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Oral Answers to Questions

Volume 449: debated on Tuesday 18 July 2006


The Secretary of State was asked—

Hospital Travel Costs

1. What assistance is available for cancer patients to help with travel costs to and from hospital. (85839)

The hospital travel costs scheme provides financial assistance to NHS patients, including cancer patients, who do not have a medical need for ambulance transport but who require assistance in meeting the costs of travel to and from care.

Does my hon. Friend accept that cancer patients, at a sensitive time in their lives, must travel to hospital an average of 50 times in the course of their no doubt excellent treatment, at places such as Clatterbridge centre for oncology? In doing so, they incur costs of hundreds of pounds in travel and in the lottery of car parking charges. Will the Department move forward with consulting on better awareness of the hospital travel costs scheme and increasing its uptake?

My hon. Friend makes an extremely important point; he has a distinguished cancer treatment centre in his constituency. As a fellow north-west MP, I know that my constituents must travel some considerable distance to Christie’s, while others in the Merseyside region travel to his constituency. I therefore accept that people can face extra financial worries at a time of stress and anxiety due to their illness. First, further work is needed to ensure that the scheme’s scope is not too rigid and focused on hospital settings as opposed to primary care, where more could be done. Secondly, and more importantly, we need to get better information to people who may be eligible to benefit from the scheme. Many patients may be able to get significant support for their travel costs.

The Minister will be aware that the cumulative cost of car parking, not just for cancer patients but for other regular visitors to hospital, can be substantial. At this point, the normal ministerial reply is that that is a local issue—but is the Department of Health at all responsible? Does it feel that it has any national role at all in the health service, or will it just allow local trusts to charge what they like?

Normally, Liberal Democrats are the first to jump up and cry foul about micro-management and targets coming from the centre. Again, dare I say, they want to have it both ways. As far as I am concerned, car parking is a big issue for the public—[Interruption.] If the hon. Gentleman will hear me out, I shall go on to say that it is perhaps a bigger issue for the public than the managers of some NHS trusts accept. In a world in which patients have more choice, many of them will make an important point of this issue, and many trusts will be required to think harder about it. Essentially, however, it is a local decision depending on the availability of space on trust land and the proximity of the trust to the town centre.

I do not expect my hon. Friend to comment yet on the publication this morning of the Health Committee’s report on NHS charges. However, we are deeply concerned about patients’ knowledge of the hospital travel costs scheme. Can he ensure that that is improved? Can he also consider setting national guidelines for hospital car park charges, especially for patients, as the situation is a bit of a mess at the moment?

I woke up this morning to reports of the findings of my right hon. Friend’s Committee, and I detected his forthright Yorkshire tones in some of the language used to describe the situation. He is right to say that more effort needs to be made to ensure that patients, particularly those on low incomes, are given access to information about their eligibility to claim for their transport costs, either in whole or in part. How people receive that money back from hospital trusts, whether after or before their treatment, is also an issue. My right hon. Friend is also right to say that car parking is a big issue for patients. Many trusts are making exceptions for car parking, particularly for cancer patients. Others that are not doing that should look at those who are, and see whether they can provide better support to patients at a difficult time in their lives.

According to the 19th report of the Public Accounts Committee, more than three quarters of NHS patients were not given information on financial benefits that could be used, for example, to help to pay their car parking fees. As it was stated in evidence to the Committee that progress was hoped for by the end of 2005 on delivery of disability living allowance and attendance allowance to cancer patients, what progress has been made?

The health White Paper published earlier this year made a specific commitment to consult on the hospital travel costs scheme: first, on whether the scope needs to be increased so that patients not under the care of a consultant but another health service practitioner can benefit; and secondly, working with Macmillan, which has done excellent work in this area, on exactly how patients are given information about whether they are eligible to benefit. It is not as easy as sticking a poster up on a wall; we must see how we can get relevant information to patients who may be able to benefit. That is a fair and legitimate point, and we will take that forward in consultation this autumn.


2. What recent discussions she has had with representatives of the Roman Catholic Church on Government policy on abortion. (85840)

When I met Cardinal Murphy-O’Connor and his colleagues recently, we discussed several issues, including whether the 24-week time limit on abortion should be reduced. The Government have no plans to change the law on abortion.

Has my right hon. Friend had consultations with any other parties, such as members of the medical profession?

Members of the medical profession, particularly the Royal College of Obstetricians and Gynaecologists and the British Medical Association, have recently made clear that they do not believe the evidence supports any need to change the time limits specified in the present law on abortion.

Does the Secretary of State accept that if a decision is to be made, it must be made on the basis of the best advice and evidence available to Members? Will she seriously consider Cardinal Murphy-O’Connor’s suggestion that a Joint Committee of the two Houses be set up to hear the evidence so that a rational and sensible decision can be made?

That is, of course, a matter for individual Select Committees and for the House, not for the Government. However, I stress that when the law was revised in the late 1980s, the medical profession believed that the age at which a foetus was considered viable should be reduced from 28 weeks’ gestation to 24. There was a clear medical consensus on that, based on evidence. There is no such consensus or similar evidence today.

Does my right hon. Friend agree that safe and legal abortion is crucial to the mental and physical well-being of women in this country, given that no contraceptive method is 100 per cent. safe? Does she acknowledge that fewer than 0.1 per cent. of late terminations take place at 24 weeks, and that the reason for those terminations is usually concern for the health and welfare of the mother and child or the death or divorce of a partner in marriage?

I agree with my hon. Friend. Many Members on both sides of the House fought to ensure that the law would allow women to choose a safe and legal abortion should they need to do so. Speaking for myself, I believe that that is right, and that it would be a tragedy for many women if it were reversed. My hon. Friend is also right about late abortions: according to the most recent figures that we have, 137 abortions in the last year took place at 24 weeks’ gestation or above.

I am sure the Secretary of State agrees that improved education and access to contraception would help to reduce the abortion rate. Why are many primary care trusts cutting the number of community clinics as part of their strategy to reduce deficits? Will the Secretary of State ensure that clinics do not close, so that a vital service remains available and doctors and nurses can retain their skills?

The hon. Lady is absolutely right: of course it is better for women not to find themselves with unwanted pregnancies. That is why we have substantially increased investment not just in contraception services but in targeted measures to reduce the number of teenage pregnancies. I know the hon. Lady will welcome the fact that the number of pregnancies among those under 18 has been falling, and is now at its lowest since the mid-1980s. However, as was recently announced by the Minister of State, Department of Health, my hon. Friend the Member for Don Valley (Caroline Flint), primary care trusts are considering how to redesign their sexual health services, including contraception services, to ensure that they are as effective and available as possible.


The Department does not collect waiting times for hearing aid fittings. We aim to deliver audiology diagnostic tests within 13 weeks by March 2007, and within six weeks by December 2008.

I am sure that the Minister has spoken to many people who now have digital hearing aids, who will have told him how tremendously their quality of life and that of their families has improved. Why are hearing aids not subject to the waiting time targets that apply to other health care provision?

We want to maintain a situation in which most patients are referred directly by GPs to audiology departments, not consultants, and we do not want to create a position that would distort that practice. However, there are genuine challenges and problems with waiting times in certain parts of the country, which is why the Department will be working with stakeholders such as the Royal National Institute for Deaf People to produce an action plan to improve waiting times across the country, rather than have the unacceptable standards that apply in some parts of the country.

This happens all the time. One tables a perfectly straightforward question, and the Minister answers another. Is not the answer to my question, as it appears on the Order Paper, “None”?

May I suggest that if the hon. Gentleman forwarded his questions by e-mail he might get a more satisfactory response? He should note that the £125 million invested in the programme for modernising hearing aid services has been warmly welcomed by people who have benefited tremendously from digital hearing aids, as my hon. Friend the Member for Bishop Auckland (Helen Goodman) said. I also have to say that Conservative Members did not vote for that £125 million expenditure on the modernisation programme.

Does the Minister acknowledge that, in addition to the long waiting lists for fitting—more than a year in my primary care trust area—and additional waits for diagnostic tests, there is a large legacy problem of analogue hearing aids that need to be replaced by digital aids in the course of time? What would be a realistic time frame for clearing the large backlog of commitments, which in so many cases are long awaited?

I entirely agree that that issue must be taken seriously. It must form an inherent part of the action plan that we take forward, which will include a number of issues as well as that one. Other issues are increasing demand, inadequate capacity, work force skills and competencies, and the fact that we do not yet have sufficient focus on modern technology. Our action plan will address the remaining obstacles and ensure that people all over the country have access to the quality treatment that they deserve.

In my constituency, residents are waiting 15 months after their tests before they receive their hearing aids. Given that there is an 18-week target, that is clearly unacceptable. I wonder whether it would be possible to seek a reciprocal agreement with European countries. I am told that in Denmark hearing aids are cheaper and arrive more quickly. Some people are going over there to get their hearing aids, to avoid the waiting lists here. In Luxembourg, too, it is possible to—

Thank you, Mr. Speaker. At one point I thought that we were having a discussion on the Eurovision song contest—[Hon. Members: “No!”]—not that anyone in the House is going to admit to watching that. The hon. Lady raises a serious issue, and if, as we develop the action plan, I can learn from international best practice, particularly where there are successes and achievements of better waiting times, I shall attempt to do so and incorporate it into this country’s approach to the problem.

Like me, 10 per cent. of British adults—5 million people—suffer from chronic tinnitus, and 1 per cent.—500,000 people—suffer so badly that it impacts severely on their quality of life. Will the Minister confirm whether audiology services for tinnitus, which are not necessarily linked with digital hearing aids, but often provide advice about therapeutic treatment to tackle the problem, are adequately catered for by the NHS? Many advances have been made in other areas of audiology, but this remains somewhat of a Cinderella service.

I would be delighted to give my hon. Friend an assurance that part of the action plan will be to look into the problem of tinnitus. I know that it can be a horrendous condition that adversely affects people’s quality of life and undermines their daily functioning. We should take it extremely seriously, and I confirm my commitment to my hon. Friend that as part of our action plan, we will look specifically into the advice and support that tinnitus sufferers receive.

What advice can the Minister give to my constituent, Mr. Sapsford, who has been waiting for five months for an audiology test? He has been told that he is not a priority because he is not over 90 years old, he is not receiving a war pension and he is not blind. My local trust cannot cope with the level of demand with the current level of staff. If the Secretary of State would consider allowing our trust to recover its budget deficit over the next two or three years, instead of in the current year, it might not have to make those cuts in essential services to patients.

During my responses today, I have frankly acknowledged the difficulties and challenges in certain parts of the country, including the hon. Lady’s constituency, but I hope that she will be equally honest with her constituents and tell them that time and again when we have debated the amount of resources that we should invest in the NHS, the party that she represents in this House has voted against that investment—so the situation could be considerably worse.

This is an important issue for people throughout the UK. What is the Minister doing to establish best practice between the UK Government and devolved Administrations? Does he agree that it is strange to hear oppositionist tones from the Liberal Democrats on this subject when in Scotland, they are in government?

Frankly, I am not surprised to hear that the Liberal Democrats are saying one thing in Scotland and something entirely different in England. In my experience in my constituency, they say one thing in one ward and something else in a neighbouring ward.

The Minister’s admission that there are difficulties in this area is to be welcomed, because many—including the 33,000 patients who have to wait longer than a year for an audiology test—would otherwise have considered his written statement today on audiology services complacent. Does he accept that the Government’s decision to exclude direct referrals from the 18-week time target, while including referrals made through ear, nose and throat consultants, raises the spectre of a two-tier NHS, in which the articulate and better-off will be able to ask to be referred through an ENT consultant in order to receive a hearing aid within 18 weeks, while those who do not know how the system works will have to wait far longer for their hearing aid? Does the Minister believe that that represents equitable access for all, including the 56 per cent. of patients in his local strategic health authority who have to wait longer than 26 weeks?

The whole purpose of the action plan is to ensure that we have equitable access and that the best practice in some areas—for example, the Pennine Acute Hospitals NHS Trust, my local trust, which has zero waiting time for such services—is replicated all over the country. We need to ensure that we do not have a two-tier system. However, including direct referrals in the 18-week target would have led to a perverse incentive that we do not want to encourage. We want to continue the situation in which the vast majority of people go directly from their GP to audiology departments. Anyway, we want to see more such treatment provided in the community rather than in hospital in the future. Acknowledging the existence of challenges and issues and committing ourselves to producing an action plan is a responsible way to tackle that serious issue.

Overseas Nurses

The NHS has a long history of welcoming nurses from overseas. We have also increased the number of nurses that we train in Britain by more than 60 per cent. since 1997. Those nurses should, of course, have the opportunity to progress in their careers. The Government recently changed the work permit arrangements so that in future, junior nurses from overseas can be appointed only if there is no suitable candidate from the UK or the rest of Europe.

I am grateful to the Secretary of State for that response. Given that many nurses are approaching retirement age, what assurance can the Secretary of State give that British-trained nurses alone will be able to replace them?

Vacancies are at their lowest level ever, and we are employing more than 85,000 more nurses than we were in 1997. That substantial increase has meant that newly qualified nurses have found it difficult to get jobs. The advantage of the managed migration policy is that where shortages arise—and there are shortages in specialist jobs in the NHS—they can be included in the shortage category so that employers can obtain work permits for nurses from abroad without having to show that there is no suitable domestic candidate. That is a flexible system that can respond to changes in our own labour market. Given the present situation of newly qualified staff, it is clearly right that we should take junior nursing jobs out of the shortage category.

I welcome the initiative by my right hon. Friend. Does she agree that there is no such thing as an ethical recruitment strategy from overseas, from developing countries? Countries simply recruited from underdeveloped countries to fill the gap, and they lost out in the end.

I am grateful to my hon. Friend for supporting the action that we have taken, but I do not agree about whether it is possible to have an ethical recruitment policy. On that particular issue, we have led the way—not only by making it very clear that the NHS itself and staffing agencies that work for the NHS are not allowed to recruit directly from developing countries that desperately need their own staff, but by entering into agreements with countries such as the Philippines or India whereby they train more nurses than they can possibly employ, and—certainly before we made this change—by being willing to employ those staff here. I also refer my hon. Friend to the excellent work of my right hon. Friend the Secretary of State for International Development and the investment that we are putting in—for instance in Malawi and other parts of Africa—to help countries to train the health care workers that they so desperately need to care for their own population.

Is not what the Secretary of State euphemistically refers to as managed migration a panic reaction by the Government to the sharp rises in the number of unemployed newly qualified nurses? What steps are the Government taking to ensure that those numbers do not go on rising, and that we are not ploughing resources into training nurses and offering them the prospect of work, but no jobs at the end of the training?

The right hon. Gentleman is quite right: as I said a moment ago, there are real difficulties this year for many newly qualified nurses and indeed others, including physiotherapists, in getting jobs. We have therefore been working with NHS employers, and the chief nursing officer at the Department recently issued guidelines that will make it much clearer that, for instance, the director of nursing within each trust should be working with colleagues right across the local health community—with other NHS organisations—to ensure that vacancies are created and filled wherever possible by newly qualified staff; that private agency temporary staff are reduced; and that in their place, where necessary, newly qualified staff are taken into NHS banks, where they can be offered part-time or full-time work in order to progress their training.

There are a number of practical steps being taken in different parts of the country and we will go on ensuring that that happens in order to support our own newly qualified nurses. I am not sure whether the right hon. Gentleman supports or opposes the action that we sensibly took, as the problem became clear, to ensure that we do not continue to recruit junior nurses from outside the United Kingdom and the rest of Europe. I think that that is the right step to take, and I would be interested to know whether he and his party support it.

What dispensations are available to NHS employees who are identified for redundancy or have been made redundant, with regard to recruitment and employment in independent treatment centres in organisations such as Southport and Ormskirk hospital in my constituency?

There are still several thousand vacancies across the NHS, and we have already taken steps to ensure that wherever possible, vacancies are ring-fenced for staff who are facing redeployment or even redundancy in their current positions. There is already a policy, which goes back a couple of years, of ensuring that staff who have been made redundant from NHS employment can, despite the additionality rule, seek immediate employment in an independent sector treatment centre that is also working for NHS patients.

A midwife who lives in my constituency and works at Bedford hospital arrived in this country seven years ago, trained as a nurse, became a midwife and has now been told, as part of the consultation process at Bedford hospital, that she is likely to lose her job. Nearby Lister hospital has made an announcement of 500 redundancies. My constituent has been told that her chance of securing another job as a midwife anywhere in the region is zero. Does the Secretary of State feel that my constituent, who is now applying for a job in Waitrose, has been let down by the Government, along with all the other nurses who came to this country seven years ago to train?

The hon. Lady’s constituent and many other staff are facing an extremely difficult situation at the moment, as are some of the newly qualified staff to whom I referred. I assume that her constituent has already secured settlement, as she has clearly been making a valuable contribution to the NHS here for the past seven years. However, the fact remains that every hospital that is in financial difficulties, or that simply wishes to make itself more effective, is doing everything possible to avoid compulsory redundancies. When those are unavoidable—as in some cases they are—hospitals are also putting in place every support possible to ensure that staff, who have sometimes given years of service to the NHS, are supported to get other jobs in the health service.

Will the Secretary of State admit that we have gone from a period of expansion to one of contraction for the nursing work force? Some 5,500 extra nurses were recruited the year before last, but 5,500 nursing posts are now to be lost in our hospital sector. It is not just nurses leaving education who cannot find a job, because, as my hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries) made clear, nurses in employment are losing their jobs. In the context of overseas recruitment, will the Secretary of State admit that? Is that not the reason why the shortages criterion has been removed not just from junior nursing posts, but from the whole of bands 5 and 6, which means that most nursing posts are affected?

We have indeed removed bands 5 and 6, which cover the jobs for which newly qualified nurses apply, from the shortage applications. I am glad that the hon. Gentleman recognises the enormous increase in the staffing of the NHS. There are more than 200,000 additional staff and more than 85,000 extra nurses—and that was made possible by the additional investment that he and the rest of the Conservative party voted against.

The hon. Gentleman talks specifically about nurses and other staff in hospitals. The reality is that as hospitals become more effective and the NHS takes advantage of changing medical practice—for example, by employing more nurses in the community and reducing the number of emergency admissions—there will need to be fewer acute beds and thus fewer staff in some of our hospitals. He really has to decide whether he believes that the NHS should use the best medical practice to give the best care to patients and get the best value from the increased investment that we have made, or whether, along with voting against the increased investment, he is also giving up on any pretence of using that investment to the best effect for patients.

It is a complete fiction that more nursing posts in the community are being created. In the last year for which we have figures, there were 500 fewer district nurse posts and 800 fewer health visitor posts. If the Secretary of State knows what is going on, she must have based her policy on a new set of work force supply and demand figures. Two years ago, the Department of Health’s work force projection said that we would be short of 40,000 nurses by the end of the decade, and that we would need to recruit 12,000 overseas nurses a year. What is the Secretary of State’s current projection?

The work force projections that the Department of Health undertakes are all based on local projections of need developed by individual hospitals and other parts of the NHS. It is already clear that when the assessments of requirements for training places were made some years ago, several hospitals overestimated their requirements. A minority of hospitals were, even at that point, overspending their budgets at the expense of other parts of the NHS, yet also taking on new staff and commissioning new training places—and now they cannot find jobs for all the nurses who have been trained. That situation is extremely unsatisfactory and unfair to the staff involved.

We still have not heard whether the hon. Gentleman thinks that we have done the right thing. The great advantage of the managed migration policy and the new system for shortage occupations is that when we see a problem emerging, as we did earlier this year, we can take action to ensure that newly qualified nurses from abroad do not continue to seek employment here. If the situation changes in future years, we can alter that. The fact is that we have substantially increased the number of training places, by over 60 per cent., so we have no shortage of nurses at the moment.

Hospital Cleanliness

7. Pursuant to the answer of 20 June 2006, Official Report, column 1792W, on hospital cleanliness (west midlands), what systems have been recently introduced to improve hospital cleanliness in the west midlands. (85845)

The former strategic health authorities which have been merged to form NHS West Midlands established their own steering groups. The membership of these groups was wide-ranging and their remits included hospital cleaning as well as infection control. Relevant action plans are now being taken forward as a result of the input from these groups.

I thank the Minister for his answer, but will he come to Dudley again to visit our new £180 million hospital, where he can see for himself a revolutionary microfibre cleaning system that is helping to combat infections? I recently met Sue Macmillan, who showed me how the system reduces infection and improves cleanliness. We can never achieve 100 per cent. perfection, but is that not a great example of the way in which extra investment, together with new facilities and ways of working, has delivered improvements for patients?

I recently made an unannounced visit to Dudley, where I saw my hon. Friend’s hospital for myself. It is, indeed, impressive, and the microfibre cleaning system used there is being evaluated by the Department to see whether or not it can make a broader contribution. Will he pass on my thanks to Sue and her team for the excellent job that they are doing? Cleaners across the NHS do a fantastic job but I am sure that, like me, the hon. Gentleman remembers the billboards at the last election that said, “How hard is it to clean a hospital?” It was a denigrating attack on the people who keep our hospitals clean, and I am sure that it was approved by the right hon. Member for Witney (Mr. Cameron). However, I am happy to pay tribute to Sue and her team, and I am sure that my hon. Friend would wish to pay tribute to many other cleaners across the NHS.

May I put on record my thanks to both public and private sector cleaners? The trouble is, however, that often they are cleaning wards that are full of litter from the Government’s bureaucracy and red tape. To be serious, is the Minister confident that MRSA, VRSA and ESBL superbugs have left the Princess Royal hospital in Shropshire? If he cannot tell the House that they have done so, why has the only isolation unit in Shropshire at the Princess Royal hospital been closed?

The latest figures for 2005 for west midlands hospital trusts rated more than 30 sites either good or excellent—none was unacceptable—for hospital cleanliness. There is therefore a good record in the hon. Gentleman’s region. However, on the question of whether we are satisfied, no, we are not complacent about the issue. It is crucial that trusts, from the chief executive down, put hospital cleanliness and control of hospital-acquired infection at the top of their list of priorities, because patients expect to be treated in a clean and safe environment. I give the hon. Gentleman a categoric assurance that that is what trusts should do, but he should take pride in the trusts in his region and constituency, because they are doing a good job.

Assaults (Mental Health Wards)

8. What recent estimate she has made of the number of assaults on patients and health care staff within in-patient mental health wards. (85846)

10. How many sexual assaults took place in in-patient mental health wards in 2005-06; and if she will make a statement. (85848)

Data from the counter-fraud security management service show 43,097 incidents of physical assault against staff working in mental health and learning disability settings in 2004-05. A report published today by the National Patient Safety Agency—a copy has been placed in the Library and I have asked for further copies to be distributed to Opposition Members—shows 558 reports of physical abuse of patients, including 122 reports of incidents relating to sexual safety between November 2003 and September 2005.

I thank the Minister for her response and for providing me with a copy of the report a few hours ago, but it is remarkable that that was prompted by Health questions, rather than previous freedom of information requests from Mind, the charity. The NPSA report is detailed, and it deserves close examination, as it recognises the important work of health professionals. However, many people are concerned about the safety of patients and the need to protect them against assault in mental health units. The report shows that there were 562 cases of patient abuse by a third party in a mental health setting, and from my reading of the graph, there were a number of cases of severe harm and, indeed, death. Can the Minister confirm that, and say what steps are being taken to minimise the risk of people in need of urgent medical treatment suffering even more trauma as a result of the actions of third parties while they are in the care of the national health service?

I certainly share the hon. Gentleman’s concern about some of the issues raised in the report. We should bear in mind the fact that about 1 million people are treated in specialist mental health services every year, but of course we take many of those allegations very seriously. In the report, in collaboration with NPSA, the Department has looked at examples of best practice which implement the guidance set out by the Department to ensure high levels of patient safety. These matters are ongoing and we will continue to examine the issues raised by the report, so that if anything else needs to be done to ensure patient safety, we will do it.

My concern is for those who are facing mental health challenges, who are perhaps the most vulnerable members of our society. In 1996 the Prime Minister made a clear commitment to the ending of mixed-sex wards. Ten years later, people have a right to know why patients are still suffering abuse at the hands of the Government—people who come to the national health service in their hour of need are found to have been abused. My question to the Minister is simple and can be answered yes or no. Will she now make the commitment to ending the use of mixed wards for mental health in-patients, and will she do it today?

Let us be clear: 99 per cent. of mental in-patient wards meet the requirements that have been laid down by the Department. Those requirements are that there should be separate sleeping accommodation and separate toilets and bathrooms. We also recommend that trusts could consider whether it is appropriate for wards to be completely male-only or female-only. Those issues are often debated, and the hon. Gentleman should recognise that. In some circumstances it is right that there are areas where males and females can go. That, in a sense, makes it a normal setting. There are also those who prefer that in some instances there should be completely separate wards. We have told trusts that where it is appropriate, they should consider such matters. As I said, there is 99 per cent. compliance in mental in-patient wards. We are working with the remaining 1 per cent. to ensure 100 per cent. compliance.

I share the concerns about the delay in the publication of the report, which I understand was available last November, but I commend the Government for collecting the information. We already knew from a report from the Healthcare Commission last May about the high levels of violence in mental health and learning disability units, which it attributed to the high level of staff vacancies, the lack of experienced staff in in-patient units, the overcrowding and the lack of a therapeutic and structured care system in wards. That was last May. Have things got better since then, and if not, why not? Will the Minister take urgent action to address these very difficult issues?

We are continually seeing improvements in mental health services, particularly with some of the community teams that have been set up so that there is less need for the in-patient care scenario. We have seen the development of those teams over the past five years, accompanied by massively increased investment—about £1.7 billion extra has gone into mental health services. I recently announced £140 million in capital investment to improve in-patient services for people with mental health problems.

Taken together, all these things mean that services are improving. That is not to say that we do not take reports such as this extremely seriously, or that we are not doing everything that we can to ensure that the existing guidance accords patient safety the highest priority.

Will my hon. Friend confirm the percentage of female patients subjected to such assaults, if that is known? Does she think that we have been rather more robust in ensuring the safety of our hospital accident and emergency ward employees—we have taken up the cudgels in that regard—and could we not show the same verve and enthusiasm in respect of our patients?

We have been very clear about the importance of patient safety, and particularly about making sure that there is proper protection for women. We have a follow-up strategy for some of the allegations made in the report, which is to look in more detail at some of the incidents that have taken place and to ensure that proper local investigations have been undertaken. We can then look at some of the details that my hon. Friend talks about.

On accident and emergency departments, my hon. Friend the Member for Don Valley (Caroline Flint), the Minister with responsibility for public health, issued a consultation recently that was particularly concerned with visitors to accident and emergency departments. However, it was decided not to issue the same kind of consultation regarding mental health patients, for obvious reasons.

Having had a Bill on this subject talked out by the Government as long ago as December 1997, may I ask the Minister what level of compensation—if any—the Government typically pay to a woman mental health in-patient after she has been raped in an in-patient unit as a result of the Government’s broken promises to eliminate mixed-sex wards?

Let me be absolutely clear: the rapes referred to in this report are allegations of rape, and we have been making sure that they are investigated at local level. If rapes had taken place and there was a police investigation, that course would obviously be followed.

Does the Minister share my concern that mental health services are more at risk of reductions in expenditure, where they have to be made, than some other areas of health provision? As she is aware from figures that I gave her yesterday, the strategic health authority in my local area budgeted for a deficit, and it is making my local mental health services pay for that deficit to a degree that has led a local authority officer to suggest that those services are not safe. What action is my hon. Friend taking to ensure—

Order. I must say to the hon. Lady that her question is far too long. Can the Minister try to answer?

We have made it absolutely clear that mental health services should not be asked to pay more than any other trust in a given area; disproportionate sums should not be taken from mental health services. If my hon. Friend has any evidence of more demands being made on mental health than on other areas, I would be more than happy to look into that.

No one who has visited a mental health hospital remotely believes the Minister’s assertion that 99 per cent. of them offer only single-sex wards: a flimsy curtain across a ward does not constitute a single-sex ward. In 2004, the Mind “wardwatch” campaign estimated that in reality, a quarter of mental health wards were still mixed, and we know that the situation has got worse, as many have had to revert to mixed-sex wards owing to deficit pressures. Only after a freedom of information request by Mind was today’s National Patient Safety Agency report published, revealing those 122 reports. There are allegations that those were only the cases that were reported. There was no mention of the cases that went completely unreported.

Is it not a disgrace that the Government sought to suppress the report eight months ago? Why did they do so? How many people have suffered subsequently because of the Government’s complacency and delay? What urgent action are they taking to improve conditions for vulnerable mentally ill patients in future?

Can I be—[Hon. Members: “Absolutely clear?”] Yes, I want to be absolutely clear about what happened to the report. It came to the Department on 16 January. Between that date and 23 May officials worked on the report with the National Patient Safety Agency, examining specific issues, including, for example, whether the allegations of rape had been the subject of a local investigation. It was important that we did not publish information without—particularly with allegations of rape—considering whether there had been a local investigation. That would have put some vulnerable people in an extremely awkward position. We did not want to do that.

We wanted to work on some of the other data analysis to ensure that that material was accurate and that the NHS could learn lessons from it. At the end of May the report came to Ministers, who signed it off on 5 June. Between then and now we have been examining a follow-up strategy, which has now been agreed. This is the response to the question that the hon. Gentleman asked. What are we intending to do with the information—

Hospitals (Surrey)

NHS organisations in Surrey recognise that health services must change and adapt to meet the challenges of the 21st century. The local NHS is therefore looking at how it organises, delivers and uses health care, as part of the creating an NHS fit for the future programme. Any proposals that emerge from the review will be subject to a full public consultation later this year, probably in the autumn.

I thank the Minister for her answer. She will be aware that the Prime Minister visited Frimley Park hospital in my constituency only last month to congratulate the workers of Surrey NHS on the superb service that they deliver. However, only last week primary care trust representatives told me and colleagues from Surrey that there would have to be cuts in all five of our district general hospitals, and that one of those hospitals might have to close. Can we have a guarantee from the Minister that hospitals will not close in Surrey as a result of the Minister’s mismanagement of NHS funding?

I am sure that there are some excellent examples of service in Surrey. The hon. Gentleman is coming to see me next Tuesday, I understand, to talk through some of his concerns. I cannot promise what he asks. It is important that we ensure that hospitals are fit for service. For example, I know that in north Surrey there has already been the relocation from acute to community settings of dermatology services and vascular surgery services. In north Surrey there is a fall service that provides out-of-hospital support for older people, particularly, who fall, with therapists and ambulance services that work together to prevent hospital admissions.

There are different approaches, which I saw in Doncaster on Friday. There are community matrons. Ken and Bill, two of my constituents, each had half a dozen visits to hospital last year. This year, they have not attended hospital. That is the sort of service that we want. We want hospitals that work for the community and services that we hope can keep people out of hospital and enable them to enjoy better health for much longer.

What message does the Minister have for residents of Guildford and south-west Surrey, who met last Thursday to be told that, because of a deficit, the loss of accident and emergency services at the Royal Surrey county hospital is a real possibility? Rather than insulting local NHS managers by saying that the deficit is the result of their incompetence, does the Minister not accept that the root cause of the deficit is her Government’s changes to the funding formula, which systematically discriminates against rural areas with many older people?

However much money the hon. Gentleman’s part of the country has had, it has been overspending for many years. There has been an 11 per cent. rise in admissions to A and E, but up to 80 per cent. of visits are non-urgent or inappropriate. Services will be reviewed to try to find better ways to provide the emergency care that some people need while allowing four out of five patients currently visiting A and E to be treated better and safely in alternative settings.

GP Lists

12. What the average size was of general practitioner practice lists in (a) England and (b) the Northamptonshire Heartlands primary care trust area in each of the last three years. (85850)

For the years 2003 to 2005, the average practice list sizes at 30 September each year were 5,968, 6,149 and 6,250 respectively. For Northampton Heartlands primary care trust the equivalent figures were 8,162, 8,214 and 8,132.

Local GPs in north Northamptonshire should be thanked for doing their best with practitioner lists way above the national average. But with 52,100 new houses set to be built in the area in the next 15 years, will the Minister meet his opposite number in the Department for Communities and Local Government to ensure that practitioner lists do not rise further within the foreseeable future?

There is considerable variation throughout the country in the number of GPs per 100,000 of the population, ranging from 41 in some of the more deprived parts of the country to 83. The number of GPs in the hon. Gentleman’s constituency is less than the national average, but nevertheless it is somewhere around the middle. I pay tribute to GPs in his constituency for providing an excellent service. There are 5,000 more GPs today than there were in 1997, and almost everywhere patients can now see a GP within two working days.

Is my hon. Friend aware that general practices sometimes strike mental health out-patients off their lists because they can become verbally or physically abusive? One can understand that reaction, but sometimes such patients are then allocated another practice 30 or 40 miles away, which is no use to them at all and will not help them to recover their mental health. Will my hon. Friend look into that system to see if we cannot serve such people better, rather than just striking them from a list and sending them miles away?

My hon. Friend rightly draws our attention to some difficult situations. Obviously, GP practices have to take into account considerations such as the safety of staff and the general relationships within their practices. It is the PCT’s responsibility to ensure that everybody has a GP, and it is right that that GP should be as close to the patient’s home as possible. If my hon. Friend has examples where that has not happened, I should be grateful if he would bring them to my attention, but we believe that that is the right policy to have.

Given the increase in the average size of GP lists, how does the Department’s recent invitation through the Official Journal of the European Union—surprisingly drafted in almost exactly the same terms as the one that he embarrassingly had to withdraw just the other day—for private sector bodies to bid for and take over PCT commissioning services and to provide health care services, help to address the problem?

The hon. Gentleman is completely confusing two issues. We are talking here about GP services in communities, not PCT commissioning. He referred to the increase in list sizes, but if he had been listening he would know that the figures that I gave show that in 2005 list sizes were lower than in 2003. The hon. Gentleman is a north-west MP and he has far more doctors per 100,000 than I do in my constituency, which is under-doctored, so I make no apology for bringing in private sector companies that are willing to provide a high-quality, open-hours GP service to parts of the country that have traditionally had poorer access to such services. If he has a problem with that, he should say so.

Mental Health Bill

On 23 March 2006, the Government announced their intention to produce a Bill to amend the Mental Health Act 1983. This Bill will be introduced as soon as parliamentary time allows.

Will the definition of mental disorder remain the same as in the 1983 Act, or will the Secretary of State use the definition that was in the two draft Bills, which would widen the group of people who could be compelled to be treated against their will?

We will take the opportunity offered by the new Bill to replace the definition in the 1983 Act. We will introduce a new and simplified definition of mental disorder, which in turn will be linked to the new supervised community treatment.

Skin Cancer

We are concerned about the number of people being diagnosed with skin cancer, which kills more than 2,000 people each year in England and Wales. SunSmart, the national skin cancer prevention campaign, has been funded by the UK Health Departments. This summer, it is focusing on men and outdoor workers.

I thank my hon. Friend for her response. I welcome the Cancer Research UK SunSmart campaign, which is highlighting the high incidence of cancer among males. There has been a 31 per cent. increase in incidences of cancer in the past decade, and on average 1,000 out of every 1,777 cases of cancer involve males. I urge the health service to promote that message and do the best that it can to raise awareness.

I thank my hon. Friend for that point, which I could not have made better myself. On Monday next week, I am meeting my hon. Friend the Member for Swansea, East (Mrs. James) to discuss how we can control the unsupervised use of tanning beds and coin-operated machines, the use of which by under-16s has caused concern.