the NHS generally. However, one of the trust’s problems has been higher than average costs associated with delivery of services. That is why it is getting particular help in looking at how it can make efficiency savings. When payment by results is introduced, difficulties will arise unless it can reduce some of its current costs by making some of the changes to service delivery that have been made in other parts of the country, so that services are delivered in the most effective manner without patient care being compromised.

The Pennine Acute Hospitals NHS Trust is the second largest hospital trust in the country, serving four district general hospitals and covering 10 constituencies and a population of some 700,000. In addition to the problem highlighted by the hon. Member for Rochdale (Paul Rowen), there are two or three more that need to be considered, including the reconfiguration of that very large trust and board appointments. I want to put on the agenda the independent Appointments Commission and the problems that it is raising in different parts of the country. I should be glad if my hon. Friend expedited the meeting that we have requested for the 10 hon. Members served by the Pennine Acute Hospitals NHS Trust.

I know that my hon. Friend has pressed the case on his constituents’ behalf about the issues that he has just raised. His persistence has led to a meeting being arranged within, I think, the week, and I look forward to discussing all the issues that he has raised with him and his colleagues.

Health Trainers

Nearly half the NHS has signed up to the health trainer scheme. Currently, 228 NHS health trainers are recruited to the programme, of which 206 are now in, or have completed, training. I was delighted to launch the Hull health trainer partnership in March with my hon. Friend the Member for Kingston upon Hull, North (Ms Johnson).

I thank the Minister for that answer. Will she join me in congratulating Hull on the pioneering way in which it has looked at the role of the health trainer? It has not just moved health professionals into the role of health trainers, but has recruited people from the local community who can really get alongside those groups that it has been hardest to reach in the past.

I endorse my hon. Friend’s comments. I met Paula Tomlinson, who is a Hull health trainer, in Hull and when she attended an event at No. 10. She said:

“People are starting to recognise us as Health Trainers and are coming forward with lots of things that are affecting their health, not just physical health but also mental health too. People are recognising the support we can give and trusting us.”

I am pleased that there are plans to get customer care assistants working in the scheme, and also community wardens. We are looking to them being part of a wider group of health trainers, in addition to those within the health services.

Will the Minister assure the House that NHS training budgets will not be selectively or excessively targeted in the drive to reduce NHS deficits?

We continue to invest in training—more than ever before. Health trainers are a support for people in communities who need additional help with healthy choices for their lifestyles. I am really pleased that we are going to be on target and to have 1,200 of them in the NHS in the next year or so. That is a credit to those who care as much about prevention as treatment.

Is it not the case that, in the long term, this initiative not only promises to be cost-effective and to save the health service money, but to offer long-term improvements in health care for our population?

I think that it does. There is a substantial amount of evidence that underpins the interventions of NHS health trainers. We have “Health Behaviour Change: A Guide for Practitioners” and various other pieces of work. We have had health psychologists in the Department working with us to ask why those most in need of our support are sometimes deterred from seeing GPs or others. The initiative is about a practical way to tackle the health inequalities that exist in too many of our communities. So far, it seems to be working well, but, of course, we will evaluate the programme as it develops and expands.

Will the Minister tell us the likely impact that the new immigration arrangements will have on the number of medical students being recruited and encouraged to come to the United Kingdom, given that they state that permits will be for only two years?

I am not sure that that question has anything directly to do with health trainers. I am happy to write to the hon. Gentleman about what health trainers are about. I understand that extensive consultation is going on with the different organisations that are concerned about the matter.

Nurses (Gateshead, East and Washington, West)

11. How many nurses were employed in the Gateshead, East and Washington, West constituency in 1997 and at the most recent date for which figures are available. (78470)

In 1997, there were 1,131 nurses employed in the NHS organisations in the Gateshead, East and Washington, West area. The current figure is 1,462. That is an increase of 29 per cent.

I thank my hon. Friend for that answer. That is excellent news. I am sure that she will be aware that I recently tabled a written question about the number of nurses nationally in various periods since 1979. I was astonished by the answer, which proved categorically that in nine years we have done much more than the Tories did in 18 years to increase the number of qualified nurses in my constituency and nationally. Does she accept that when people ask where the money goes, we should shout from the rooftops that it goes on increasing staff numbers and pay, which is a major part of recruiting? Does she also—

As it happens, I could not agree more with my hon. Friend, particularly about shouting from the rooftops about some of the changes that have been made and the improvements in the pay and number of nurses. It is important to add one other thing: we have also managed to reform the way in which nurses work, giving them extra responsibilities and making sure that there are new posts, such as nurse consultant posts. All that means that—when she talks about recruitment and retention—under a Labour Government, we have made it easier not only to go into nursing, but to stay in nursing. We can all be proud of that.

New Pharmacies

The Secretary of State for Health announced a review of progress on reforms to the control of entry system for NHS pharmacies in England in a written ministerial statement on 13 June 2006, along with a wide-ranging three-month public consultation.

I think the Minister for that answer. He will realise that it is sometimes difficult and expensive for smaller community pharmacies to set up in business. When the review takes place, will he ensure that as much help as possible can be given to such pharmacies, perhaps in particular by looking again at the exemptions to the control of entry regulations and allowing pharmacies that comply with those exemptions to open for 80 hours a week, instead of 100 hours, so that people can continue to get their medication from not only supermarkets and large chain pharmacies, but smaller community pharmacies?

The hon. Gentleman may be aware that the issue provoked considerable debate in the last Parliament. The proposal at the time was for the Office of Fair Trading to take away all controls of entry to pharmacies. The Government adopted a different approach by retaining the ability of primary care trusts to control their pharmacies’ position, but did not rule out innovation in local pharmacy services when possible. It is my guess that the arrangements have served us quite well, but we will find out when we see the results of the review that has been commissioned.