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Oral Answers to Questions

Volume 459: debated on Tuesday 24 April 2007


The Secretary of State was asked—

NHS Information Technology

1. What recent assessment she has made of the effectiveness of the use of information technology in the NHS. (133172)

The digital technology being delivered through the national programme for IT is already being used widely by clinicians on a daily basis, and 91 per cent. of general practitioners have made a booking through choose and book. Most importantly, it is bringing benefits for patients by improving their care, safety and experience, and by improving the efficiency of services across the NHS in England.

The Minister will be aware that the British Medical Association’s working party on information technology is concerned about the non-compatibility of the IT systems of the four home countries, and in November it wrote to the director general for IT in the NHS to express that concern. Will the Minister please say why it was not thought appropriate to design compatibility into the systems from the outset, and what effect does she think that lack of compatibility will have on patient safety, particularly in border areas?

Of course we are working with our colleagues across the borders of England to set standards and to consider issues of interoperability. For example, although the devolved Administration in Wales have chosen to adopt different approaches to the development of IT in relation to the health service in Wales, we are in discussions about how we can facilitate the migration of existing NHS shared administrative services, so that the NHS care record service data spine can be used. We are working together, and I am pleased to say that across England, we can prove that we can work with the system to produce results daily. Choose and book is rapidly being taken up across the country, and we are making progress on electronic prescriptions and many other measures. I am sure that that is something that the devolved Administrations will want to consider.

Will my hon. Friend take this opportunity to congratulate the managers and staff at the Clatterbridge centre for oncology, which several years ago introduced an innovative IT scheme enabling its nine new Linux scanners, which deliver radiotherapy, to be chosen and booked by people who are expecting treatment? That ensures that there is huge productivity, and waiting lists for radiotherapy, which used to be very long, have now plummeted. People are getting their cancer treatment at the time of their choice, much faster than ever before.

Exactly. Our ambition is to provide better and safer services, quicker than ever before, and innovative clinicians are working with managers in the health service, and are co-operating with us, to do exactly that. I pay tribute to those people at her local hospital, who are making a difference to the lives of the patients whom they serve.

The April Public Accounts Committee report on the national programme for IT reported that the care record service is running two years behind schedule, with no firm plans for deploying the necessary software. Clinicians do not have faith in the programme. Four years after its start, there is uncertainty about the costs for the local NHS, and one of the largest suppliers, Accenture, has bailed out. Why is it that under Labour management, the NHS appears to be in the information super lay-by, when it should be on the information super highway?

We acknowledge the PAC report, but it happens to be a year out of date, and it is based on a previous National Audit Office report— [Interruption.] Let us just hear what the NAO has to say about our programme for improving technology in the NHS. It says that the NHS connecting for health programme

“has adopted the highest security standards for access to patient information”,

and that

“The Programme has the potential to generate substantial benefits for patients and the NHS.”

It also says:

“The Department and NHS Connecting for Health have made substantial progress with the Programme.”

On the electronic patient record, it is important that we take time to get it right; that is better than speeding ahead and getting it wrong. [Interruption.] The Tories had 18 years to get on top of the technology, and not a lot was done. The question was asked—

Has my hon. Friend made any assessment of the switchover from X-ray to digital imaging at St. George’s and other hospitals, and on the roll-out of packs in that regard?

I thank my hon. Friend for raising that important point. We are moving from old-fashioned X-ray films to digital images, which will transform the NHS. Over 170 hospitals are already using the system, and all NHS hospitals will have it by the end of the year. I congratulate St. George’s hospital on its commitment to providing the best possible service. On top of all that, within the first year we expect to save £40 million.

Among the large number of answers that I have received from Ministers is one from 4 September last year in response to a question about what information the Department collects from primary care trusts, acute trusts and strategic health authorities on the allocation of budgets for choose and book, as well as information returned about assessment. The answer was “None”. How can the Minister, in response to earlier questions, suggest that the Department is satisfied that it can make an assessment about the choose and book system if it is clearly not collecting any kind of information from people who are using the system?

We regularly collect information in different ways on the choose and book system and how it is working. I was pleased to visit a GP practice on Monday, and I talked to the GP about how it was working in that area. One thing is true: the IT to support choose and book has been delivered; the IT to support electronic prescriptions has been delivered; the broadband network has been delivered ahead of schedule; and digital X-ray machines have been fully deployed across London and the south of England. That is what is happening, and it is transforming lives. We will collect information where necessary, but we would rather provide the facility and ability for the local health service to get on with the job and produce the results.

The Minister says that everything has been delivered, but the blunt truth is that twice the Government have set a target for choose and book, and twice they have missed it. Last year, Lord Warner promised to resign if choose and book was not delivered this March; in December he scuttled off on a fix-up job and is now blaming GPs and MPs for his failures. David Nicholson has criticised the bunker mentality of connecting for health, and today—

Very quickly, I should like to ask a question. When will the Secretary of State admit that that is a missed target, come clean and deliver something that is worth while?

We are delivering connecting for health on time and on budget—but perhaps the hon. Gentleman’s question was written by Professor Ross Anderson, who is an independent adviser on IT to the Select Committee on Health. Among a number of suggestions for Conservative party policy, he proposed a fresh look at IT policy, suggesting that in each civil service department there should be a chief information officer at grade 1 and that

“the top 50 per cent. performers should expect a knighthood”,

based on their IT advice. If that is the best advice that the Opposition can obtain for operating a modern Government using the modern technology necessary for our public services, so help them.

Cost Shunting

2. What recent assessment she has made of the extent of cost shunting between NHS hospitals and local authorities. (133173)

Delivering high-quality social care and health care in every area while securing maximum value for money can be achieved only by NHS bodies and local authorities working together to make the best use of the available resources. We have made it very clear that cost shunting is not acceptable.

Can the Minister confirm that 17 per cent. of NHS capital resources are locked up in that problem? Does he agree that it does not matter whether we rebrand bed blocking as delayed discharge or cost shunting, because we are dealing with some of the most vulnerable people in our community, many of whom suffer from dementia? It is not just embarrassing, it is shameful that no Government Department is prepared to get a grip on the problem, whether it is the Department for Communities and Local Government funding local authorities, or the Department that runs the health service. We cannot go on with wards full of people who should not be in hospital and need not be there, because it is all down to accountancy.

Some very specific things have been done to bring local authorities and the NHS together at the local level. Local area agreements bind them together through shared objectives and targets, joint appointments are increasingly made between the health service and local government at local level, and the Local Government and Public Involvement in Health Bill requires a duty of partnership for the first time from local government, primary care trusts and other health bodies. I have to say to the hon. Gentleman that Members on both sides of the House remember when winter crises were an annual event under the Conservatives, so we will not take any lectures on bed blocking from him.

Does my hon. Friend agree that one issue for social services has arisen because of the success of the NHS in dealing with more patients and discharging more patients? With that increased throughput, many such patients have more intense needs, so will my hon. Friend look at developing more intermediate care schemes in which health and social care departments can work to discharge people into the community, but with more support so that they can go back into their own homes?

My hon. Friend is absolutely right. That is at the heart of the debate about re-engineering services away from the acute end of the national health service into community-based health services and social care. That leads to more investment in early intervention and preventive services, and it increasingly gives people what older people and their families tell us they want—care so that individuals can be supported to continue living at home for as long as possible. It is shameful that the Opposition automatically present all those changes as cuts, not as changing services to meet people’s needs.

To what extent will greater co-operation and accountability be introduced by pooling budgets? Is the Minister aware of Cornwall county council’s local government review submission, which proposes exactly that? Are any discussions taking place at a cross-departmental level to encourage that?

I have a great deal of sympathy with what the hon. Lady says. We need to move from a notion of partnership between local government, the NHS and the voluntary sector to a notion of integration in every local community. We must move away from health care and social care being provided separately, so that local government and the health service locally truly secure the health and well-being of the local population, strongly focused on the needs of individuals, older people, disabled people and their carers, and families.

Is there not some risk that the discussion will develop into blame shunting, as David Stout, the newly appointed director of the PCT Network, has suggested? Local people do not know who runs what, and if organisations blame each other, public confidence in both sectors will deteriorate. How can we restore the momentum towards co-operation between social services and the NHS that my right hon. Friend the Member for Holborn and St. Pancras (Frank Dobson) set in train all those years ago?

I agree entirely with my hon. Friend. We must break down the Berlin wall between the NHS at local level and local government. No longer is the prize simply the integration of health care and social care. The full range of services that local government provides make a difference to the quality of life of older people, disabled people and vulnerable people. Local area agreements, a statutory duty of partnership, guidance on how services should be commissioned in an integrated way—all these matter, but so does the culture at local level. We expect leaders in the NHS and local government to provide leadership. We expect professionals to put aside their professional prejudices, organisational boundaries and historic enmities and focus on the needs of the people who require services.

Acute Hospital Services

The future of acute hospital services increasingly lies in high-quality, independently regulated and locally accountable NHS foundation trusts, such as Frimley Park in the hon. Gentleman’s constituency.

The Minister is aware that accident and emergency units in hospitals that serve my constituents are threatened with closure. What she may not know is that the so-called clinical evidence base justifying these cuts on medical grounds has been drawn up by someone who is not even a doctor, and the officials executing the cuts refuse to make improving clinical outcomes one of the aims of their work. Is it not clear that the cuts have nothing to do with helping people in pain and everything to do with ministerial mismanagement?

The hon. Gentleman is talking absolute nonsense. Hospitals are changing because medicine is changing, and there are discussions going on in Surrey and other parts of the country about how to improve services—in some cases by giving more treatment closer to patients’ homes in health centres, community hospitals or GP surgeries, but also about how to ensure, for instance, that for people who have suffered a heart attack or stroke, specialist life-saving care is available in specialist centres. That will not be the case in every single local hospital—but no formal proposals have been made yet on service improvements and changes in Surrey. They will be made in due course, and consultation on them will not start until the summer. That is the appropriate time to have a debate about how services in Surrey can be improved to give people better care and a better chance of having their lives saved.

The Secretary of State knows that there has been a promise of new money for Leicester—£700 million for the pathway project. Although there will be a delay in the application for foundation status, will she reiterate the Government’s full support for the rebuilding of the hospitals that was promised under pathway, including refurbishment of the Leicester general hospital, so that in Leicester we can provide the best possible care in the best hospitals in the country?

My right hon. Friend and I have taken a close interest in this matter over several years, and I am delighted to say that last year the Minister of State, my hon. Friend the Member for Leigh (Andy Burnham), who has responsibility for reform and delivery, announced a private finance initiative rebuild across the three hospitals of the University Hospitals of Leicester NHS Trust. My understanding is that, following some discussions with the private sector partner about the cost, a review is taking place, but I have no doubt that that investment will continue for the benefit of people not just in Leicester but across Leicestershire and other parts of the east midlands.

Does the Secretary of State agree with the Department of Health document “Keeping the NHS local: a new direction of travel”, which in referring to smaller acute general hospital reconfigurations states:

“The objective is to provide at a minimum a ‘first port of call’…a service able to receive and provide assessment, initial treatment and transfer where necessary”?

As the hon. Gentleman knows, we have recently published a series of reports from the clinical directors—the tsars—on, for instance, accident and emergency medicine, heart attacks and stroke. He will also be aware that, because of the rapid changes taking place in medicine, we now have an opportunity to ensure that some of those assessment and diagnostic services to which he refers can be provided even more conveniently than in a local district hospital—for example, in a walk-in centre, a GP centre or an urgent care centre—but also that some of the more specialist services need to be provided in specialist centres with enough patients to ensure that the doctors and other staff there can provide the best possible care. However, as I recently saw at Harrogate district hospital—one of the two best hospitals in the country, according to the Healthcare Commission—it is very possible for a small hospital that has made itself the focal point for a wider network of care to provide outstanding services to patients within its community.

My right hon. Friend’s visit to the Manor hospital in Walsall was very welcome. Apart from the reduction in waiting times, was she shown the extensive building plans, the largest development of the hospital since it was built in the 19th century, which was the subject of an Adjournment debate of mine last June to which the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis) replied? As I say, I am pleased that she did visit.

My hon. Friend has been rock solid in his support for Manor hospital and the trust, and the substantial investment programme for the new hospital, which is so badly needed on the Manor hospital site. I congratulate the staff at Manor hospital and the local primary care trust. It will be one of the first hospitals in the country to ensure that for almost every patient with almost every condition there will be a maximum of 18 weeks—and far less than that, for many of them—between GP referral and hospital operation by the end of this year, one year earlier than we pledged in our manifesto. That kind of excellent, fast, safe care was never delivered in hospitals around the country under the Conservative party. It is now being delivered, thanks to the investment and reforms that we are making.

The Secretary of State will be aware that in Surrey the accident and emergency provision at St. Peter’s hospital and at the Royal Surrey county hospital are under threat. My hon. Friends take the view, as I do, that this will be deeply damaging. Is the Secretary of State worried that although the proposals have been floated since last year, the promised consultation document did not come out at Christmas, in January or in March, as we were led to believe, and is now promised for some time in June? Can the right hon. Lady guarantee that this suspense for the people of Surrey will not be dragged out much longer? It is a great burden for them at present.

I understand the uncertainty that is inevitably caused when the local NHS considers how best to improve services. As I have just said to the hon. Member for Surrey Heath (Michael Gove), there will be a consultation on specific proposals in relation to hospital and other services in Surrey, and the commitment is that that will start in the summer. The important thing is to ensure that the proposals are right and clinically based, and now that the NHS is back in balance and the NHS in the hon. Gentleman’s part of the country has made such enormous progress in getting on top of the financial problems that have arisen, I hope that he and his constituents will accept that the changes proposed will be driven by the need to improve clinical outcomes for patients, not the need to balance the books.

Will my right hon. Friend join me in welcoming the action taken by my local hospital, the Queen Elizabeth hospital in Gateshead, which is another of the 13 early adopter sites? That will ensure that the 18-week target is hit by this December—one year early, as she said in reply to my hon. Friend the Member for Walsall, North (Mr. Winnick).

I am grateful to my hon. Friend for giving me the opportunity to thank and congratulate the staff at that Gateshead hospital and others. Eighteen hospitals will expect to achieve that 18-week target one year ahead of time by the end of this year. Staff at Gateshead, Walsall and other hospitals are reorganising services. For instance, in the case of orthopaedic patients at Walsall, the staff found that it was taking 200 hours of staff time, much of it administrative, to take a patient from initial receipt of the GP referral through to the hip replacement or other operation. By reorganising the way in which they worked—not by putting in more money—they reduced that to just 30 hours, enabling them to transform the lives of between six and seven people in the time they had previously taken to treat just one. That is the kind of improvement that we are seeing, thanks to NHS staff.

Is the Secretary of State aware of a document called “Squaring the Triangle”, which is intended to be the basis for the reconfiguration of acute hospital services in west Surrey? It says:

“Current Department of Health and Strategic Health Authority guidance suggests that to be viable, a full A&E Department in the future would need to be supported by a catchment population of between 450,000 and 500,000 people. On this basis only two full A&E Departments (rather than the existing three) will be viable for the West Surrey population in the future.”

Is the Secretary of State aware of that? Does she endorse or reject that reference to Department of Health guidance?

As I have said, there are as yet no settled proposals for service improvements in west Surrey—or, indeed, in east Surrey. As the hon. Gentleman will be aware from Professor Sir George Alberti’s recent report on emergency medicine, there is already a very wide range of different kinds of A and E departments, from those providing the full range of trauma centres down to those providing—[Interruption.]

Order. The hon. Member for Surrey Heath (Michael Gove) must be quiet. A question has been asked and it is courteous to listen.

Thank you, Mr. Speaker.

There is already a very wide range of services provided by different A and E departments. I hope that the hon. Member for South Cambridgeshire (Mr. Lansley) would be as focused as we are on ensuring that A and E services give the best possible care to every patient, whether they need it locally, much closer to home, or in a specialist centre, possibly slightly further away, in order to save their lives.

The Secretary of State is not answering the question. I am focusing on both specialisation and access, and quality of services includes the issue of access. Will she answer the question? Does she endorse or reject the reference to Department of Health guidance? If this is acted on in west Surrey, the implication is that an A and E department will shut. If it were to be acted upon in the north-west of England, where there is one type 1 A and E department to every 207,000 people, half the A and E departments in that region would have to shut. Why do not we not see that happening in the north-west of England, when my colleagues in Surrey see their A and E departments threatened, apparently on the basis of Department of Health guidance?

I think that we can all see the next Conservative party campaign coming, with the misleading propaganda that we have come to expect from it on health. The hon. Gentleman completely misses the point that different A and E departments will offer different sorts of services. For the most specialist services, including stroke services, about which I know he has a long-standing concern, a larger population is required to ensure that specialist staff are available 24 hours a day, seven days a week to deal with the patients who need that care. Different A and E departments will provide a different range of services. That will be one of the key themes of the guidelines and proposals on urgent and emergency care that the Department will publish shortly.

CATS Services (Chorley)

4. If she will make a statement on clinical assessment, treatment and support services in Chorley. (133175)

I suspect that this answer is a direct response to my hon. Friend’s persistence on the matter, Mr. Speaker. Central Lancashire primary care trust has agreed with Lancashire Teaching Hospitals NHS Foundation Trust that CATS services will be provided at the trust’s hospitals, including Chorley and South Ribble hospital.

I thank the Minister for reaffirming the position. He could possibly go as far as congratulating the primary care trust on listening to the people of Chorley, because the decision is ground-breaking. It ensures not only that no private company will operate CATS in Chorley but that the services will be run and funded by the NHS and based at the local hospital. That is good news for Chorley. Does my hon. Friend agree?

I congratulate my hon. Friend on the points that he has been making for some time about this issue. The consequence of the PCT’s decision is that patients in my hon. Friend’s constituency and in neighbouring constituencies will get the choice that they deserve, and any unacceptable waiting times for particular treatments will be slashed. In many areas, that requires a contribution from the independent sector. However, the PCT in Chorley has shown that where the NHS believes that it can do the job and achieve the outcome, it is chosen as a suitable provider. Most importantly, waiting lists and times in my hon. Friend’s constituency will be reduced.

The first wave of independent sector treatment centres was paid 11 per cent. more than NHS organisations for carrying out exactly the same operations. What is the uplift? How much more will private sector, not NHS, CATS be paid for carrying out precisely the same operations in future?

In the context of the first wave and incentives, the issue was creating a position whereby we could ensure that, in communities where waiting lists and times were unacceptable—and should be unacceptable to the NHS—the independent sector could build its capacity and help the NHS treat those patients as quickly as possible. Whatever debate there may be about the specific amount of the incentive, that was why it was required at that stage in the process.

Community Hospitals and Services

We are committed to community hospitals when they represent the best solutions for local communities. To support that, we have set up a five-year £750 million programme to promote the development of community hospitals and services. To date, we have allocated around £100 million to 14 different schemes. Decisions are outstanding on a further 18 schemes.

Bringing community care and health care closer to individuals will have a profound effect on their lives, ensuring that people live longer and healthier lives. The PCTs have a vital role to play in that. Will my hon. Friend join me in condemning the Lib-Dem council in Brent—also known as the Fib-Dem council—

Order. The Minister will not do that. Perhaps he will answer the first part of the question.

It is tempting to do as my hon. Friend asks, and I would like to, Mr. Speaker. However, perhaps I shall simply say that I agree with her that patients support the move to provide more and extended services in the heart of communities, including those in London. That comes through time and again in all the consultations that the Department has carried out.

Does the Minister agree that minor injury units are an essential part of community hospitals but that the services provided are often cut, as are the hours of opening? Will he ensure that community hospitals are adequately funded to ensure a consistency of service for minor injury units and look into standardising those services in order to ensure that when people go to such units, they know what services they are going to get?

The hon. Gentleman makes an important point. Minor injury units are an important part of the 10 community hospital schemes that I announced recently. I agree that PCTs should take a view locally on where those schemes can help to fill an identifiable need. That is precisely the sort of scheme that we want. In looking further at the range of schemes recently approved, I found that many are very innovative and are offering new kinds of services to communities that have often had poor to patchy general practice in the past. It is all about bringing better and extended services to communities that have not benefited from such services in the past.

May I thank my hon. Friend for his recent announcement about the building of a new primary care centre in Rotherham? Does he accept that that will not only provide patient services seven days a week, but will have further benefits to services in the acute sector? Does he also agree that those reconfigured services in the NHS are improving the level of service to patients and should be welcomed by everyone and not cried against by Opposition Members every time we attempt to improve patient services?

The points that my right hon. Friend makes about the links between pressure on accident and emergency departments and acute hospitals generally are extremely well made. The scheme that we recently put forward and approved in his constituency includes a walk-in centre and a minor injuries unit. It also includes access to diagnostic facilities, dietary services, physiotherapy and audiology, so it truly provides a step forward for my right hon. Friend’s community. He is absolutely right that the beauty and benefit of those schemes is that they can take the pressure off local acute hospitals and give patients another option rather than trekking into accident and emergency as the only available option for treatment.

Mental Health Patients (Children)

We have made a commitment to eliminate within two years the use of adult psychiatric wards for children younger than 16. My officials are writing to strategic health authorities informing them that if a child younger than 16 is placed on an adult psychiatric ward, it should be reported directly to the Department so that we can take appropriate action.

Given that the Government’s own commissioner, Professor Sir Al Aynsley-Green, has said that children who go into adult wards for treatment come out in a worse state than when they went in, will she guarantee that the current provisions in the Mental Health Bill that require age-appropriate treatment settings will remain unamended?

No, I will not. One of the problems with the House of Lords amendments to the Mental Health Bill is that, in certain circumstances, they restrict the ability of clinicians to treat 16 or 17-year-olds, for example, who might be better placed on an adult ward. That imposes quite a straitjacket in terms of the clinician’s ability to place people. There is also the issue of emergency treatment and the Lords amendments create further problems in that respect. However, as I said, we are certainly committed to ensuring within two years that children younger than 16 are not treated on adult wards.

As my right hon. Friend is aware, during recent consideration of the Lords amendments to the Mental Health Bill, a number of interesting suggestions and proposals were made. Will she give me a guarantee that she will consider them very carefully?

My hon. Friend is right to say that this is an extremely important issue. I know that he is concerned about it, and he has raised the matter with me separately. As I have said, the problem with the House of Lords amendments is that they would create a clinical and legal straitjacket, but that is not to say that important issues have not been raised, and I am sure that we shall discuss them in Committee.

My constituent, Miss Fiona Gale of Sherston, having been treated in an adult mental health care ward and abused in various ways while she was there, was then discharged against her wishes. Tragically, she committed suicide in front of a train in my constituency shortly afterwards. The coroner agreed that she should have been treated in a separate children’s ward and that there should have been a halfway house between the completion of her treatment and her discharge into the community. I welcome what the Minister has said about under-16s; will she also consider what I have said about the provision of a halfway house?

It is absolutely tragic to hear about such cases. The hon. Gentleman mentioned that the child had been discharged against her will, and that obviously should not happen if a child is still in need of psychiatric help. The hon. Gentleman will be aware of changes made to the Mental Health Bill in the House of Lords that we are seeking to overturn, but one of the provisions that we are seeking to introduce is supervised community treatment. That would enable someone to be discharged but to remain under the care of health care professionals.

What evidence is there that primary care trusts and mental health trusts are discharging their duty of care to the under-18s who need mental health treatment? What proportion of under-18s have access to early intervention provision, which has proved highly successful in treating psychosis among people of that young age group?

I cannot give my hon. Friend the exact number of children using the early intervention teams, but the spending on child and adolescent mental health services—CAMHS—increased from £284 million in 2002 to £530 million in 2005. With that increased investment, we have managed to employ more staff. There were about 7,700 in 2003; that figure went up to 9,800 in 2005. The case load has also risen by about 40 per cent. between 2002 and 2005, however. The extra investment is making a difference, but we certainly accept that there is some way to go, particularly in the development of CAMHS services, and the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), is continuing to work on further improving those services and, in some instances, integrating them more effectively with the other services.

Yesterday in Committee Room 16, in front of MPs and Members of the Lords, two teenage girls, Lois and Antonia, gave harrowing accounts of their experiences in acute mental wards. Those were adult, often mixed-sex, wards, which contained people who had committed homicides, in which the girls were subjected to sexual abuse and invasion of privacy, and received little or no age-appropriate treatment from inappropriately qualified staff and no help with their education. On behalf of the hundreds of children placed in those wards—the number is growing—they begged for the age-appropriate amendments to the Mental Health Bill to be retained. They do not think that the Lords amendments would prove to be a straitjacket, because they would provide for age-appropriate treatment and allow for emergency admission. Why are they wrong?

They are wrong because—[Interruption.] I am not saying that those girls are not well intentioned, or that we do not want to ensure that the situation improves. At the moment, the number of such bed days—that is, the number of days when a bed in an adult ward is occupied by under-16s and 16 to 17-year-olds—is dropping. We need to ensure that we have more accurate information about that.

The Lords amendments include the proposal that a child should be seen by a specialist practitioner—in this instance, a CAMHS specialist. If they were on an adult ward, that would be difficult to achieve. In that sense, the problem is a real one because the CAMHS specialist would not be assigned to an adult ward. Were it more appropriate for the care of an individual aged 17 to 18 to place them on an adult ward, they would not have access to the specialist. As I have said, however, there are certain problems with the Lords amendments—

Nurses' Pay

7. What the pay level of a newly qualified student nurse would be if their pay had risen in line with average earnings since 1997. (133178)

I thank my right hon. Friend for putting into context the large and fully justified pay increases for student nurses since 1997. New nurses need to know, however, that they have an adequate career path once they enter the service. Will she indicate what “Agenda for Change” means for nurses throughout their careers?

My hon. Friend makes an extremely important point. One of the most important reforms introduced by “Agenda for Change” was to open up new opportunities for nurses to build their skills and take on new responsibilities. Under the old Whitley scale, a clinical nurse specialist grade 1 could hope to achieve a salary of £26,000—barely twice that of a newly qualified nurse. Under the new system of “Agenda for Change”, by November this year a nurse consultant at the highest level will be able to earn more than £90,600, which is a measure of the change and improvement that we have been able to make.

Is the Secretary of State comfortable with the fact that, because of the actions of the Chancellor of the Exchequer, nurses in England are experiencing a staged pay increase, while those in Scotland are having a full pay increase?

I understand the concerns of nurses and other health service staff about the staging of the pay award. When we accepted the independent pay review body recommendations across the public sector, not simply those for the NHS, we decided to stage the implementation for this year as we took account of the wider economic position on inflation and interest rates. That is not only fair to nurses and other public sector staff, but right for the public as a whole.

I acknowledge the increases in pay over the years, which were clearly needed. Nurses are still, however, one of the lowest- paid groups of professionals in public service. Does the Secretary of State accept that nurses this year are getting a real-terms cut in pay, and that the impact on morale of the phased increase, combined with the fact that many newly qualified nurses have no job at all, is really damaging the profession? Is she proud of that situation as we approach the 10th anniversary of the Labour Government?

I have just explained, as I have on many occasions, why it was necessary to take account of the wider economic circumstances. It would not be in the interests of newly qualified nurses or anybody else were we to see inflation and interest rates return to the levels that they reached under the Conservative Government. We will not take risks with the economic stability and strength that have been achieved, particularly as a result of the policies of my right hon. Friend the Chancellor. The hon. Gentleman mentioned newly qualified nurses and their difficulties in getting jobs. We are making great efforts to ensure that the NHS in each region finds appropriate posts for newly qualified NHS staff to address that precise issue.

Not only are nurses receiving a real-terms cut but the Department of Health originally argued for a pay rise of only 1.5 per cent. Given that the independent review body for nursing not only rejected the Government’s figures but criticised the Department of Health for failing to provide any evidence as to how its estimate was reached, does the Secretary of State understand how angry and cheated nurses up and down the country feel when the Government seem to be plucking figures out of thin air in order to keep salaries low?

Salaries for nurses and other NHS staff are a great deal higher than they were under the Conservative Government, and a great deal higher than they would have been under the Conservative party’s new policy of cutting public spending to make way for tax cuts.

I remind the hon. Gentleman that there are over 80,000 more nurses in the NHS now than there were when we were elected 10 years ago. Not only has their pay increased substantially and not only will it continue to rise substantially this year as a result of the increments under “Agenda for Change”, but nurses are increasingly enjoying more flexible working conditions and support for child care needs—and, of course, much better holidays, maternity and paternity leave and pay than they ever enjoyed under the hon. Gentleman’s party.

Asylum Seekers

9. What health care provision her Department makes available to victims of human trafficking who have applied for asylum. (133181)

Asylum seekers, including those who have been victims of human trafficking, are entitled to free NHS treatment for as long as their applications, including any appeals, are being actively considered by the Home Office. Any ongoing treatment will continue free of charge for unsuccessful applicants until their removal from the United Kingdom.

Trafficked women inevitably display mental as well as physical damage. Can the Minister guarantee that all victims who have applied for asylum will receive mental health support, some kind of counselling, and psychological care—not just to help them gain security and confidence as required by article 12 of the Council of Europe convention on action against trafficking in human beings, which the Government signed only last month, but to help the criminal authorities pursue traffickers?

I pay tribute to the work done by the hon. Gentleman as chair of the all-party parliamentary group on trafficking of women and children..

People who have been trafficked and who claim asylum can gain access to mental health services, but the Department, along with colleagues in the Home Office, intends to review access to health services for foreign nationals. We hope to report in October this year. As the hon. Gentleman will know, as part of the action plan to which the Government are committed and following the signing of the convention, we are examining ways of preventing trafficking and identifying its victims, as well as considering what services are needed. The POPPY project, which we have funded, now has funds to provide an outreach service, which will be very important to the many agencies that will play a role in supporting the needs primarily of women, and in some cases of children.

I am delighted by my hon. Friend’s reply. It is comforting to know that trafficked women will be given that level of care, but what provision will there be for people who are in the country on visitors’ visas?

I thank my hon. Friend, who I know takes a huge interest in this issue. I should make clear that my original answer related to those who have been trafficked and are claiming asylum. As for my hon. Friend’s question about visitors’ visas, emergency treatment is available to those who present themselves provided that it has priority over establishment of their status or ability to pay. That underpins the way in which we run our health service.

There are issues involving people who should be paying and the reclaiming of funds. I understand that the Minister of State, my right hon. Friend the Member for Doncaster, Central (Ms Winterton) and colleagues across Government are examining a range of issues relating to health service access for foreign nationals, which may include insurance issues.

Maternity Services

On 3 April we published “Maternity Matters”, which sets out how we propose to deliver on our commitment to improve maternity services for women. By the end of 2009, for the first time, mothers-to-be will have a guarantee that the NHS will give them real choice. That will include the opportunity to be supported during births, either at home or in midwifery units, by midwives whom they know and trust to care for them.

St George’s hospital in Tooting has an excellent maternity department. Both my children were born there. This summer, the hospital will open a new midwifery-led unit for low-risk women. Does my right hon. Friend agree that such units, which help to create a home away from home for women and their families, should be offered to all who wish to have their babies delivered naturally?

I strongly agree. That kind of midwife-led unit, which can provide superb support for women and their partners and babies, is exactly the kind of development that we want to see repeated in other parts of the country. I congratulate midwives and other staff at St. George’s on that excellent development. The fact that there are 60 more midwives at St. George’s than there were 10 years ago is in part what has helped make that improvement possible.

On 17 March we heard the devastating news that the proposed new children’s and maternity hospital in Leeds would not go ahead, despite having been approved by the then Secretary of State for Health in July 2004. Why has the project been pulled despite leading local specialists having said on 27 March that current services are “not fit for purpose” and that they are anxious about the continuing safety of children in hospital? When will the people of Leeds get the children’s and maternity hospital that they so badly need?

There is no doubt that the people of Leeds need a new children’s hospital and improved services; that has been recognised for a long time. Following the recent concerns and the possible delay in respect of that new hospital, the Minister of State, my hon. Friend the Member for Leigh (Andy Burnham), recently met the strategic health authority and colleagues from the trust to discuss that and to ensure that issues, particularly to do with cost, can be looked at so that the scheme can get back on track.

Will the Secretary of State congratulate my sister-in-law, who happens to be a constituent, on the recent birth of her son, Thomas, at the Royal Surrey county hospital, and does the Secretary of State share my hope that my constituents continue to benefit from its excellent maternity unit for many years to come?

I am happy to congratulate everybody whose children have recently been born at that hospital, or anywhere else—perhaps I can cover all congratulations at this point. As we discussed earlier, proposals will come forward for improvements and changes in services in various parts of the country, and there will be proper and full consultation on those proposals. It is important to ensure that in the constituency of the hon. Member for South-West Surrey (Mr. Hunt) and everywhere else women and their partners have the proper choice of having a baby at home if that is what they want and it is safe, having a baby at a midwife-led unit, or having a baby in a hospital, where there would be a consultant-led unit as well as a midwifery team. We will guarantee that choice.

NHS Finances

On the basis of results reported at quarter three, we believe that the NHS is on course to deliver at least a balanced financial position at the end of the 2006-07 and continues to perform well against key service targets.

I thank the Minister for that reply. He might be aware that the Health Service Journal recently published some very out-of-date and inaccurate information about the financial aspects of various trusts, one of which was the Shrewsbury and Telford Hospitals NHS Trust. Please will he issue the latest figures so that publications such as the Health Service Journal have up-to-date figures? Also, does he agree that Tom Taylor, the chief executive of the Royal Shrewsbury hospital, is doing a great job of turning around the finances of our hospital?

I agree that the chief executive is doing an outstanding job. The hon. Gentleman might be aware that the latest figures at quarter three show that the trust was forecasting a £2.3 million deficit for year-end, but I can update that by telling him that the view of the strategic health authority is that the trust continues to make improvements and the expectation is that it will continue to improve in this financial year. The expected improvements relate to both the application of resource-accounting and budgeting and the effect of the national payment by results policy. Therefore, there is good news. The hon. Gentleman is right that his trust is on an improving course, and I hope that we can look forward to having his support in continuing to help it get into financial balance.

Will my hon. Friend the Minister congratulate my primary care trust on getting its books back into balance and, pursuant to his response earlier on community hospitals, will he ensure that the next round of investment takes into account fabulous community institutions such as Ellesmere Port hospital, which are especially fabulous for patients such as stroke victims?

I certainly pay tribute to my hon. Friend’s primary care trust and to others around the country, which have done an outstanding job in difficult circumstances in getting the NHS into a position whereby we can predict that overall, it will balance its books this year. It is because we have asked the NHS to take some of those difficult decisions and to tackle overspending that PCTs such as my hon. Friend’s can support the excellent community services that he rightly draws attention to. It has been a difficult year for many PCTs, but we can now look forward to a year in which we can bring down waiting lists and improve the range of services for patients.


12. What assessment she has made of access to NHS dentistry services in (a) 2005-06 and (b) the 2007-08 financial year. (133185)

In April 2006, primary care trusts had commissioned 75 million annual units of dental activity; by January 2007 that had risen to 78.4 million.

The chief dental officer leaked to the press on Friday that instruments used to perform root canal treatments will now have to be disposable. The excellent NHS dentist on North End road is concerned about access, pointing out that those regulations could cost £35 per root canal treatment, which is half the total that a PCT typically spends on a whole course of treatment. Given those new regulations and the fact that no extra funding is being provided, is not the Minister’s purpose to create an NHS dentistry system that is solely about tooth extraction?

First, I challenge the hon. Gentleman’s assertion that this information was leaked; it was sent to all dentists, and there was a ministerial statement about it. Moreover, and as he knows, this was a safety issue relating to Creutzfeldt-Jakob disease. Dentists with a good NHS commitment are given some £80,000 towards their business expenses and are expected within that to offer proper equipment and treatment and proper staff to carry that treatment out. So such expenses are perfectly well covered by the existing amount given to dentists to help run their businesses.