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Oral Answers to Questions

Volume 456: debated on Tuesday 6 February 2007


The Secretary of State was asked—

Hornsey Central Hospital

1. What assessment she has made of the performance of Hornsey Central hospital; and if she will make a statement. (118583)

Hornsey Central hospital closed in 2000. At the time of its closure the hospital was underutilised and in a poor physical condition. In November 2006, Haringey Teaching primary care trust board endorsed plans for a new community hospital on the Hornsey Central site. The PCT aims to commence building work in the summer.

I thank the Minister for that statement. He will be aware that the London strategic health authority backs the bid for community hospital funding from the Government, but my understanding is that it is held up by technical accounting difficulties because of its connection to a local improvement finance trust scheme. Will he assure my constituents that they will not be denied this health facility due to those technical accounting difficulties?

I have been reading the hon. Lady’s blog on this very subject, and I commend it to all hon. Members as an eloquent and persuasive endorsement of Government health policy, calling as it does for an expanded range of services delivered from a modern community hospital setting. She will know that the Department is considering the very bid to which she refers, but I hope that, like me, she will celebrate the fact that her PCT has endorsed this ambitious £12.8 million scheme, which seems likely to succeed. I look forward to reading on her blog about it all being made possible by Labour’s substantial investment in the NHS.

Macular Degeneration

2. What provision her Department has made for funding treatments for macular degeneration; and if she will make a statement. (118584)

All primary care trusts are funding photodynamic therapy for age-related macular degeneration in line with National Institute for Health and Clinical Excellence guidance. NICE is appraising Macugen and Lucentis for treating this condition and it expects to publish guidance in October.

I am sure that my right hon. Friend is aware that Macugen, an anti-vascular endothelial growth factor drug that can stop macular degeneration occurring in the eyes of elderly people, has already been approved in Scotland. As the increase of diabetes is likely to result in a vast increase in age-related macular degeneration, is it not time that the English authorities were allowed the same funding to give people the drug that is now available in Scotland?

My hon. Friend is right that the Scottish Medicines Consortium has approved Macugen since August, although it has not arrived at any decision on Lucentis. Its view will be superseded by NICE guidance when it is available. The important thing is that decisions on the cost and clinical effectiveness of new drugs should be made by independent clinical authorities, not by politicians, and that is precisely why we established NICE and back it in making its judgments.

The Secretary of State will be aware that 57 people start to lose their sight daily through this condition, and the average annual cost of support is £9,500. Given that these therapies are widely regarded as being very effective, is there not a case for fast-tracking the NICE decision so that fewer people go blind?

No patient should be refused Lucentis or Macugen simply because NICE guidance does not yet exist, but NICE needs to evaluate the new treatments thoroughly and it has decided, I think rightly, to evaluate them together so that the two treatments can be compared with each other as well as with the existing treatment. That means that it is taking a little longer, although it started on the evaluation before Lucentis was licensed, as it was only a couple of weeks ago. The guidance will be ready as fast as possible, consistent with arriving at a good, thorough and fair decision.

My right hon. Friend will know that wet AMD is also being treated at the moment on the NHS in some parts of the country by the use off-licence of a drug called Avastin that is licensed for the treatment of bowel cancer. When or if either of the drugs being appraised by NICE come into the marketplace with NICE’s approval, will Avastin still be available on the NHS if both the clinician and the patient believe that it should be?

My right hon. Friend has raised an extremely important point. As he has said, Avastin has not been licensed for use on macular degeneration, although it is being used by some clinicians with the support of the NHS. The problem is that the companies concerned—Genentech which manufactures it and Roche which distributes it in Europe—have not applied for a licence for its use on macular degeneration, and no clinical trials have been conducted for that purpose. At the moment, if a clinician wants to use Avastin and the patient is willing to have an unlicensed drug used, it is available on the clinician’s judgment, which will continue to be the case within the NHS. Although we cannot require the companies concerned to apply for a licence, in view of the very promising results that have been reported by a number of doctors, I urge both companies to initiate clinical trials for the use of Avastin for people with macular degeneration and to consider applying for a licence in the light of those trials.

What is the Secretary of State doing to ensure that people have the same opportunity to receive treatment for macular degeneration right across the country? In particular, Northern Ireland seems to be the last part of the United Kingdom to receive access to drugs, while others on the mainland benefit from them based on NICE guidelines.

Health is a devolved matter. At the moment, I understand that the health boards in Northern Ireland are not funding either Macugen or Lucentis. However, I am sure that they will want to take account of the NICE guidance, as soon as it becomes available.

On the basis that prevention is better than cure, will my right hon. Friend congratulate Simon Kelly’s team at the Royal Bolton hospital, which has established a firm link between AMD and smoking? Does she agree that we should get the message across to all smokers in the land to try to avoid incidences of that difficult condition?

My hon. Friend is absolutely right, and I readily congratulate that team on its excellent research. The introduction of smoke-free legislation later this year will be an important step forward in public health generally, and specifically in reducing the risk of other people acquiring that appalling condition in future. We will, of course, redouble our efforts to get across the message about the huge dangers involved in smoking for people of any age.

Does the Secretary of State agree that the cost of the drugs that can have a successful effect on people with conditions such as AMD are insignificant compared with the social costs of failing to treat such diseases?

The hon. Lady is right, because one has to look at the consequences for an individual and for social care and health services of a patient losing their sight. However, it really is not good enough for Conservative Members constantly to demand additional funding for new drugs, new treatments and additional services, when they have been wholly unwilling to support additional investment in the NHS—investment that we made and they voted against.

I think that the frightening thing is the speed with which the degeneration occurs—one of my constituents recently wrote to me about it. What are the Government doing to further research into vision and particularly into AMD? I welcome the Secretary of State’s statement on Lucentis today.

My hon. Friend has raised an extremely important point. Research on vision and on many medical conditions is the responsibility of the Medical Research Council, the funding for which we have significantly increased. I draw my hon. Friend’s attention to the review that we recently published of eye-care services, which emphasises the need to ensure that local primary care trusts get the best possible local eye-care services, with an emphasis on early diagnosis and better treatment in the community.

As we have heard, despite Macugen being approved by the Scottish Medicines Consortium, and Lucentis receiving its European licence, neither drug will be appraised by NICE until later this year. Given the real concern felt by many—in particular, the Royal National Institute of the Blind and people such as Alice Mahon—that cash-strapped PCTs are withholding funding, and given the fact that the Government are not assessing what proportion of patients recommended for such treatments are being turned away, which is something that my PCT is struggling to answer, what concrete assurances can the Secretary of State give that PCTs are following her instruction that funding should not be withheld purely on the grounds that NICE has not yet issued its guidance?

Just before Christmas, we reiterated guidance to the NHS that no patient should be refused Lucentis or Macugen, or indeed other treatments, simply because NICE guidance does not yet exist. Until NICE issues its guidance, as it will later this year, it is up to each primary care trust, whose professional executive is chaired by a clinician, to consider each case on an individual basis. The hon. Gentleman has to decide whether he supports NICE, which is widely regarded as a model around the world, or wants to go on undermining the outstanding and important work that it does.

Maternity/Paediatric Services (Hartlepool and Teesside)

4. If she will make a statement on the recommendations made by the independent reconfiguration panel on maternity and paediatric services in Hartlepool and Teesside. (118587)

My right hon. Friend the Secretary of State agreed the recommendations of the independent reconfiguration panel as regards building a new hospital accessible to the people of Hartlepool, Stockton, Easington and Sedgefield and improving local community services.

Two and a half years ago, the Prime Minister was quoted in the Hartlepool Mail as saying, with regard to the University Hospital of Hartlepool:

“There is no question of the hospital closing or services being run down. John Reid is saying it won’t close, I’m saying it won’t close, I don’t know what the next authority is you go to.”

Given that, as my right hon. Friend said, the Secretary of State has accepted recommendations from the independent reconfiguration panel that will result in the closure of the hospital, can she advise me as to what authority I go to next?

I should remind my hon. Friend that in terms of the independent reconfiguration panel recommendations, we are talking about opening a new hospital. I recognise that changing the way in which health services operate is a very emotive issue, as he has indicated. However, it is also important to say that the panel looked at the best way of ensuring that maternity and paediatric provision met high-quality care and safety standards and concluded that centralising consultant-led maternity and paediatrics on one site would make the best use of staff and ensure patient safety.

May I support the hon. Member for Hartlepool (Mr. Wright) in the concern that he expressed? I declare an interest as an honorary vice-president of the Royal College of Midwives. Midwives are deeply concerned about the reduction in paediatric and maternity services that will occur throughout the country if the Government’s proposals are carried forward. Will she listen to the RCM, which represents mothers, babies and mothers-to-be? Its views are important, and it believes that the local provision of paediatric and maternity services is essential for the safety and well-being of mothers and children.

Midwives are always deeply concerned to ensure that the services offered are safe and of high quality. I refer the hon. Gentleman to the report that has been published today, which my hon. Friend the Under-Secretary has put together with input from the Royal College of Midwives. It talks about the importance of those services but also recognises that things sometimes have to change as regards the way in which they are delivered, particularly when demographic changes and changes in medical technology and staffing patterns mean that there needs to be a bringing together of services if they are to be safe and of high quality. That is the best thing for patients and for midwives as well.

Will my right hon. Friend assure the hon. Member for Macclesfield (Sir Nicholas Winterton) that there is no threat to maternity services in Hartlepool and never has been? The residents of Hartlepool—I am a Hartlepudlian by birth and upbringing—are worried about reports in the press that the hospital at Hartlepool will be demolished. That cannot be so. As the new hospital is established and begins to function, it will provide specialist services, but Hartlepool General hospital will remain as a secondary form of medical provision—hard-nosed clinical provision for the community.

My hon. Friend is quite right to say that and to point out that there is a consultation process on how to put together a package to examine existing facilities, improve services in the community and prepare for a new hospital with high standards of safety and care.

Will the Minister consider favourably requests to refer cuts in community hospitals to the independent reconfiguration panel? My constituents refuse to believe that the closure of every NHS bed in our community hospitals will serve their needs and they hope that the panel will intervene. I look forward to an answer from the Minister.

I am sure that the hon. Gentleman knows about the process that has been established to make referrals to the independent reconfiguration panel. Consultation is undertaken with the local community; overview and scrutiny committees can examine that and refer the results to the Secretary of State, who decides whether to take them to the independent reconfiguration panel.

Will my right hon. Friend confirm that the consultants of North Tees and Hartlepool NHS Trust made a statement to the independent reconfiguration panel that the maternity and paediatric services are not safe enough or of sufficiently high quality? Will she explain why a new hospital would ensure that we have safe services that are of sufficient quality for the constituents whom we represent?

My hon. Friend is right to say that the clinicians showed strong support for the independent reconfiguration panel’s conclusions. A consultation is taking place on them, but she can be assured that the outcome will be high quality, safe services, which are best for her constituents.

As the Minister knows, the independent reconfiguration panel’s conclusions in December 2006 are similar to those of the Tees service review, which reported in December 2003. Will she therefore tell the House why, in August 2004, the Department instructed the strategic health authority to conduct its own review to revisit the Tees service review?

The future of maternity and paediatric services in the area has been controversial for many years. Opinions have differed. Emerging standards were set when we considered the way in which paediatric services should be delivered. The Darzi review was undertaken, but when the Secretary of State examined the issues that the joint overview and scrutiny committees raised, it was decided—straightforwardly—to refer the matter to the independent reconfiguration panel.

I wish that the Minister would be honest and say that, in July 2004, Peter Mandelson said that he was off to Europe to be a Commissioner and a by-election was held. The Department held a review with the intention of maintaining the fullest range of services at Hartlepool hospital so that the Secretary of State and the Prime Minister could promise the people of Hartlepool that their hospital would be maintained. That is now all over. How can the Minister justify the fact that three years have passed, during which money was spent and people in Hartlepool and north Tees did not know what would happen to them, only to arrive at the same position? How can she and her ministerial friends have the effrontery to accuse us of standing in the way of change when, during the by-election, her right hon. Friends, including the Prime Minister, objected to change?

The hon. Gentleman has to make up his mind whether he is interested in a future for patients and people who work in the health service or whether he wants to go around nit-picking about every decision that is made. The process has been clear and decisions have been taken in the best interests of patients in the area. It is about time that the hon. Gentleman got behind the decision-making process and the improvements that we are making to the NHS in the local area.

I empathise with my hon. Friend the Member for Hartlepool (Mr. Wright). Will the Minister and the Secretary of State deal with an issue that I raised last month—whether the decision of the Greater Manchester PCT should be referred to the independent reconfiguration panel?

Order. The hon. Gentleman informed me before the business of the House started that this question related to his hospital, but this question is about Hartlepool.

Internal Market

5. What assessment she has made of the effects of the operation of the internal market in the national health service on staff morale and job numbers in trusts which lose service provision. (118588)

We had ample opportunity to assess the disastrous effects of the NHS internal market that the Conservative Government introduced in the 1990s, which is why we scrapped it. By contrast, this Government’s approach has seen record investment in the NHS with about 300,000 more staff compared with 1997, better pay and longer holidays for our NHS staff, more choice for patients and waiting lists at their lowest level since records began.

I thank the Secretary of State for that reply. I was not allowed to use the word “marketisation” when I tabled the question, but marketisation certainly still exists. That was brought home to me by letters from constituents—highly skilled cytologists in the county of Worcestershire. That county has just lost the contract for its own cytology services to Gloucester, which is 40 to 50 miles away from where my constituents live. With the increasing impact of marketisation on health care, this problem will—

Order. I try to give the hon. Gentleman some leeway because he is an independent Member and works on his own, but a long speech is not proper in these circumstances.

Thank you, Mr. Speaker. As it happens, I have had the opportunity to see the hon. Gentleman’s column in his local newspaper, Kidderminster’s The Shuttle, in which he objected to the fact that his local NHS was getting its cervical smear service in the most efficient way possible. I draw his attention to what Dr. Abudu, the cervical screening co-ordinator for the local primary care trust, said—that the new cervical cancer screening service will give women faster and better results and that they will go on having their samples taken locally. Although I have great respect for the hon. Gentleman’s clinical expertise, I would expect him to support his local NHS in getting the best value and the best services for his local constituents, which is—

Is it not the case that the various royal colleges speak out strongly in favour of an internal market and service reconfiguration? What more can the Secretary of State do to ensure that senior consultants argue strongly for service reconfiguration when it is in the best interests of good clinical practice.

My hon. Friend is absolutely right that clinicians need to be in the lead in deciding how best to organise local services and then in arguing the case—if the decisions are difficult, as they sometimes are—with the local public. I am glad to say that this morning we published two excellent clinical reports from the national clinical director for maternity and children’s services making the case for change and yesterday we published a report from the national clinical director for primary care services. That is exactly the kind of approach that the royal colleges are, I am glad to say, supporting.

May I ask the Secretary of State about the impact that the private clinical assessment, treatment and support centres—to which patients will be referred by their GPs, first in Cumbria and Lancashire—will have on what seems to me to be the internal market? Is not there a risk that these centres, with their guaranteed income, will distort the internal market, and directly undermine patient choice and staff morale? Might not they create the possibility of a conflict of interest in which the same group runs the treatment centre to which patients will be referred? Will they not also undermine the viability of local hospitals?

Clinical assessment and treatment services are an essential part of continuing to give patients better and faster care and, in particular, of ensuring that we achieve our goal of reducing waiting times to an absolute maximum of 18 weeks for most hospital operations by 2008. For most patients, of course, the waiting time will be far less. Whether those services are run by NHS organisations or by the independent sector will depend on decisions being made in each region on how to get the best services and the best value for money. I hope that the hon. Gentleman will support that, because it is in the interest of patients.

GP Services (Calderdale)

6. What assessment she has made of recent changes to GP services in the Calderdale primary care trust area. (118589)

In recent years, there has been a steady increase in the number of GPs working in the Calderdale primary care trust area, and major improvements to primary care facilities.

I thank my hon. Friend for that reply. Hundreds of residents in the Mixenden area of my constituency have recently signed a petition calling for their local GP surgery, which is very popular and vocal in the community, to be included in the redevelopment plans for the area. Will the Minister outline what support his Department will give to the project to improve GP services in that part of Halifax?

My hon. Friend’s constituents will welcome the announcement today of an additional £202,000 for capital investment in her primary care area. The local primary care trust is seeking additional GP hours at Horne street, in the centre of Halifax, for which I know my hon. Friend has been campaigning. Also, between 2001 and 2005, four new purpose-built practices have been built in the area, including the Horne street health centre, and there have been major extensions and refurbishments at a further eight practices. My hon. Friend’s local community has already seen massive investment in primary care as a consequence of this Government’s policies, and I expect that to continue. I hope that she will continue to work in partnership with her primary care trust to continue the investment in primary care services.

I am sure that GPs and patients will benefit from GP services being opened up to enable them to do more clinical work, with less being done in hospitals. Does the Minister agree, however, that there should be no role for bureaucrats in the PCTs blocking referrals from Calderdale or other PCTs for any other reason than clinical need? On what grounds have 100,000 more managers and bureaucrats, who are blocking treatment on grounds other than clinical need, been appointed to the health service since 1997?

That is a disgraceful attack on the integrity of the people who do their best to manage the health service in our local communities. What we really need is a proper partnership between the managers and the clinicians—supported, I hope, by responsible politicians—making the right decisions locally to meet the needs and expectations of patients. If the formula advocated by the hon. Lady’s party were applied to her constituents, there would be a reduction in health expenditure in her constituency.

NHS Finance (Oxfordshire)

7. What assessment she has made of the number and nature of reductions in clinical and care services that may be required to achieve financial balance in the NHS in Oxfordshire. (118590)

I am surprised that the Minister is unable to make an assessment about the service cuts, because Oxfordshire primary care trust has been forced to create restrictions, including those on consultant-to-consultant referrals, and on so-called low-priority treatments for hernias. It is now looking at placing restrictions on hysterectomy, tonsillectomy and D and C procedures. As someone who voted for the increased resources that the Government put in, and for the tax rises involved, will the Minister now explain what “elective stretch” is? Will he confirm that it involves forcing people to wait up to the maximum waiting time, as is now being proposed in Oxfordshire? That is not what we envisaged when the Government were talking about reducing waiting times.

Does the hon. Gentleman welcome—I should like him to nod if he does, if that is allowed—the 17 per cent. increase in allocation for revenue over two years in his PCT area? Does he welcome today’s announcement of an additional £1.4 million capital in his local PCT infrastructure, which is an increase from £1.1 million last year? It is not Liberal Democratic policy to spend one additional penny on the national health service—

Will my hon. Friend join me in praising the accomplishment of staff at all levels in the NHS in Oxfordshire, not only in reducing the deficit, but in starting up the wonderful new children’s hospital that we have alongside £100 million of new investment to extend services relocated from the Radcliffe infirmary? Are not those achievements of which the NHS and the local community can truly be proud?

At last, a right hon. Member who is talking up the national health service and paying tribute to the everyday heroes—the professionals on the front line—who are making a difference to the quality of patients’ lives. The reality is that much of the redirection of resources in local health economies is leading to enhanced services, resulting in services that patients need and want. I am proud of the fact that we treat children in our national health service no longer as little adults but as children, and ensure that they have access to the specialist services that they need and deserve.

Many of the changes in Oxfordshire that are causing concern are not cost driven; they are seemingly driven by a desire to centralise. Labour’s manifesto at the last general election promised that mothers would have greater choice. If the recommendations of the Shribman report, published today, are followed through, that will reduce choice for mothers and threaten many valued maternity units, such as that at the Horton general hospital in Banbury. Why are this Government so hellbent on centralising NHS services?

What women and fathers tell us they want from the whole experience of antenatal care, post-natal care and the actual birth is choice. That choice is home birth, or the opportunity to have the birth at a maternity-led unit or a consultant-led unit. What is important in every community is that we make a reality of that choice for home-based birth, midwife-led birth and consultant-led birth. When we produce our plan to deliver our commitment that by 2009 every parent in every community will have access to that choice, the hon. Gentleman will finally understand that we are responding to what parents tell us they want.

Some of my constituents have written to me to say that they cannot get vital cancer treatments on the NHS in Oxfordshire, but now have the opportunity to travel and make use of addresses in Scotland, where such treatments are free. What advice, encouragement or support can the Minister offer such patients?

Does the hon. Gentleman support the role of the National Institute for Health and Clinical Excellence, because the Conservative party needs to make that clear? How dare he talk about cancer care when waiting lists and waiting times are at record low levels? The scandal was that too many people died unnecessarily because of the disinvestment in the health service under the Conservatives.

Local Improvement Finance Trust Scheme

8. What assessment she has made of the NHS local improvement finance trust scheme; and if she will make a statement. (118591)

The NHS LIFT scheme is delivering modern surgery facilities that co-locate a range of services offered in the heart of deprived communities. To date, 107 super-surgeries have opened under the LIFT scheme and a further 80 are under construction. Throughout 2006, on average one facility opened every week—a rate of progress we expect to continue throughout 2007.

I thank the Minister for that reply. In my constituency, the LIFT centre in Stapleford serves 18,500 of my constituents—nearly a quarter of the whole constituency—with a range of services from health to dentistry to social services and many others that were not available locally before. In my last question at Health questions, I asked Ministers about the difficult reorganisation of secondary services in Nottingham. In this question, I ask the Minister to reinforce success. As my hon. Friend the Member for Bolton, South-East (Dr. Iddon) says, prevention is better than cure; let us reinforce the primary health sector.

I could not agree more with my hon. Friend. The Stapleford care centre scheme is an excellent example of the success story that is LIFT. It has quietly got on with investing £1.2 billion in some of the most deprived communities in the country, which often have the poorest primary care services, and is delivering for constituents such as those of my hon. Friend. The extra time that we have allowed Nottingham University Hospitals NHS Trust may provide breathing space which will allow staff to work in the new community facilities that have been created in my hon. Friend’s constituency and others nearby.

The maternity unit in Oswestry closed last Wednesday, and there is huge public pressure for it to be reopened as a demountable unit. Would LIFT funds be relevant to such an operation? I shall be visiting the strategic health authority tomorrow; would the Minister like to ring the chairman and chief executive before my meeting?

I commend the hon. Gentleman on his opportunism, but LIFT relates to primary care facilities throughout the country. We have heard him make his point about his constituency, but I think he should be focusing his attention on what his party will do to improve primary care in the same way as the Government.

How does the 30 per cent. increase in capital funding for PCTs fit in with the LIFT scheme? Should the Government not be focusing investment much more on dental practices, so that areas such as Biddulph in my constituency can have new NHS dental surgeries?

My hon. Friend is absolutely right. Only today we announced £60 million of capital for primary care trusts across the country to invest in improving dental facilities for communities like my hon. Friend’s, and her PCT will benefit from the extra cash.

The truth is that more dentists and more GPs are working in our communities. There is more to be done to ensure that people everywhere have access to the highest-quality primary care services, but we have a strategy to provide new buildings through the LIFT scheme and recruit extra staff to work in some of the most deprived communities in this country.

What is the Minister doing to ensure that the exclusivity given to LIFT companies is not deterring or deferring other interested investors from building new GP surgeries, community hospitals and other core services in LIFTCo areas?

The hon. Gentleman makes the point very well. A mixture of investment is being made in primary care: LIFT is one example, but other forms of finance are also improving primary care facilities. What is important is not the means by which funds are delivered, but ensuring that facilities are built quickly so that we can rapidly improve primary care in communities—particularly those that need enhanced primary care services—and prevent the ill health to which Labour Members have referred.

Private Sector

Improving public health relies on the engagement of many partners in the private, public and voluntary sectors, as well as individuals and their families. There are many examples of private sector employers making a positive contribution, and of key agents contributing to improving public health.

Contrary to what the Secretary of State told my hon. Friend the Member for North Norfolk (Norman Lamb) a few moments ago, the Government gave PCTs no choice but to enter into private contracts with providers of non-complex, non-urgent procedures. Those private treatment centres are still being paid regardless of whether they complete the work. Have the Minister and the Government made any assessment of how much taxpayers’ money has been wasted on those contracts, and on contracts like them?

What is clear is that 480,000 people have already benefited from access to independent treatment centres. The way in which the NHS used to buy from the independent sector—the old-style ad hoc spot-purchase procedure—led to the paying out of more than 40 per cent. of the cost of the same sort of service. Bulk procurement has cut the cost of doing business with the independent sector.

I am pleased to say that the Plymouth and Bodmin treatment centres are on target for up to 100 per cent. capacity. I am sure the hon. Gentleman would not want to suggest that his constituents should not benefit from quicker and good access to health care.

I was very taken when I visited a pharmacist in my constituency recently—Coopers chemist on Abel street in Burnley—by quite how much work it does in the field of public health, such as in methadone administration and smoking cessation. Is that a model that my hon. Friend the Minister hopes to build on?

I thank my hon. Friend for that contribution. Our partnership with pharmacists has grown and grown. Chlamydia testing is happening throughout London through Boots, many pharmacists provide blood pressure testing, and I am pleased to say that next week the Co-op is promoting condom use as part of our safe sex strategy. I will be down at the Co-op in Rossington to support that, and I hope that every Member will take the opportunity to support their local Co-op in promoting good sexual health. However, we have not begun to realise the contribution that pharmacists can make in providing the best quality services at the most local level for the people whom we all represent.

Wilson, Mr. Speaker; nearly there.

Is the Minister aware that recent research has found that when a hospital is built on a 30-year private finance initiative basis, the taxpayer ends up footing a bill of £55 billion for only £8 billion-worth of investment in capital assets? Does the Minister think that that is good value for money?

Of course we are not just talking about paying for the building; we are paying for the services as well. We should also be mindful of the fact that when we came to power in 1997 much of NHS stock predated the establishment of the national health service. I am proud that we have been behind a major hospital-building programme—not only hospitals, but LIFT projects—and that we have been working with different partners in the community to provide the best possible health service for all the people of England.

Is not the private sector’s involvement in public health through the food industry’s guideline daily amount food labelling system confusing, complex and requiring of a certain strenuous level of mental arithmetic? Is it not really an attempt to undermine the Food Standards Agency’s traffic light system? I can say with some personal authority that showing the red light to fat, sugar and salt is the correct thing to do.

It is fantastic that a discussion about which system should be displayed on the front of our packets of meals of whatever sort—such as shepherd’s pie or soup—has become so prominent in public debate. I personally think that the colour-coded traffic light is easy to glance at, but we, along with the industry and the FSA, have commissioned some independent research to find out what works best for consumers. I would not mind if we had a mixture of both GDA and traffic light; I think that that would be helpful. However, what is important is that we have something that is simple for the public to understand.

Has any assessment been made of the impact that the proposed independent treatment centre at Braintree might have on the Broomfield hospital PFI scheme? Will the Minister be kind enough to ask her hon. Friend the Minister of State, the hon. Member for Leigh (Andy Burnham), the answer to Question 18, so that she can tell me when it is expected that that scheme will get the go-ahead—or that it will not?

I understand that there will be announcements soon, and intensive discussions are taking place between the trust, the strategic health authority and officials to conclude the rescoping exercise. I am sure that my hon. Friend the Minister of State has heard the hon. Gentleman’s point about where the independent treatment centres fit into that jigsaw.

UK Stem Cell Bank

I am grateful to the Minister. Does she agree with the Medical Research Council, the scientific community and patient groups that there have been enormously beneficial developments—for instance in tackling neurodegenerative diseases—as a result of research combining animal and human materials? Given that she allows research involving human embryos, why is she delaying important research involving chimeras and hybrids? Is that not inconsistent, and is that not putting important medical research in the UK at great risk?

We are not seeking to disadvantage research in the UK in this area at all. However, to date, Parliament’s stance has been to prohibit the creation of hybrids or chimeras, backed by various committees and expert groups—

Yes, many scientists took part, and I am happy to write to the hon. Gentleman to that effect.

We think that we should go further than the law currently allows, which is why we propose to make exceptions to the prohibition by way of regulation. As the hon. Gentleman will be aware, the Science and Technology Committee is holding an inquiry, and the Human Fertilisation and Embryology Authority is also discussing and debating this issue. I felt it very important to have pre-legislative scrutiny of changes to human fertilisation and embryology legislation, to make sure that we have as wide a discussion as possible. We are not trying to deter research in the area, but we have to be absolutely convinced that such research can be carried out and regulated in the right way, to make sure that we can take public confidence with us.

NHS Finance

11. What assessment she has made of the effect of GP and consultant pay rises on NHS finances; and if she will make a statement. (118594)

By next year, this Government will have trebled investment in the national health service compared with 1997, including substantial extra funding for GP services and a new consultant contract. That has led to 32,000 more doctors in the NHS compared with 1997, and the improving or refurbishing of more than 2,800 GP premises.

GPs and consultants are both dedicated and hard-working. Parts of the NHS are clearly short of funds, yet there has been a recent fifteenfold increase in consultants’ pay, and GPs earn, on average, more than my chief constable, considerably more than a brigadier and nearly four times average teachers’ pay. Is it not therefore time for us to draw a clear line between the money paid to GPs and consultants to do their job, and the money that they have to provide services?

I am very interested in the implication of what the hon. Gentleman has to say, and I am sure the British Medical Association will be too, since he seems to be proposing a reduction in GP pay. The reason why GPs are paid significantly more under our new contract is that we were determined to deal with the parlous state of general practice that we inherited from the hon. Gentleman’s party and his Government, when thousands of GPs were taking early retirement and medical students simply did not want to become GPs. As a direct result of our new contract, GPs are doing far more to prevent ill health and far more to support people with long-term conditions. The result, as a recent international survey showed, is that our general practice is among the best in the world.

Does my right hon. Friend remember that before 1997 the general public were concerned about the brain drain of doctors going to work in other countries, and will she make sure that we do not return to those days by ensuring that we pay doctors properly?

My hon. Friend is right, and I am proud of the fact that we have more than 32,000 GPs, which is a rise of more than 4,500 compared with 1997, and very nearly double the number of GP registrars in training. That shows that the investment, improvements and reforms that we are making in the NHS are paying off for GPs and their patients. All of them would be put at risk by the policies of the Conservative party.

The Government negotiated a new contract with GPs, defined in it a series of outcomes that the Government presumably want, and linked the payment of improved remuneration to GPs to the delivery of those outcomes. The Secretary of State then made a speech blaming GPs because their income has gone ahead of her budgetary expectations. Is it not hardly surprising, therefore, that morale among GPs is low and that there is a divorce between them and the Government? The GPs feel, “If we’ve delivered what the Government wanted, what more can we do?”

I am very surprised that the right hon. Gentleman has not welcomed the fact that there are 360 more GPs in our east midlands region than there were when he left office. We did indeed negotiate with the BMA a performance-related pay contract. Because GPs are doing so much more than we anticipated at the time, particularly on prevention and long-term conditions, they are rightly being paid more. We will of course continue our discussions with the BMA, in order to ensure that the public go on getting the best possible value from that contract, but now that we are giving GPs even greater freedom and responsibility with practice commissioning, I have no doubt that the services that patients receive in the community from general practice will continue to improve under this Government.

My right hon. Friend will know that I had the pleasure of welcoming her excellent Minister of State, my hon. Friend the Member for Leigh (Andy Burnham), to Leicester, East, where he launched a new £12.8 million GP centre for my constituency. I agree that it is important that we should pay GPs a proper salary, but what responsibility will she place on them to ensure that they provide more training contracts for trainee doctors? I have heard anecdotal evidence of students going through medical school and coming out to find that there are no jobs for them. Can my right hon. Friend ensure that there is more responsibility on GPs to ensure that that does not happen?

I am delighted to hear my right hon. Friend’s praise for the new GP centre and new health centre in his constituency, and I know that it is excellent. I am glad that the number of GP registrars in training has doubled, as I have said. Although we have some 300,000 more staff in the NHS than in 1997, some newly qualified graduates are finding it difficult to get jobs this year. However, I am glad to say that there are some 2,000 more training places available for new doctors than there are medical graduates in England. I hope that that reassures my right hon. Friend.

Is not the real point of public concern the one raised by the hon. Member for Cannock Chase (Dr. Wright) in Prime Minister’s questions last week, when he asked the Prime Minister—and received no satisfactory answer—why GPs are being paid considerably more and doing considerably less in the way of after-hours and weekend service?

I stress that if a GP practice has decided not to carry on taking responsibility for out-of-hours services—and most of them chose not to do so—it does not get paid for that service, which is then the responsibility of the primary care trust to provide. In most places, that system works very well. GPs are earning more because they are doing more. In particular, they are doing more to care for people with long-term conditions, such as coronary heart disease, and there are thousands of people who are alive today as a direct result of the new contract. I would have thought that the hon. Gentleman would want to congratulate GPs on that achievement.

Will the Secretary of State tell us why on 17 January she told the BBC that the Government should have insisted that the new GP contracts limit the profits that hard-working GPs can earn in relation to total income, but on 4 February she told ITV that she did not believe in capping GP profits? She is all over the place. Will she tell the House her view today?

I have made it clear ever since I became Secretary of State for Health that part of our responsibility is to ensure that we get the best possible value for the increased investment and contributions that we have asked all our constituents to pay. As I have indicated, the main reason GPs are being paid significantly more is that they are doing more under the quality and outcomes framework. It is also true that a number of GP practices are taking a larger share of the practice income as profits. That is of course an issue that we will continue to discuss with the BMA to ensure that the increased investment that we are making in GP practices continues to be reinvested for the benefit of patients, as well as giving GPs the fair return that they deserve.

NHS Staff Pay

Is the Minister aware that the Maidstone and Tunbridge Wells NHS Trust has written to its staff asking them

“to contribute one extra day of work without additional pay”?

Given the mess that Ministers are making of the NHS, with community hospitals under threat and physiotherapy, midwifery and health visitor jobs cut, and an inherited deficit for that trust of £17 million, which is carried forward year after year, would not it be more logical for Ministers to give up a day’s pay and contribute it to the trust?

I know that the trust wrote to its employees and that that followed the setting up of a clinical governance group, which considered possible measures in response to a projected overspend of some £5 million. In retrospect, the group, which included staff representatives, felt that it had gone slightly over the top in that request. The trust is still looking for ways to cut back—for example, on agency and bank staff—but it is rightly also seeking to ensure that it breaks even at the end of the financial year.

Making It Better and Healthy Futures Consultations

13. What requests she has received from overview and scrutiny committees in Greater Manchester to review the “Making It Better” and “Healthy Futures” consultations. (118596)

My right hon. Friend the Secretary of State today has asked the independent reconfiguration panel to undertake a review of the issues raised in relation to the reconfiguration of in-patient services for women, babies, children and young people in Greater Manchester.

I welcome that announcement from the Minister. I am sure that she is aware of the strong feeling in Rochdale about the Rochdale infirmary. The campaign to preserve that hospital is ably led by Father Arthur Nearey, the chairman of the Friends of Our Hospital group. What is the time frame for the inquiry? Will the Friends of Our Hospital group be consulted on the proposals that are made?

There will certainly be full consultation on the proposals. We will announce the timetable in due course. The area to be covered is rather large, so I expect the consultation to take at least three months.

One can imagine that the news that there is to be another stage in the process will not be welcomed in those areas of Greater Manchester where people had thought that maternity and paediatric services were established. My constituency is one of those areas, so what reassurances can my right hon. Friend give me that ministerial commitments made on the Floor of the House about the future of secondary paediatrics and maternity services at North Manchester general hospital will be met by the further review?

As I am sure my hon. Friend knows, a very clear process exists for these matters. The proposals will go before the joint overview and scrutiny committees, which will look at all the relevant clinical evidence and take into account all the points that have been made in the consultation process so far.