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Health

Volume 453: debated on Tuesday 28 November 2006

The Secretary of State was asked—

Healthy Start Scheme

The new healthy start scheme, which was launched nationwide yesterday, promotes good nutrition for certain low-income pregnant women and all pregnant under-18-year-olds by providing vouchers to spend on a range of healthy foods. All Members of Parliament were sent details of the scheme last week.

I am most grateful to the Minister for her response. In October, I spent a week trying to live on income support and to eat a healthy diet fit for a pregnant mother. I could not afford to eat five portions of fruit and vegetables every day, so I know that this announcement will be very welcome. For it to be really effective, it has to be available throughout the country. How many retailers have signed up to the scheme, and what is my hon. Friend doing to ensure that it is available in all communities?

My hon. Friend is right. The scheme widens the range of choice beyond the traditional milk offered under the welfare food scheme to include fruit and vegetables. Retailers large and small will be given the opportunity to back the scheme. We are working on a recruitment target of 35,000 retailers with more than 40,000 outlets, which will double the amount in England by about 30,000. The pilot in Devon and Cornwall has enabled small retailers to think about how they can get on board with the scheme—that is welcome.

Advice to pregnant women is lacking in many respects, not only on healthy eating. Thankfully, when a pregnant woman seeks an abortion she is seen and counselled by two professional doctors—

I will do my very best, Mr. Speaker.

While I entirely applaud the Minister’s sentiments, does she accept that for many of us this is a step too far? It is not the job of Government to tell people what to eat and how to conduct their lives. This is elevating the Secretary of State to the nanny of the state, and we do not want that.

Healthy start is a revamp of the welfare food scheme, which has been around for about 60 years, so the hon. Gentleman and his party had the opportunity to get rid of it or revamp it during their 18 years in power. The scheme is not only about providing the vouchers and the extension to fruit and vegetables—parents said they wanted that flexibility—but about giving midwives and health visitors the opportunity to play an important part in supporting families, particularly in the early days of babies arriving, by giving them the best advice, which they can choose whether to take, on the best possible healthy and nutritional start for their children. Importantly, the scheme is also about pregnant mums and the benefits that they derive from a good diet.

How will women in my constituency and elsewhere find out about the scheme, and how can we, as Members, encourage them to access it?

All families who are currently part of the welfare food scheme will be transferred automatically on to the healthy start scheme. For pregnant women, that should be discussed when they check in for their ante-natal care with their midwives. We are providing a pack to every health professional, health visitor and midwife throughout the country; we are doing work with Sure Start; and we are providing my right hon. and hon. Friends, and hon. Members across Parliament, with information so that you, too, can spread the word across communities—[Interruption.] I meant colleagues, not you, Mr. Speaker, although you could do so as well. We will monitor take-up because we want get the widest possible reach into as many communities as possible, particularly for those on low incomes.

NHS Trusts (Budgets)

2. What changes in the budgets for 2006-07 for NHS trusts serving Lambeth and Southwark have been agreed since her meeting with me, the right hon. and learned Member for Camberwell and Peckham (Ms Harman), the right hon. Members for Dulwich and West Norwood (Tessa Jowell) and for Streatham (Keith Hill), and the hon. Member for Vauxhall (Kate Hoey). (103768)

Following the meeting to which the hon. Gentleman refers, I asked NHS London to look again at budgets in Lambeth and Southwark. It has confirmed that after other factors have been taken into account, Lambeth and Southwark primary care trusts were asked to contribute less to the London-wide risk reserves for this year than most other London PCTs.

Does the Secretary of State accept that although Lambeth and Southwark are among the two most deprived boroughs in the country and have the most health service needs, that although we have cuts totalling an estimated £23 million to the Guys and St. Thomas’, King’s College Hospital and South London and Maudsley Trusts, that although there was no dispute that that will affect community services, mental health services, preventive health services and others, and that although she agreed at our meeting that it was unfair, there has been no change—there will be just the same cuts, and this year the two local communities will suffer exactly the same reduction in their services as before the meeting, which we left thinking that she was likely to be able to influence the result and produce a fairer outcome?

As I explained to the hon. Gentleman when we met, the NHS in London and in other regions was asked to take into account the impact of the technical adjustment that was made through what is called the purchaser parity adjustment. It has done that, and it is because of that that Southwark and Lambeth have been asked to contribute less to the London-wide reserve than most other PCTs. Of course this is difficult, particularly in Southwark and Lambeth, which are very deprived communities, but the speed with which they will get back the money that they have contributed this year will depend on the speed with which other, overspending organisations in London get themselves back on track and cease to rely on organisations that are in balance to compensate for their overspending.

As one of the other Members at that meeting, I share the concerns expressed by the hon. Member for North Southwark and Bermondsey (Simon Hughes), because we left the meeting thinking that there would be some changes. The new planning framework shows a further 3.6 per cent. cut next year in Lambeth and Southwark. These are the most deprived areas in London, and the cuts will affect projects such as the healthy living centre in Stockwell, which will have to close, and all sorts of provisions that affect ordinary people in their daily lives. Why is the Secretary of State not considering the poorer PCTs that have stayed in budget yet have to suffer because of the overspending of others?

It is precisely for that reason that we are insisting that overspending organisations, of which there are far too many in London, get their finances back under control so that we do not have to go on asking the communities in areas such as Lambeth and Southwark, which have been in balance, to make these difficult decisions. As I explained in the letter that I sent to my hon. Friends and other hon. Members after the meeting, it is simply not possible for the NHS in London to reopen the allocations, and the decisions that were made with all the London PCTs, to deal with the situation this year. We will continue to ensure, through the allocations formula, that the areas with the biggest needs get the biggest growth. That will be fair to Southwark and Lambeth. It is, of course, opposed by the Conservatives.

Patient Satisfaction

Forgive me, Mr. Speaker. I thought that another hon. Member was seeking to ask a supplementary on Question 2.

Yesterday, we announced our plans to survey 5 million patients to measure how easy it is for them to see their general practitioner. This the first time that the Government have asked patients directly about their experience of the GP appointments system.

I am very grateful for that answer. Has my right hon. Friend seen the recent survey by the Healthcare Commission, which shows that 92 per cent. of patients rate their experience of the NHS “good” to “excellent”? In the light of that, what can she do about closing the gap in perception between those who use the NHS and those who merely read about it?

That was a supplementary question well worth waiting for. My hon. Friend is absolutely right about what patients say about their experience of the NHS, and I am sure that all of us would want to pay a real tribute to NHS staff. There is a big gap between patients’ experience and public perception, however. I hope that Conservative Members and the media all around the country will continue to pay at least as much attention to all the improvements taking place in the NHS as they pay to the sometimes difficult decisions that have to be made in some areas.

Will the Secretary of State also assess the impact on public satisfaction with the NHS reconfiguration process of, for example, the announcement last week by the hospitals trust in my constituency that it will definitely close one of the maternity units in the trust, despite the fact that the public consultation on that option is not due to start until the middle of January?

No decisions are made on significant changes to services of the sort that the hon. Gentleman describes without full public consultation and the involvement of local councillors through the overview and scrutiny committee. I very much regret that, on occasions, when local primary care trusts and hospitals are considering changes—which are generally driven by the need to keep up with changes in medicine and clinical practice and to give patients even better care—people leap to the conclusion that there are to be cuts or reductions in services and protest before any decision has been made.

In the context of patient satisfaction, is my right hon. Friend aware of the deep vein thrombosis diagnostic service at Leek Moorlands hospital, which last month won the Community Hospitals Association award for innovation in clinical practice? Not only have almost 200 patients been saved a difficult journey to the acute hospital, but emergency capacity has been freed up, saving the local PCT £100,000 a year. The service will now be rolled out across the boundaries of the new reconfigured primary care trusts. Will she congratulate the team on their excellent work in that area?

I am aware of that service, which is absolutely excellent—[Interruption.] Unlike Conservative Members, I want to congratulate all the staff involved in providing an excellent service, which shows how the modern NHS can both improve care for patients and save money, especially on services previously provided in an acute hospital, thus freeing up resources to spend, for instance, on new drugs and other service improvements that patients also need.

Is the Secretary of State aware that 83 per cent. of patients surveyed in a recent breast cancer forum were unaware of the hospital travel costs scheme? Will she consider again whether trusts can be persuaded better to advertise that scheme and to make claiming under it easier?

Of course I will consider the issue raised by the hon. Gentleman. As he indicates, however, it is very much the responsibility of local hospitals to ensure that patients, particularly those such as cancer patients who must have repeated treatment, are aware of the help with travel costs that is available.

Research confirms the high level of public and patient satisfaction with Alder Hey, the Royal Liverpool children’s hospital in my constituency. Will my right hon. Friend ensure that the national burns review takes into account the high level of public satisfaction with the burns treatment available at Alder Hey and at Whiston? Will she also ensure that, alongside other options, the national review seriously considers encouraging burns centres across the north of England to network together to improve burns treatments and therefore support even higher levels of public satisfaction?

My right hon. Friend is absolutely right about the high levels of public satisfaction, which reflect in part that waiting times, for instance, are shorter than ever before. We will consider carefully the review of specialist burns units and its recommendations, but she is right that a network of specialist centres is needed to ensure that those patients with the most serious burns receive the necessary specialist attention, which only a limited number of specialist centres can provide.

A Healthcare Commission survey of patients this year found that more than one in five had had to stay in a mixed-sex room or bay. Given that the 1997 Labour manifesto said that the Government would work towards getting rid of mixed-sex wards, the 2001 manifesto said that they would abolish them, and the 2005 manifesto did not mention the subject at all, when will the promise be kept?

The Healthcare Commission survey to which the hon. Gentleman refers includes patients who had recently been cared for in accident and emergency or medical admissions units. When we set the target for single-sex sleeping accommodation, we asked trusts to report on the wards used for regular admissions, not A and E or medical admissions units, which, as Sir George Alberti, the national clinical director for emergency care, has pointed out, cannot always provide single-sex accommodation, because to do so would mean turning away patients who were critically ill and needed short-term observation. We have achieved 95 per cent., which was the target that we set back in 2004, and 99 per cent. of hospital trusts say that they now provide single-sex accommodation in their general wards along with single-sex bathrooms and toilets.

A couple of the consequences of the massive talking-down of the NHS by the Opposition are massive demoralisation among staff and patients being scared to receive treatment. Will my right hon. Friend please ensure that some of the research and surveys that she has mentioned are widely disseminated to bust the urban myths put out by the Opposition?

I entirely agree with my hon. Friend. We try all the time to put across the good news about what NHS staff are now achieving, backed by record investment that the Conservatives oppose. With waiting times at their shortest and cancer treatment in particular having been transformed over the past 12 months, there are many reasons for patients and the public to be enormously proud of what the NHS is achieving, although there is still more to be done.

In her first answer, the Secretary of State referred to the survey assessing satisfaction with GPs’ services. The Department of Health has added two more questions, about the opening hours of general practices.

It is the Government’s own GP contract that has led to the closure of practices on Saturday mornings. Does the Secretary of State seriously intend to ask patients whether they want surgeries to be open on Saturday mornings—although their surgeries are not commissioned to be open— and subsequently withhold payments from GPs?

The hon. Gentleman must decide whether patients should be asked whether they are satisfied with the arrangements that their local GPs are making. He must also decide whether he thinks GPs should have been given the choice—which we gave them—of whether to provide out-of-hours services. [Interruption.] That was the choice that we gave them in the survey.

The result of the new contract is that GPs are providing better services for patients according to the quality and outcomes framework, and doing much more work on prevention and long-term care. They are also receiving big increases in payments. I think it right for us to ask patients for their views on their local practices, and to adjust payments to general practices accordingly.

It is always rather depressing when it clear that the Secretary of State does not understand. If GPs are not commissioned to open their surgeries on Saturday mornings, there is no basis on which they can do so, and it is therefore difficult to assess them on that ground.

The satisfaction survey ought surely to extend to out-of-hours services, but the Government do not seem to intend that to happen. Will the Secretary of State undertake to extend the survey to those services? Then, perhaps, she will be able to explain why patients have an out-of-hours GP service that is much less satisfactory to them than it used to be, and why the Government are spending not the £105 million that they thought it would cost last year, but £346 million—a quarter of a billion more than they expected.

It is the hon. Gentleman who simply does not understand the new GP contract. The new contract, which has led to primary care services being rated as better in our country than in almost any other advanced country—as is shown in a recent survey by the Commonwealth Fund—allowed GPs to choose whether to provide out-of-hours services, in which case they would receive higher payments, or to hand the responsibility back to the primary care trusts. PCTs commission out-of-hours services where local GPs have decided not to provide them themselves. If all PCTs commissioned those services as efficiently as the best, they would save money on the allocation that we made, rather than overspend.

We do indeed survey patients about their satisfaction with out-of-hours services, and more than 80 per cent. are satisfied or very satisfied with the services that they are receiving.

Choice has also been a major factor in patient satisfaction. Patients in parts of my constituency now have access to their medical records online, which is proving hugely beneficial. Has my right hon. Friend any plans to roll that out so that all my constituents can benefit from it?

My hon. Friend is absolutely right. By extending choice and the control that patients have over their own services, we are in increasing the responsiveness of the NHS to what patients want and contributing to that increased satisfaction. Through the NHS IT programme, we are trying to ensure that patients everywhere will have access to the online services about which some of my hon. Friend’s constituents are already so pleased.

Mid Essex Hospital Services NHS Trust

4. How many compulsory redundancies have been made in the Mid Essex Hospital Services NHS Trust area in the past six months. (103770)

The Mid Essex Hospital Services NHS Trust has announced that 24 members of staff have been made redundant. The trust is making every effort to protect front-line services.

I am staggered by the Minister’s response because a written answer from his Department of only two weeks ago informed me that the figure was 42, rather than the number that he has given. Also, as the Minister should know but might not, on the same day a further 203 jobs were cut in the hospital trust. I am therefore staggered by the Minister’s response. I want him to explain something to me and my constituents. Since those 245 job cuts were announced, the Government have changed the regime for redundancy pay. Given that those job cuts are being made to reduce the deficit in the trust, how do the Government reconcile changing the redundancy arrangements for trusts seeking to cut their deficits?

I will check whether there is that discrepancy between the figures that the hon. Gentleman has brought to my attention, and if there is I will correct it. However, yet again he and other Conservative Members are seeking to spread anxiety by quoting figures that do not reflect the reality. [Interruption.] They seek to create an impression that P45s are being handed out to nurses up and down the country; in reality, that is not the case. [Interruption.] If he or his party continue to try to spread anxiety in that way, that will not reflect well on them.

The hon. Gentleman and his colleagues have been lobbying me about a new hospital for the trust—he goes quiet and listens now that I mention that. If that trust is to get that new hospital, it must of course be financially viable. Although the decisions that have been made are difficult for the staff concerned, I hope that the hon. Gentleman will support my party in helping the trust make the difficult decisions that will get it into a financially stable position, as that will enable it to have the new hospital that he keeps on asking us to provide.

Does the Minister agree that compulsory redundancies are likely to be only part of the cause of staff reductions in that trust and throughout the rest of the NHS? As an example for the rest of the NHS, will he consider breaking down staff reduction figures into compulsory redundancies, voluntary redundancies, retirements and the vacancy factor effect in respect of the 10 per cent. of staff that are turned over every year?

I thank the hon. Gentleman for that constructive question, because he is absolutely right. We want to put correct information into the public domain. There are some who seek to use figures to scare, and spread anxiety in, the national health service, so we fully recognise the need to put accurate figures into the public domain so that people can make their own judgments about the state of work force planning within the system.

The hon. Gentleman is right that there is a need to put out more information, and we have put information into the public domain about voluntary redundancies. On a trust-by-trust basis, trusts are making statements about reducing their use of agency staff. I will constructively take on board the point that the hon. Gentleman has made, and we will of course seek to put accurate information into the public domain as and when we can.

PCTs (Local Services)

5. What steps she is taking to safeguard the provision of small local services affected by the changes to primary care trust boundaries. (103771)

It is for primary care trusts, in consultation with local people, to decide what small, localised services are needed in their areas.

I thank my hon. Friend for that answer. In particular, I want to raise the issue of toenail-cutting services for elderly people. It is an important service and it should be raised. Because of the redrawing of the boundaries of the primary care trusts, I am seriously worried that small local services that are vital for elderly people—such as those who cannot reach their feet—are not being safeguarded. I would very much like the Minister to give an answer that reassures me that such small, vital services are being safeguarded in PCT funding.

My hon. Friend raises an important issue: toenail-cutting services are important for older people, particularly those with diabetes or vascular problems. In such circumstances there is a commitment to maintain those services. However, I must also say to my hon. Friend that one of the reasons why a review is taking place is that some people have been receiving those services for more than 10 years, and although that might be entirely appropriate for some older people, it might not be necessary for others. The objective is to make sure that those services are protected where there is clinical need, because they are an important lifeline for many older people, but we must also make sure that resources are used appropriately.

Is the Minister aware that among the worst affected small local services are the integrated health care services of chiropractic, homeopathy and herbal medicine? Is he also aware that his right hon. Friend the Secretary of State for Health, when she was presenting the Acorn award for integrated health care at the NHS Alliance conference last week, said that they are what patients want? Why, therefore, are there cuts across the board in primary care trusts, and why are the Tunbridge Wells and Royal London homeopathic hospitals under threat? Will he and the right hon. Lady—

I know that the hon. Gentleman has a long-standing interest in, and commitment to, complementary medicine, as Members in all parts of the House will acknowledge, but the fact is that more than 50 per cent. of GPs do use complementary medicine and make sure that it is available to their patients in some circumstances. The hon. Gentleman asks me to intervene in local PCT decision making, but I should point out that his own Front Benchers are suggesting that we have complete operational independence for the health service, where local decision making will be the norm.

Has my hon. Friend heard from the Minister, my hon. Friend the Member for Don Valley (Caroline Flint), about the interest that she has taken in Trevi house, which is a unique drug rehabilitation centre in my constituency for young mothers and children? Indeed, I thank her for the help that she has recently offered to them. However, will he and his colleagues give serious consideration to issuing guidance to PCTs about the position of such small services? Two or three places are provided for the Plymouth PCT area, but a regional and a national service is also provided.

My hon. Friend the Minister has made me aware of the excellent work that Trevi house does. I believe that my hon. Friend the Member for Plymouth, Sutton (Linda Gilroy) has visited the service, and she makes a really important point. An holistic approach is taken there, and the rehabilitation services that are available not only for women who have had drug-related problems, but for their children and other family members, are incredibly important. In issuing commissioning guidance to PCTs, one of the things that we are most concerned about is rehabilitation outcomes and the needs of those women and children and the families as a whole. Where such quality services are being provided in the voluntary sector or perhaps by social enterprises, we will try to ensure that commissioners understand that we expect them to commission such services against the outcomes that we specify.

One way to conserve and perhaps develop local services is to realise redundant assets. Will the Minister therefore look at the situation of the Queen Camel doctors’ surgery, which has lain empty for several years since the new surgery was built? It is situated right in the middle of a village, is vandalised regularly and is an eyesore, yet my repeated approaches to the South Somerset primary care trust, and now to the Somerset PCT, have failed to lead to its being sold. Will the Minister look into this issue, find out why probably £500,000 of NHS assets is being wasted, and write to me?

I am more than willing to ask the PCT to have a look at this issue, which is exactly the sort with which the Member of Parliament concerned, the local authority, the PCT and, indeed, the local voluntary sector should engage, in order to come up with a solution that meets the needs of the local population. However, this is not necessarily a job for me, sitting in an office in Westminster or Whitehall, but I am willing to contact the PCT and to ask it to engage properly with the hon. Gentleman in an effort to resolve the issue.

Ill Health Retirement

6. What assessment she has made of the potential impact of retirement through ill health of NHS staff on funding available for service provision; and if she will make a statement. (103772)

There has been a major decrease in the number of awards of ill health retirement in the NHS—from 9,520 per year in 1993-94 to 2,673 per year in 2005-06. It was estimated in November 2001 that each ill health retirement involving a pension cost the pension fund up to an extra £60,000, and cost the trust the same again in indirect costs.

I thank my hon. Friend for that answer. Will he reassure the House that staff are not being coerced or forced into applying for early retirement in order to mask the numbers facing compulsory redundancy?

I certainly can give my hon. Friend that assurance, and I also wish to pay tribute to him and other colleagues in the trade union movement who have played a part in bringing down the number of ill health retirements in the NHS. The NHS as an employer has been in the spotlight this year, and today in the House, but sometimes the good things that it does—including the way in which it looks after its staff—do not get the appropriate praise. We should give the NHS that praise. My hon. Friend will know that the NHS, in consultation with the unions, has looked at managing ill health retirement and, by making earlier use of occupational health services and redeploying staff from onerous duties, it has managed to bring down the figures. More work remains to be done, but I would never countenance the manipulation of the figures that my hon. Friend suggests.

Those figures, which are welcome, suggest abuse in the past, and that people have retired on health grounds without justification. At a time when we are reorganising the NHS, will my hon. Friend and his colleagues ensure that any applications for retirement on grounds of ill health or redundancy are rigorously examined, bearing in mind the fact that there is a duty on the trade union and the employer to explore all opportunities for redeployment, to avoid those bogus and costly charges on the public purse?

My hon. Friend makes an important point. Of course, the peak of 9,500 in the early 1990s was for a much smaller work force. The figure for the last financial year—2,673—is for a much larger work force, with some 300,000 extra staff. That shows a much better performance. My hon. Friend is right about redeployment, and we will continue to work with NHS employers to look at every possibility for keeping staff in the service and retaining their skills and knowledge, by helping them to work elsewhere if they are struggling in their existing job. I will reflect more on the important point that my hon. Friend makes.

Northamptonshire Heartlands PCT

7. What the weighted capitation allocation for Northamptonshire Heartlands primary care trust was for 2003-04 to 2005-06; and how much was available to be drawn down by the PCT over the same period in relation to the capitation allocation. (103773)

Northamptonshire Heartlands PCT received revenue allocations of £222 million in 2003-04, £244 million in 2004-05 and £267 million in 2005-06. Over the three years covered by this allocation, Northamptonshire Heartlands PCT received an increase of £63.6 million. By the end of 2005-06, the PCT was 4.4 per cent. below its target allocation.

In August 2005, Sir Richard Tilt, the then chairman of Leicestershire, Northamptonshire and Rutland strategic health authority, said:

“We are however the worst funded SHA relative to the national capitation formula…Indeed North Northamptonshire is our most pressurised health community. Northamptonshire Heartlands PCT which covers this population…is £32 million (9.9 per cent.) below capitation.”

Does the Minister agree with Sir Richard, and is it not true that we do not have a national health service any more, but a postcode lottery health service? The people of Northamptonshire have drawn very bad numbers.

I do not agree with that statement. The hon. Gentleman should cast his mind back to the NHS of the early 1990s before making such comments. Let us get the matter straight. The funding increase that his party voted against—[Interruption.] Instead of rolling his eyes, the hon. Gentleman should listen to the facts. His PCT received an increase over the two years of this funding allocation of 29.4 per cent. The national average increase for PCTs was 19.5 per cent. and—

The hon. Gentleman cannot keep saying that. The resources that this Government have put into his local PCT are on a scale never seen before, and they have been adjusted to account for the population increase in his area. Overall, they constitute an extremely generous package for the health service in his area. If he wants more resources for the health service, he should try voting for them next time.

Does the Minister agree that the principle of fair funding, which the Government say that they espouse, should mean that resources within the growing budget of the NHS, which we all welcome, should be targeted at health need? Does the Minister understand that there is a growing perception throughout the NHS, including in Northamptonshire, that resources in the health service are no longer allocated in a way that reflects the health needs of the population, but are increasingly distributed in a way that reflects the political needs of the Government? Is there not an urgent need—

The right hon. Gentleman is straying into territory that is slightly dangerous for his party. His colleague the hon. Member for Wellingborough (Mr. Bone) said that health funding was inadequate because his PCT was under target, but the formula balances a range of factors, including deprivation, age, rurality and market forces, in producing notional target allocations for all PCTs in the country. Recently, the Opposition have suggested that health resources should be distributed according to what they called the “burden of disease”. The result of such a policy would be that the constituencies of every Minister on the Front Bench today would get significant extra resources, at the expense of the areas represented by the people who are pointing their fingers at me right now. The Tory party needs to decide—

Perhaps the Minister can help me, because my constituents, who used to be in the former West Lancashire PCT, are a little confused. The money from last year’s budget top-slicing will be used to finance NHS facilities in Lancashire, but that excludes the Southport and Ormskirk hospital, which serves my constituents. Moreover, South Sefton PCT—

Order. That is where a brief question should end, so we shall stop there and let the Minister answer.

My hon. Friend raises an important point. Overspending by any part of the NHS means that another part of the system has to underspend to make up for that poor use of resources. I represent a constituency very close to hers, and areas such as ours are having to help the NHS collectively and put money into the system to help other areas where there are financial pressures. She is right to say that the system should ensure that the money goes to the areas that need it most, and I shall look very carefully at the problem involving the Southport and Ormskirk hospital.

Let us try again, after the travesty of an answer that the Minister gave to my right hon. Friend the Member for Charnwood (Mr. Dorrell), a former Secretary of State for Health. The Government calculate the need for health care according to the weighted capitation allocation derived from deprivation indices, but the Minister must know that that need is determined largely by morbidity, and hence age. Northamptonshire Heartlands PCT has a projected deficit of £4 million, and it is being condemned to the regime of cash freeze and cuts experienced by most PCTs that serve older populations. Non-existent public health provision has failed socially deprived areas. Will the Minister concede that his funding formula discriminates against elderly people?

No, I most certainly will not. Our health formula gets funding into the areas that need it most, but it is time the hon. Gentleman made his mind up. I think that I heard him correctly: he has just said, at the Dispatch Box, that funding should be distributed according to age. However, less than two months ago the Opposition issued a policy document that stated that funds should be distributed according to the “burden of disease”. That is entirely different. The burden of disease—that is, the incidence of diseases such as cancer or coronary heart disease per 100,000 of the population—is larger in my constituency of Leigh than it is in his constituency of Eddisbury. If the Opposition want funding to be distributed according to age, they need to change their policy.

Purley Hospital

Although this is a matter for the local NHS, I am advised that NHS London’s timetable is currently dependent on the developers finalising their own plans for the site.

The key point in that reply is that the matter is in the hands of the developers. The Government made a pledge about the hospital nine years ago, which was repeated at the Dispatch Box five years ago, yet we still do not have a firm date, because the project is in the hands of the developers, who are now in some difficulty. Does the Minister agree that this is a classic example of how not to run a public-private partnership for building a new hospital?

I can certainly understand the hon. Gentleman’s frustration about the considerable time it has taken to get the project started, particularly as it will bring in £9 million-worth of new investment and bring together acute and community care services, as well as mental health services and a minor injuries unit. I understand his frustration. In February a contract was signed with the developer, and the detail was signed off earlier this month. I know that the hon. Gentleman met the new chief executive of the trust, Helen Walley—on Friday, I think—and I hope that gave him some confidence that the project is now moving forward. I met Helen Walley yesterday, and she is very keen to take it forward. She assured me that she would keep in touch with the hon. Gentleman about his concerns to reassure him that the project is moving forward.

NHS Trusts (Deficits)

In the minority of organisations that do have deficits, the targets we have set—for example, on waiting times and faster access to cancer treatment— are being met. The overall quality of services to patients continues to improve, but I do not underestimate the very difficult decisions needed in some organisations to restore financial balance.

Since the Secretary of State’s visit to Milton Keynes in the summer, we have seen the closure of the Fraser day hospital and the surgical assessment unit, cuts to mental health services, cuts to language therapy, cuts to oral health services, cuts to podiatry, cuts in ambulance call-out availability, cuts to counselling services and cuts in payments to the hospital of £2.8 million. Despite all those cuts, the primary care trust still needs to find cuts of another £18 million before March, which the chairman says he has

“not a cat in hell’s chance of achieving”.

As well as promising never to come to Milton Keynes again, will the Secretary of State suggest what the PCT should do to make more cuts in Milton Keynes?

I and my hon. Friends will promise to continue voting for record investment in the NHS—in Milton Keynes and every other part of the country. The PCT in Milton Keynes is getting more money than ever before and there will be more fast growth in its funding next year. Yes, people have to make some difficult decisions to ensure that they give patients the best care within available resources. As spending for those of the hon. Gentleman’s constituents who have cancer is below average, while spending on urgent care is above average, I hope that he will support his local PCT in ensuring that it rebalances that spending, puts more services into the community, and increases investment, for instance, for patients with cancer.

Even at this time of record investment in the NHS, everyone involved in providing its services, including in my right hon. Friend’s Department, has to understand that resources are finite, so local services require careful planning. Does my right hon. Friend agree that introducing independent treatment centres in local health economies needs careful planning, as their effect could be to undermine health care trusts that are trying to recover their budgets and go into balance? Does she agree that where independent treatment centres may have such an impact, they need to be reviewed?

I entirely agree. We have written a big cheque for the NHS, but it is not a blank cheque; it never has been and it never will be. Of course, we need to look at the introduction of independent sector treatment centres and we are doing so with the strategic health authorities and others, in each region, to ensure that the centres are properly integrated in the local NHS and continue to give NHS patients better care, but also faster care.

On Saturday, more than 2,500 people marched in the rain to protest against closures and cuts at St. Helier hospital. What assurance can the Secretary of State give me and my constituents that the decision to close 200 beds and cut 500 staff at the Epsom and St. Helier trust will not result in more mixed wards, more premature discharge of patients who are not well enough to go home and a rise in levels of infection at the hospital?

The decisions at that hospital are taken first and foremost, as I hope the hon. Gentleman would expect, on the basis of patient safety and quality of care. Difficult decisions have to made in his part of London in order to ensure that the local NHS gives patients the best possible care within the available resources and does not ask other parts and services of the NHS to bail out its overspending. As demonstrated by the quality and value indicators recently published by the NHS Institute, there is ample opportunity, for example, for hospitals to do more day case surgery, providing better care for patients, with better value for money as well. Those decisions are difficult for the staff, as we all recognise, but it is all about getting better care for patients within budgets that are bigger than ever before.

I fully accept the need for our PCT to deal with its own deficit and get into balance by the end of the year, but it is hard when the strategic health authority comes along in mid-year, takes the money away and tells it to get into balance—and even harder when, with four months to go, the SHA comes back and takes more. Will my right hon. Friend ask the SHA to give us a bit of leeway and assure me that we will get our money back quite quickly in future?

I know that my hon. Friend recognises the difficult decisions that have to be made in order to be fair to trusts that have not overspent, and to ensure that those who have overspent get enough time to take good decisions to get themselves back on track. The NHS is committed to repaying money that has contributed to regional reserves as quickly as possible, usually within the three-year allocation period, and those with the worst health problems will get their money back first. That, I believe, is fair, but the speed with which it can be done depends on the speed with which difficult decisions by overspending organisations can be made so that they get back on track and do not keep asking other people to bail them out.

Does the Secretary of State share my concern that the present financial crisis in the NHS may be leading hospitals into inequitable ways to balance the books? In Basingstoke, hospital car park charges were raised by 25 per cent. this year and the money was used—and needed—to fund medical services in the hospital. Does the right hon. Lady feel that that is right?

I would have to refer the hon. Lady to what the right hon. Member for Witney (Mr. Cameron) has recently said. He is not prepared to wipe out overspending any more than I am. If the hon. Lady believes, as does her right hon. Friend, that decisions should be in the hands of NHS professionals, I wish that she and other Conservative Members would support local NHS professionals when they make proposals and decisions to give better care to patients, with better value for money. As her party voted against increased investment in the NHS, I am not prepared to take lectures from the hon. Lady on how that money should be spent.

My near parliamentary neighbour the Secretary of State is right to say that record investment has transformed performance at the three acute hospitals in the city of Leicester that serve our constituencies. The award of an excellent rating a few weeks ago, followed by an award for being the joint best teaching trust, was no great surprise. Was my right hon. Friend disappointed that, almost in the next post, the strategic health authority wrote requiring the University Hospitals of Leicester NHS trust, which covers the three hospitals, to make further in-year savings of £15 million, which led to operational delays, frozen posts and a range of other changes, including reduced training? Can she reassure the House, our constituents and the million people in Leicestershire, Leicester and Rutland that this bitter pill to swallow will—

My hon. Friend is right to congratulate those at University Hospitals of Leicester on the excellent quality of care that they give to their patients, as confirmed by the Healthcare Commission, but he may not have noticed that, for instance, on day-care surgery those hospitals are well below the national average. On length of stay, for instance for hip fractures, they are well above the national average. Certainly, when I recently met the chair and chief executive of the hospital trust, they confirmed that there is ample scope for them to become even more effective in their use of resources and to continue to give excellent care to patients as a result.

May I turn the Secretary of State’s attention to deficits in mental health trusts? She knows that in May, Rethink produced the report “A Cut Too Far”, which identified at least £30 million-worth of cuts to mental health services, in response to which the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton), who has responsibility for mental health, said:

“There is no evidence to suggest that mental health services were being disproportionately targeted compared to other health trusts.”

Last week, Rethink came up with another £37 million-worth of cuts to mental health services, and the Secretary of State’s mental health tsar had to admit that

“some acute trusts should be ashamed that they have had to be helped out by services that have been historically underfunded”

—that is, mental health services. Who is more in touch with the disproportionate impact of deficits on mental health services—her Minister or her tsar?

Both our tsar and the Minister of State are absolutely right. There is no evidence that mental health trusts are being asked to take any disproportionate burden while the financial problems are sorted out, but the problem that this underlines is that all too often in the past mental health trusts have bailed out acute hospitals. There is a need to make acute hospitals more efficient, and that means more day-case surgery and reduced lengths of stay so that patients do not spend unnecessary days and weeks in hospitals when they would be better cared for at home. It is high time that the hon. Gentleman supported difficult decisions to make acute hospitals more efficient, to give better value for the money contributed by taxpayers and patients, and in that way, we will ensure that we can go on increasing the already unprecedented funding for mental health services as well.

Bed Closures

A constituent of the hon. Member for Morecambe and Lunesdale (Geraldine Smith) suffered a suspected heart attack earlier this month, but instead of being rushed to his nearest heart unit in Lancaster, he was redirected to the heart unit at Westmorland general hospital in Kendal in my constituency, because there were not enough beds at the Royal Lancaster infirmary. Does the Minister therefore share my horror that the trust is planning to close Westmorland general hospital’s excellent heart unit? Will he intervene to save it?

I understand the concern that the hon. Gentleman expresses, but the Liberal Democrats seem continually to advocate devolution, and decisions being taken as locally as possible. To then suggest that a Minister ought to intervene in local decision making is nonsense. Decisions on patient safety and quality of care must be made locally. Those must be the guiding principles that determine such decisions. I urge the hon. Gentleman to make representations on behalf of his constituents, but to accept that those decisions are responsibly made, and best made, locally.

At a cost of only £250,000 a year, my primary care trust is treating 400 drug addicts, thus reducing accident and emergency hospital admissions and the use of beds by drug addicts by more than 400 per cent. Should we not be looking throughout the NHS to see where else we can remove the unnecessary use of NHS beds by drug addicts and others?

I entirely agree with my hon. Friend. We want exactly that kind of best practice to become mainstream. The difficulty is that when there is local advocacy to shift resources, quite rightly, from acute services to community-based and preventive services, the Opposition parties irresponsibly proclaim that that means cuts, when those changes will in fact lead to better services for patients and more rehabilitation, thus preventing such conditions from deteriorating. Surely that is the responsible way to develop a modern national health service.

Those of us with community hospitals and other health care assets that are being shut down on the back of sham, tick-box consultations will agree with the new NHS chief executive, who wrote to MPs last week in the following terms:

“The NHS certainly needs to improve how we listen, engage and respond to the genuine concerns of the public, patients, clinicians and other stakeholders.”

Developing that statement of the glaringly obvious, will the Minister say specifically what shortcomings Mr. Nicholson has identified during his short tenure, and what improvements in listening, engaging and responding our long-suffering constituents can look forward to?

The Opposition really must think that the British people are stupid. This is the first Government to announce a £750 million programme over five years to develop a new generation of community hospitals, which will shift resources from acute health care to preventive and community-based solutions. It is not true to say that we are going backwards in terms of community hospitals. This is the first Government to say that we need to modernise and improve community hospitals. As for consultation, when we proposed the reconfiguration of primary care trusts, the consultation process took note of what local people said, and as a consequence, many of the proposed reconfigurations were changed. We will take no lectures on consultation from the Opposition.

Diabetes (Stoke-on-Trent)

11. What the increase has been in the number of people with diabetes in Stoke-on-Trent over the last five years. (103777)

We do not hold the information in the format requested. Our latest figures show that there has been an overall increase in the prevalence rate of diabetes in Stoke-on-Trent of 11.3 per cent. since 2004.

I thank the Minister for that reply, but in Stoke-on-Trent the rate is 4.2 per cent., compared with the national average of 3.6 per cent. My constituents are distressed about the fact that the PCT and GPs are taking away blood glucose test strips. Does she agree that it is really important to have a structured education and support system in place, and will she work with the national Diabetes UK association and the all-party group on diabetes to try to find a way of making sure that we do not have health inequalities of that kind in areas such as Stoke-on-Trent?

My hon. Friend is right to say that that kind of supported education programme is extremely important. The work done by Diabetes UK, together with some of the regional teams that we have set up through the Department’s diabetes national service framework, is making a real difference in many areas of the country. I know that, particularly in her area, diabetes clinics, patient information and the work of the diabetes networks have been effective in putting in place some of the education to which she refers.