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Volume 458: debated on Tuesday 13 March 2007

The Secretary of State was asked—

Local Improvement Finance Trust Schemes

It is for Leicester City primary care trust to determine its plans for LIFT schemes by developing its strategic service development plan. I am pleased to confirm that it has already opened three new buildings to patients, with another two under construction, and five more in the planning stages.

I welcome the Government’s huge investment in our health service in Leicester, but what explanation can I give to my constituent, Mr. Mark Golding, whom I met on Saturday and who is suffering from a double hernia? He has waited four months for an operation, even though his surgeon told him that he would have to wait only three months. I do not propose that the Minister or the Secretary of State should conduct hernia operations themselves; in fact, we are grateful to them for not doing so, but how can we convince our constituents that we are making a huge investment when they still have to wait for operations—in my constituent’s case, in agony?

I am pleased that my right hon. Friend is absolving me from personal responsibility. The only kind of doctor that I have ever been is a spin doctor, as he knows, and I would not trust anyone’s care to me. I know that he raised his constituent’s case at business questions last week, and I am informed that the waiting time targets have not been breached, as the case is being treated as routine, rather than urgent. If his information is different from that, I recommend that he bring it to the attention of his primary care trust. More broadly, on LIFT, in his constituency investment has been made in the Humberstone health centre and the Charnwood health and social care centre, and I believe that there are plans for a Belgrave health and social care centre. That is a huge investment in the primary care infrastructure in his constituency, and it will bring benefits not only to patients such as the gentleman whom he mentioned, but far more broadly.

Will the local improvement finance trust schemes have any bearing on the pathway project for the future of Leicester hospitals, and what should I tell my constituents now that the east and north wards in Hinckley and District hospital have been shut? Does the Minister think that the LIFT schemes will stretch across the county from Leicester and touch Hinckley?

The service at Hinckley is, of course, a matter for local decision, but there is an interrelationship between the facilities that are being developed through LIFT in the city of Leicester and the hospital’s trust, because LIFT allows for the development of services much closer to the patient’s home. Services that were traditionally provided in a hospital setting may now be delivered in local communities, because of the high quality of the facilities being built in the constituency of my right hon. Friend the Member for Leicester, East (Keith Vaz) and elsewhere. Getting the infrastructure right, so that there is a secondary service, surrounded by high-quality facilities in the community, is a matter for local decision making.

The Minister is an honest, shrewd and talented man. How convinced is he that handing over long-term, exclusive contracts to the private sector, so that it owns, manages and finances public infrastructure and services, represents good value for patients and taxpayers, given that there is a growing body of evidence that points in precisely the opposite direction?

I am grateful for my hon. Friend’s generous comments at the beginning of his question, and I hope that I can assure him that there is a process locally, whereby each scheme is tested and signed off by the district valuer. Before the scheme proceeds, it needs to be clear that it represents good value for money in the long term. LIFT schemes are a different way of funding primary care facilities; they deliver facilities that could not have been delivered under the old ways of funding, because they bring together a broader range of partners, who invest in something far better than GPs or primary care practitioners operating alone could ever have built. There are persuasive and compelling arguments in favour of the LIFT model, because LIFT schemes are transforming health care in some of the most deprived communities, including inner-city communities, of the country.

Will the Minister ask for an audit of LIFT schemes in the Leicester area and elsewhere to assess the number of projects that have been able to incorporate energy-generating systems, rainwater harvesting or recycling measures in their design? Given that they make a fundamental contribution to climate change measures, it is disappointing that we have experienced so much difficulty in getting those schemes accepted as part of the design brief, so it would be useful for the House to know how successful we have been.

My hon. Friend makes an important point. It is fair to say that some LIFT schemes have made a considerable step forward in incorporating energy efficiency measures into their design, but others could have done better. That is an honest response to his question. The health service must make sure that the people who make decisions on procurement have energy efficiency and environmental issues at the top of their concerns as well as the provision of the highest-quality facilities offering modern health care services. My hon. Friend is therefore right to push us on that point. I will take an interest in the way in which LIFT schemes that are under development pay attention to energy efficiency, and I will write to him on the subject.

NHS Turnaround Programme

The estimated expenditure on the turnaround programme to 31 March 2007 is £10 million in central costs and £36 million locally. This is about 3 per cent. of the forecast in-year savings from the programme.

Since the Secretary of State’s visit to Milton Keynes last summer, the Fraser day hospital has closed, along with a 23-bed surgical assessment unit, and there have been cuts to mental health services, oral health services, language therapy services, podiatry services and counselling services—the list goes on—so does she consider the turnaround programme in Milton Keynes a success?

I am surprised that the hon. Gentleman did not mention the fact that in the past three years the budget for the national health service in Milton Keynes has increased by more than £47 million. In the current two years, it will receive a further £55.6 million increase. I congratulate the staff of Milton Keynes primary care trust and others working in the local NHS who have made difficult decisions this year to reduce their deficit, although they will need longer than this year to do so. I suggest that the hon. Gentleman speak to his hon. Friend the Member for South Cambridgeshire (Mr. Lansley), who said in the House yesterday that primary care trusts

“receive a given amount of public expenditure resources.”

He might have said they receive more than every before. He continued:

“They should live within the overall resource envelope.

He said that a PCT

“has a responsibility not to spend more than the resources that are voted to it through the House.”—[Official Report, 12 March 2007; Vol. 458, c. 41.]

Does the hon. Member for North-East Milton Keynes (Mr. Lancaster) agree with that, or not?

My right hon. Friend will know that in its report on NHS deficits the Select Committee on Health said that the fact that the turnaround programme had to be introduced was

“a sad reflection on the quality of much management in the NHS over many years.”

When does she think that the turnaround teams will leave NHS institutions, which will be capable and competent enough to run services themselves?

I congratulate my right hon. Friend on the Health Committee report that was debated yesterday. The scale of achievement by NHS managers and front-line staff, supported by turnaround teams, is indicated by the in-year position of organisations that had a deficit last year. That deficit has been reduced by £600 million, almost all of which—nearly £500 million—can be attributed to the turnaround organisations, which have supplemented the excellent management in many parts of the NHS. It is up to local organisations to decide when they cease to make use of them.

Following the turnaround team’s work in mid-Essex, how will the closure of all three intermediate care wards at St. John’s hospital alleviate the problem of delayed discharges at Broomfield hospital?

The decisions to which the hon. Gentleman refers are, of course, for the local NHS to make. Delayed discharges are a serious problem, and the local primary care trust must satisfy itself that alternative arrangements are in place, including intermediate care in patients’ own homes, to ensure that it does not recur and become worse, as it did when his party was in power.

Turnaround teams are important, because they resolve the problem in the current financial year so that there are not even bigger projected problems in the next financial year, 2007-08. Is it not right that individual trusts live within their means so that other partners and NHS trusts are not disadvantaged?

My hon. Friend is right. It was unfair and unacceptable that in the past a minority of overspending trusts were bailed out, sometimes year after year, when other parts of the NHS—mental health organisations or, more often, underspending trusts in parts of the country, especially the midlands and the north—had even worse health problems. That was not fair and it gave the overspenders no incentive to sort themselves out. I am glad to say that with the fair, transparent and responsible financial system that we have put in place, we are stopping that unfairness at last.

In figures dragged from them last June, Ministers said that the declared central costs of the turnaround programme would be £5 million. Successive freedom of information requests showed that those costs have more than doubled to £11 million, and more recently we managed to extract the information that the local cost of the programme is more than £24 million. The central £11 million plus the £24 million means that the financial incompetence of the Secretary of State has so far cost £35 million, and rising. As the growth deficit of the NHS is forecast to increase this year, will the right hon. Lady tell us what the turnaround teams have delivered, what the final cost of the programme will be, and above all, at what cost to front-line patient care?

Spending on the turnaround teams has been higher than we originally estimated because we found that more organisations had been overspending—some of them for years—and needed to go into the turnaround programme. The investment in the turnaround programme is a very small proportion of the savings that are now being made. The hon. Gentleman might wish to acknowledge that, as we indicated in the most recent financial report, eight out of 10 hospital trusts and seven out of 10 primary care trusts report an improvement on their in-year position. There has been an enormous improvement in the in-year position, and thanks to the difficult decisions that NHS managers and staff have made, the NHS has got a grip on its finances while continuing to improve waiting times, cancer treatment and other key services. By returning to balance at the end of this month, the NHS will be in a far stronger position for the next financial year and able to make further improvements for patients, particularly in cutting waiting times even faster.

Brain Tumours

The Department of Health is currently investing some £170 million a year in cancer research. We have the highest level of patient participation in cancer trials of any country in the world. Through the National Cancer Research Network we are providing the research infrastructure for 20 studies on brain tumours, seven of which are focused on adults and 13 on children.

Given that no fewer than 16,000 people a year are diagnosed with brain tumours, that they are the biggest single disease killing children and that more than half of those suffering aggressive brain cancers die within 12 months, is it not a scandal that the General Medical Council treats brain tumour research as a Cinderella sector and that, as a consequence, life-saving medical breakthroughs are delayed or denied?

I pay tribute to the hon. Gentleman, who is Chair of the all-party parliamentary group on brain tumours. He is also here today, I think, to promote March as brain tumour awareness month. I know from his constituent, Sue Farrington Smith, who was one of the founders of the charity Ali’s Dream, that the hon. Gentleman has been very involved and shown his commitment in a number of ways. I understand the point that he makes. That is one of the reasons we have tried to increase the funding for cancer research across the board. Significantly, more than 60 per cent. of our total spend on non-site-specific research develops our understanding and ability to treat many different cancers. We have established, as he knows, the National Cancer Research Institute, primarily to identify the gaps and opportunities for future research. That is why I am pleased about the 20 projects that are under way, but clearly this is an area that needs looking at. My right hon. Friend the Secretary of State announced in November that she has asked Professor Mike Richards to develop a cancer reform strategy to build on the 2000 cancer plan and to consider how we can improve cancer services, especially for the less common cancers, of which brain tumour is one, although I appreciate the hon. Gentleman’s point about the mortality rate of those who develop brain tumours.

Does my hon. Friend share my worry that the big problem is early detection? People go to GPs and get passed on for other treatments, when what is needed is early diagnostics to show that they have a brain tumour, of whatever type. Does she agree that we need to give that support and extra funding to GPs?

I thank my hon. Friend for raising that point, which was raised with the Minister of State, my right hon. Friend the Member for Doncaster, Central (Ms Winterton), by the hon. Member for Rugby and Kenilworth (Jeremy Wright) in an Adjournment debate last year. In summary, it is necessary to consider early diagnosis. That is why the National Institute for Health and Clinical Excellence updated its referral guidelines for suspected cancers in June 2005. The guidelines are aimed exactly at the people my hon. Friend mentions—primary care health professionals—in order not only to identify patients who are most likely to have cancer but to see how we can identify the early signs and symptoms of cancers in children and young people. In addition, the NICE guidance on improving outcomes is a useful tool for trying, through the cancer networks, to get not only better diagnosis but better care and treatment plans for individuals who are affected by cancer of whatever form, including brain tumours.

The Minister will be aware that there is a new drug with great potential to deal with brain tumours—Temodal, which, it is hoped, will have NICE approval in June. She will also be aware, however, that approval has been delayed by 12 months because of a statistical error in the first draft of the NICE report. What would she say to my constituent, a 41-year-old father of two, who is dying of a brain tumour that, it is widely accepted, will respond dramatically to Temodal but who cannot receive it because Richmond primary care trust has a policy of not funding drugs that have not yet received NICE approval, despite the fact that everyone knows that that is a matter of only months away? What advice would she give—

PCTs have the authority to approve drugs even if they have not received NICE approval. It is always extremely difficult for families who are going through cancer or other diseases, but we have a process to try independently to come to the right conclusions about different drugs and treatments. It is difficult to plan for these things when people are experiencing such diseases and cancers as we sit here today. However, I hope that the hon. Lady will agree that in establishing NICE we have tried to provide the best independent mechanism for thoroughness as well as the opportunity for appeal, which is why the drug went back to NICE to ensure that NICE can make reasoned and properly thought through recommendations for the NHS. I understand that it is due to report in June this year.

The Minister has already mentioned the Adjournment debate that was held on 28 March last year, to which the right hon. Member for Doncaster, Central responded. In the course of that response, she was kind enough to indicate that she would be prepared to visit the children’s brain tumour research centre in Nottingham. Has there been a ministerial visit, and if so what was derived from it? If there has not yet been a visit, may I encourage her or one of her colleagues to go as soon as possible to speak to Professor David Walker and his colleagues about the valuable work that they do and how the Government might help?

I thank the hon. Gentleman for that contribution. My right hon. Friend says that she is not aware of an invite, but of course she is always open to such invitations. We are mindful of the opportunities that we have to improve our knowledge and awareness of how the NHS can provide better services. I am pleased to say that in the past 30 years survival rates have improved for children. However, this is clearly a difficult area that poses different challenges to, say, leukaemia, but requires our attention. That is why we have tried to direct NICE to look for gaps and opportunities to further our knowledge while providing the best diagnosis, treatment and rehabilitation services.

NHS Finance (London)

Ministers have regular meetings with MPs and other stakeholders about services in London. We also receive a regular flow of correspondence from across the country, including London.

To balance its books, Epsom and St. Helier University Hospitals NHS Trust is making cuts of £24 million in beds and clinical staff over the coming year. As part of that, it has a programme of cutting one in four beds across the trust. In October this year, it closed one ward at St. Helier hospital and reduced another from 26 to 14 beds, only to decide in December to reverse those decisions and reopen the wards. Surely that is the sort of false economy that undermines and disrupts staff teams, damages morale and puts patient care and safety at risk.

Overspending in the health service must be tackled; if it is not tackled, that will store up problems in the health economy of the hon. Gentleman’s constituency, to the detriment of patients who live there. It will also put on hold plans to invest in improving the health of people in the east of London who have contributed top slices to the central fund. I would be the first to agree that overspending should be tackled sensitively, without compromising patient care. Having looked at the trust plan to make savings by March 2008, however, I am satisfied that it is taking appropriate steps to recover such overspending. It is making progress, and the hon. Gentleman should support it in doing so. Ultimately, that will benefit his constituents, as well as the rest of London.

The City and Hackney Teaching primary care trust was top-sliced because it is a good financial performer, as I have often said in the House. Will my hon. Friend tell the PCT and the people of Hackney when the money that was top-sliced from it will be returned?

It is precisely because of the rigour in the system and the requirement that overspending be tackled that we can begin to return money for investment to those parts of London where health is poorest. To put that in context, London PCTs will receive an average 8.3 per cent. uplift in 2007-08, compared with an average of 5 per cent. this year. The top slice will also be returned earlier than expected because of the overall improvement in London’s finances. The picture is therefore more encouraging, although I do not dispute that difficult decisions needed to be taken to get us into that position.

Will the Secretary of State use her office to ensure that there is joined-up thinking about planning the provision of hospital services? People in Broxbourne face the closure of Chase Farm hospital in Enfield and of the Queen Elizabeth II hospital in Welwyn, which would remove accident and emergency and maternity services from the north and south of the borough. When planning hospital services, will the Secretary of State ensure that such considerations are taken into account, because Hertfordshire and London are very different, although hospital services for the two areas overlap?

I admire the hon. Gentleman’s opportunism in asking his question during a question on London, but I accept that his constituents do use hospital services in the London area. It is important to get the right model of care in London to ensure that its health economies are stable in the future. Professor Sir Ara Darzi is currently conducting a review across London to develop the right model of care and the right balance between high-quality tertiary and secondary services and good-quality services in every community. He is therefore taking forward precisely the issues that the hon. Gentleman is asking us to take on board, and he will report in due course.

The Minister will be aware of the challenge from the Commission for Racial Equality to Brent PCT on the impact of cuts in local heath services, particularly on black and minority ethnic communities. Bearing in mind that, under this Labour Government, health inequalities have been increasing rather than reducing, does he find it acceptable that some of the most vulnerable communities are suffering cuts to vital services—such as district nurses, school nurses and mental health services—in order to clear deficits? Does he plan to do anything about that?

I am grateful to the hon. Gentleman for that question, because it is important. As I said to the hon. Member for Sutton and Cheam (Mr. Burstow), it is important that when decisions are taken to recover a financial position, that must be done sensitively and not have a disproportionate impact on any particular section of the community. The Department is working closely with the Commission for Racial Equality to ensure that that is the case. However, I take that important point on board. I shall consider it in relation to Brent and write to the hon. Member for North Norfolk (Norman Lamb), giving a fuller answer to the local situation that he raises.

Voluntary Organisations (Acute Hospitals)

5. If she will make a statement on the role of voluntary organisations working in acute hospitals. (126774)

In many hospitals, voluntary organisations play an important part, and are highly regarded, in providing a range of services to patients, staff and visitors.

Will the Minister join me in recognising the excellent voluntary work and major fundraising efforts of the League of Friends of the Princess Royal hospital in my constituency? Does he share my concern that it recently purchased £27,000 of ophthalmic equipment, donated it to the hospital trust and was told by hospital bosses that they could not accept it, even though it was needed, because they did not have the funds to run it? Does he agree that that farcical situation must be urgently investigated? If so, will he meet a delegation from the League of Friends in the near future?

I pay tribute to the work of the Princess Royal League of Friends. It has done an excellent job within the hospital in raising significant amounts of money and providing services over a number of years.

The specific issue must be resolved by the League of Friends, the hospital itself and the primary care trust to ensure that there is sufficient revenue to support the use of the capital equipment. The problem should be resolved at a local level.

Specialist Parkinson’s disease nurses provide clinically effective and cost-effective information, research and specialist care to people on acute wards. Will the Minister use his specialist nurse summit on 1 May to stress to local health boards and trusts that those nurses must not be moved from their specialist role and used in normal duties on general and acute wards? Will he also attend the Parkinson’s disease reception on 17 April?

I am always willing to join my hon. Friend at any reception to which she chooses to invite me. I pay tribute to her work on highlighting the important contribution that specialist nurses make within our NHS. It is one reason I decided to host the summit in May. We need to highlight best practice, raise the status of specialist nurses, and make it clear to the health service at a local level that specialist nurses have an important role to play, especially in long-term and chronic conditions.

One of the imponderables of life is the value that the voluntary sector brings to our acute hospitals. Does my hon. Friend agree that that same service is provided in hospices the length and breadth of the country, which do a terrific job, and by other organisations such as Erskine, which provides acute services to our disabled ex-servicemen and women returning from theatres of war?

I agree with my hon. Friend, who is the hon. Member who has not resigned—at least on this occasion, Mr. Speaker.

To secure the best possible health care and social care within local communities, it is crucial that we have a partnership between the NHS, local government and the voluntary sector. The voluntary sector often has a distinct and unique role to play in securing personalised, sensitive services that are close to local communities. We should use this occasion to pay tribute to the hospice movement, which does an amazing job in difficult circumstances. We recently made £25 million available specifically for children’s hospices. We are reviewing the way in which we provide palliative care to children and are, for the first time, about to make a significant announcement on major capital investment in the hospice movement.


6. What action her Department is taking to improve advice and support for those with caring responsibilities. (126775)

We recently announced the new deal for carers, a package of support including £25 million for short breaks for carers in crisis situations in every council, £3 million towards a national helpline for carers, and £5 million for an expert carers programme. The Chancellor has also announced that we will be holding the most far-reaching national consultation ever on the role of carers. In the months ahead, we will invite carers’ groups and the voluntary sector to help us to design a modern vision for caring. That will inform the development of a new cross-government national strategy.

Does my hon. Friend agree that people living in care homes should have good access to dentists, chiropodists and opticians, even when they have mobility problems and cannot go out? As that appears not always to be the case, will he take steps to require care homes to make proper arrangements for such people, and also to require dentists, chiropodists and opticians to be willing to visit them in the homes?

My hon. Friend has made an important point. This is a two-way process. First, there are the responsibilities of care homes. Standard 8 of the national minimum standards states that a registered person

“promotes and maintains service users’ health and ensures access to health care services to meet assessed needs.”

That includes access to

“specialist medical, nursing, dental, pharmaceutical, chiropody and therapeutic services… access to hearing and sight tests and appropriate aids, according to need.”

Care homes must fulfil their responsibilities, but equally the professionals on the front line must acknowledge their responsibility for ensuring that older people, even those living in residential homes, have the same rights to high-quality health care as those who continue to live in the community. Responsibility must rest with both the managers and owners of residential care homes and the professionals who provide those services.

Why are the thousands of people who have important family responsibilities as carers in receipt of state pensions, but unable to claim the carers allowance? When will the Minister have a word with his colleagues in the Department for Work and Pensions to sort out that iniquitous, unfair position?

With all due respect, this Government introduced the annual carers grant for every local authority for the first time in 1999; this Government introduced the right for carers to request flexible working from employers; and this Government, through Parliament, are arranging for carers to be able to claim credits towards their pension entitlements. The cross-government review will take account of the fact that millions more people will fulfil caring responsibilities in the future, because as people live longer they also develop more conditions. Of course we will examine the issue that the hon. Gentleman has raised, but I remind him that the shadow Chancellor of the Exchequer recently made very clear—

When visiting the Portsmouth carers group, I have been struck by the dedication of our young carers. Will the carers programme provide any specific help and support for those dedicated young people, who are performing such a valuable task?

I entirely agree with my hon. Friend. I can assure her that as part of the development of a new national strategy, we will pay specific attention to the needs of the often hidden young carers. Those young people are heroes, who spend the vast bulk of their lives looking after, usually, a dependent parent. Their caring responsibilities may affect their education, their health and their ability to lead the lives that most young people and children, thankfully, take for granted. We need to consider the specific needs of those children and young people and ensure that we give them the necessary and appropriate levels of support.

Is the Minister aware that one of the most vulnerable groups of carers consists of elderly people, often parents whose adult children have mental health problems? As part of his review, will the Minister ensure that mental health trusts provide a service to deal with crises? A telephone line may be useful, but it is no use unless there is a dedicated team of people who can go to the home or other place where the crisis is taking place. Will the Minister take action to ensure that vulnerable elderly parents are not disadvantaged further?

I entirely agree with the hon. Lady. Ironically, as people live longer the age of carers increases, and the responsibilities that relatively older and frail people fulfil become more important. We will look into that as part of the review. However, it is also fair to say that in the announcement we made a couple of weeks ago on the new deal for carers, we specifically addressed the question of emergency respite. It has been suggested that that is not what people need, but many carers tell us that on occasions it is the emergency respite that is lacking. I should also mention the investment that we have put into telecare, which ensures that we can make the best use of the most advanced technology in people’s homes. That is another support mechanism that is making a real difference to the lives of carers.

The new deal for carers is very welcome. My hon. Friend mentioned hidden carers, and it is true that many carers do not identify themselves as such and that they do not know to look for the advice and support that is already available and that which will become available. Health professionals can help with that, as they are the people with whom carers have to be in contact. Will the Department of Health make a special effort in the coming months to inform GPs and their teams of that task and to make sure that they perform it?

First, I pay tribute to my hon. Friend for the work that she has done over many years in highlighting the needs of carers with regard to public policy—she has done a tremendous amount. I do not want to upset the Minister of State, my hon. Friend the Member for Leigh (Andy Burnham), who is responsible for negotiations with GPs on their annual contracts, but if I am allowed to express a personal opinion I would say that one of the things that we want GPs to do in a modern health care system is to identify those of their patients who are carers—as GPs are frequently the health care professionals whom carers have the most contact with and confidence in—and then, having identified them, make sure that they get signposted to whatever services they need to support them to fulfil their caring responsibilities.

Is the Minister aware that there is real consternation throughout Staffordshire among carers and others at the decision of the county council to close all its care homes within a year? Will he summon leaders of the county council to discuss the implications of that decision and to satisfy himself that adequate provisions are being made for all the vulnerable people who are currently very anxious?

I understand the anxiety and insecurity felt by the older people affected by that decision, and also by their families and the staff who work in those homes. The local authority must make decisions in consultation with the affected parties. I have previously told my hon. Friend the Member for Stafford (Mr. Kidney) that if it would be helpful I would be willing to meet those who are most affected. However, it is only fair to say that we cannot any longer make decisions about the best way to provide local services from offices in Westminster and Whitehall. What we can do is support that local decision-making process and make sure that the people who are most affected feel that they are listened to and respected.

My hon. Friend will be aware that many carers are unpaid and need training. What is he doing to ensure that they get the training they need to support their family members and to look after them in a proper manner?

My hon. Friend makes a very important point. As part of the new deal for carers, we announced two weeks ago the creation of an expert carers programme. That will specifically do two things: first, provide training to carers on the practical issues that they need to feel comfortable with and confident about in terms of lifting, handling and supporting whoever they are caring for in their own home; and, secondly, boost the confidence, knowledge and expertise of carers so that they feel that they can fight for the rights of the person whom they are caring for and relate on a more equal basis with professionals. Those will be the two objectives of our expert carers programme. I agree with my hon. Friend that the issue we are debating will become increasingly important, especially given the demographic changes that are taking place in our society.

May I make a plea to the Minister for there to be an entirely cross-party approach to those who have caring responsibilities? The biggest sector comprises those who provide it free—the volunteers. Does the Minister agree that although the Government have done quite a lot to assist them, those who voluntarily undertake caring responsibilities for the young, the old and those who are disabled genuinely deserve a better and fairer deal?

I agree with the hon. Gentleman. We introduced the annual carers grant, we announced the new deal for carers a couple of weeks ago, and we are also giving new rights and a new pension entitlement to carers, but there is a lot more that we have to do. The reality is that our society is changing. People are living longer and in doing so are developing an increasing number of frail conditions, which is asking new questions not only of the Government and the state, but of families. Disabled people, thankfully, are now having fuller and longer lives. The current review, led by the Treasury, on the needs of children with disabilities and their families and carers, is incredibly important. Wherever possible, these issues should of course be of a non-party political nature, but in the end it comes down to hard choices about the level of investment that the Government are willing to make in these services, and whether we are willing to prioritise families and carers in the context of the changing demographics to which I have referred.

NHS (Private Sector)

The NHS has always used the private sector for many services and will continue to do so where it can help the NHS to give patients even better care and better value for money. By the end of next year, patients needing elective treatment will be able to choose from any health care provider—NHS or independent sector—that meets NHS standards within the NHS price.

When Ministers held the proverbial gun to the heads of primary care trusts and told them to privatise the easiest elective procedures—or else—was the Secretary of State aware that under European competition law she was opening a Pandora’s box in that if she wished to run the NHS by market rules, she would have to play by those rules—even to the point that that would perpetually restrict her capacity to intervene to protect the public interest?

I do not accept for one moment the hon. Gentleman’s accusation. It is a great pity that he does not recognise the contribution that the independent sector is making at the Bodmin treatment centre, for instance, or—in a different part of his region—at the Shepton Mallet independent sector treatment centre. The latter is not only giving the patients whom it receives very good and much faster care, it has also led Yeovil District Hospital NHS Foundation Trust to change the way it organises its services, making it one of the first hospitals that will achieve for most of its patients the 18 weeks target—and a year ahead of the goal that we set.

My right hon. Friend will be aware that successive Secretaries of State for Health have assured the Health Select Committee that the policy of developing the use of the private sector is being pursued to address lack of capacity in the NHS. Can she confirm that that remains the major reason for that policy?

My hon. Friend is right. When we began the new compact with the private sector through the NHS plan in 2000, it was precisely to address the problem of additional capacity. However and as we have made clear in several successive documents—including the 2005 Labour party manifesto—we also use the independent sector where it can help to challenge under-performing parts of the NHS, support patient choice and give patients even better care. The fact is that there has always been private health care in Britain, but the difference is that under a Conservative Government, private hospitals recruited patients on the back of NHS waiting lists and treated only the few who could afford to pay. Today, thanks to our reforms, private hospitals and treatment centres are part of the NHS family. They are helping to cut waiting lists and to treat NHS patients—all of it free at the point of need.

To continue the theme, the Secretary of State is possibly aware that there is a charitable health trust associated with Epsom hospital. It has put in a bid to the local NHS agencies and authorities to purchase that hospital, and the intention is to run it for NHS, charitable and private patients. It has the backing of the local medical fraternity, and enormous financial backing. Is the Secretary of State willing to meet a very small delegation at or near the end of those discussions, so that it can set out its innovative and expanding programme?

I would certainly be happy to meet the hon. Gentleman to hear about what sounds like an interesting proposal. I will draw it to the attention of the local primary care trust, which will—I am sure—look at it with interest.

The independent sector treatment centre in south Yorkshire has done a good job in helping to reduce waiting times throughout the area. It has been able to do so because it has been guaranteed money over and above the tariff, unproblematic cases and a set number of patients. If those advantages are to continue, eventually the centre will be in conflict with NHS hospitals, which will struggle to survive against that unfair competition. Will my right hon. Friend ensure that that situation does not come about and that the independent centres do not threaten the existence of NHS acute hospitals?

All treatment centres take the simpler cases—that is why they are there—whether they are run by NHS hospitals, as the majority are, or by the independent sector. That is what they do, they do it well, and it speeds up care for hundreds of thousands of patients who need elective treatment. My hon. Friend is right that in the first wave of the independent sector treatment centres a premium was paid, although far less than the premium that the NHS used to pay to the private sector when it needed to use it to reduce waiting times. That was needed in the first wave to bring in new capacity, especially from abroad, when it was desperately needed. As I have indicated, what we are seeking to do is to move to a level playing field so that the independent sector and NHS hospitals will all provide care to the same quality and price, and all free at the point of need.

To assist integration between private sector treatment centres and the NHS, will the Secretary of State look at the practicalities of letting NHS consultants work in the private sector treatment centres even if they are in, for example, orthopaedics, which is currently defined as a shortage specialty?

That is an important issue and one that we keep regularly under review. We have discussed it over the past year or two, especially with the Royal College of Surgeons, and as a result have made some changes to both the shortage and the additionality rules in order to ensure that NHS surgeons and other consultants make their time available to their NHS employer first and foremost. If they have additional time that is not needed by that employer, they may make it available to those parts of the independent sector that are also treating NHS patients within the NHS family.


8. If she will assess the merits of placing advertisements in magazines and media aimed at teenagers about the (a) potential dangers of sunbed use and (b) availability of fake tanning products. (126777)

The SunSmart skin cancer prevention campaign will, we understand, include in its next phase the dangers of sunbed use, especially by those under 18. SunSmart is an integrated public health campaign that includes a high profile, intensive press and PR programme, supported by targeted distribution of public information resources.

I thank my hon. Friend for that answer. I wish to draw to her attention some research on children under 15 that has been sent to me by two doctors at Singleton hospital. They found that 32 per cent. of girls and 9 per cent. of boys said that they had used sunbeds. I have also had information sent to me by the Killing Cancer charity, which found that 75 per cent. of girls under 15 said that they had used sunbeds. There are many doubting Thomases who say that there is no problem—

My hon. Friend has been constructively engaging with me and the Department to share her knowledge, especially her work on the worrying use of coin-operated sunbed parlours. As I have said, SunSmart will consider the next phase of the campaign, and especially how to approach and raise the awareness of those under 18. I have heard what my hon. Friend has said and I ask her to come into the Department to share her information with us so that we can think about how it can be incorporated into the next phase of the campaign. I very much welcome her interest and that of other hon. Members.

NHS Finance

9. What percentage of NHS trusts have (a) deferred operations, (b) made redundancies and (c) restricted provision of treatments in 2006-07 on grounds of reducing costs; and what percentage plan to do so in 2007-08. (126778)

As set out in the most recent financial report, it is now clear that the NHS will achieve the three financial targets set for this year while maintaining key service standards. Achieving financial balance this year means that the NHS will be in a far stronger position in the new financial year and, in particular, will be able to make substantial progress towards achieving the target of 18 weeks maximum from GP referral to hospital operation.

That was just typical: I asked three specific questions and received not a single reply from the Secretary of State. I thought that she would at least quote the results of the Health Service Journal survey of chief executives of trusts across the country, which revealed that 50 per cent. of primary care trusts are delaying operations; that 47 per cent. of all trusts may, have made or intend to make redundancies; and that 73 per cent. of PCTs are restricting access to treatment. Is not the conundrum this—that at a time when there is record cash going into the NHS and welcome investment in capital projects, we nevertheless have cuts in treatment? How can that be?

At least the hon. Gentleman and his party voted for those extra resources. I am surprised, however, that he did not refer to the fact that the NHS in Somerset will get additional funding of almost £120 million over the current year and next year. That is being reflected in the improvements taking place in Minehead hospital, the new cancer centre in Taunton and Somerset and the new community hospital at Frome. We believe that what we need is fair funding for the NHS—record funding for the NHS—and the best care for patients within the budget available. I know that the Liberal party has never been very keen on sound public finances or value for money, but the Government will continue to ensure that patients get the best possible value from the record investment that we have made.

Is my hospital trust typical? The university hospital of North Staffordshire announced 1,000 redundancies as a result of its deficit, but ultimately only 150 redundancies resulted, two thirds of which were voluntary. Clearly, any redundancy is a matter of regret, particularly in an area such as north Staffordshire, but where does that leave the Opposition’s claims of 20,000 redundancies nationwide?

My hon. Friend makes an extremely important point. In striking contrast to the scaremongering that we get from the Conservative party about 20,000 redundancies, over the current financial year there have been just over 1,400 redundancies, the great majority in management and administrative jobs. Although it is of course difficult for the individuals concerned—we are ensuring that the NHS supports them in these difficult times—it is very different from what the Conservative party and some of the media have been telling people.

What the hon. Member for Somerton and Frome (Mr. Heath) failed to mention was that the Health Service Journal survey also revealed that seven out of 10 PCT chief executives agreed that patient care would suffer because of restricting access to treatments. Does the Secretary of State think that they should be applauded as good financial planners, encouraged by her Department to fudge the books and please the accountants, or is it a false economy that forces consultants to twiddle their thumbs for several months while sick patients are denied the treatments they need?

I very much regret the fact that the hon. Gentleman completely fails to give credit to the NHS managers and staff who, in a very difficult year, have got a grip on NHS finances and will achieve financial balance at the end of this month, putting the NHS in a far stronger position. May I suggest that he has a word with his hon. Friend the Member for South Cambridgeshire (Mr. Lansley), just two seats along, who told the House only yesterday that it was the statutory responsibility of—

Acute Sector

The new strategic health authorities provide leadership and support to ensure that trusts operate effectively and deliver improved performance. The NHS Institute for Innovation and Improvement, as its name suggests, helps trusts to introduce best practice and radical new ideas to deliver health care.

Will my hon. Friend congratulate all the staff at the Royal Bolton hospital for saving lives, increasing efficiency and cutting waste by adopting the lean style of management? What can his Department do to spread such best practice throughout the national health service?

Staff in the health service are rightly suspicious of politicians or NHS managers who appear to have swallowed a management consultancy textbook. However, I went to the Royal Bolton hospital with my hon. Friend and, like him, I was incredibly impressed by what I saw. The key principle of the lean management process is that staff lead the change. They are empowered to make changes and drive through the programme on the wards. My hon. Friend’s hospital trust has seen a 30 per cent. reduction in length of stay for trauma, a 37 per cent. reduction in post-operative mortality and a cut in the processing time for blood samples from five hours to 30 minutes. Those are the huge benefits resulting from staff leading change in the hospital.

The Minister must know that thousands of doctors across the hospital sector are deeply angry at the disgraceful mismanagement of the modernising medical careers system. Three months ago, his predecessor said:

“Doctors in training in England should…be pretty confident about securing a training post”.

Will the Minister renew that assurance now?

The hon. Gentleman will know that, on learning of the problems, we immediately set up an independent review led by Professor Neil Douglas, the vice-president of the Academy of Medical Royal Colleges. The findings emerging from the review are already being implemented. We are not seeking to minimise the problems, or saying that they are not causing uncertainty for doctors in training. We accept that, which is why we have taken this swift action and why measures are now in hand to improve the situation. I point out to the hon. Gentleman, however, that these changes were, in origin, agreed with the royal colleges.

For a start, the Minister should apologise to junior doctors for the disgraceful shambles that they have been landed in. He has issued a ministerial statement today about the review, but it does not answer this question: if there are insufficient training posts—and if the assurance that junior doctors should be “confident” about securing a training post cannot be fulfilled—will the review recommend that additional trust grade posts be converted into training posts in order to address the problem?

We will see what the review tells us. Significant changes have been made to improve selection in the second round. People want to see immediate changes so that the situation will improve. We are trying to work our way through the situation to give people more certainty. More broadly, we have to get work force planning right in the national health service to ensure that there are sufficient people in training. If the hon. Gentleman is suggesting that there are simple answers, and asking us to commit to new spending on extra posts, he is sorely mistaken.