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Health

Volume 460: debated on Tuesday 22 May 2007

The Secretary of State was asked—

Brent PCT

At quarter 3 of 2006-07, Brent teaching PCT reported a forecast deficit of £17.6 million. The NHS as a whole reported a small surplus, and we expect the final position to show further improvement. We will publish quarter 4 of NHS finance report in June.

At the Department’s instructions, Brent primary care trust is embarking on a devastating series of cuts, including to health visitors, drug, alcohol and sexual health services, mental health, and services for children with special needs. Will the Minister apologise for the long-term impact those cuts will have on the lives of my constituents; and will he go back and reconsider?

May I point out to the hon. Lady that it is a statutory duty of all NHS organisations to break even? I accept that we are dealing with issues that concern services for vulnerable people, which I accept are matters of huge importance to the hon. Lady’s constituents, but may I point out that the PCT and the council both serve her constituents and that it cannot be in their best interest to stoke up a row between the PCT and the council. The only solution is to support a sensible agreement to ensure the continuation of services to her constituents. I hope that she will drop her political posturing and work to that end.

Does my hon. Friend agree that there has to be dialogue between the local authorities and the PCT to ensure seamless health care? In the past 12 months, the Lib-Dem/Tory-run council has failed to have any positive meetings with the PCT, failed to provide any social care services to the people of Brent, and failed to respond to any of my letters. Does my hon. Friend agree that all the hon. Member for Brent, East (Sarah Teather) has proved successful at doing is producing leaflets saying “Save our NHS”, which does nothing for anybody? Does he agree that they should stop—

I thank my hon. Friend for her comments and her positive approach to this situation. It has to be in the interests of vulnerable people everywhere that councils and PCTs put aside their differences and work together for the benefit of those people. A blinkered approach or one where people are casting blame will not get us anywhere. It is important to get agreement on these important issues and I understand that the Minister for Local Government and the Minister of State, the noble Lord Hunt, will soon meet to discuss how progress can be made on securing such agreement, which will be in the interests of constituents.

Independent Sector Treatment Centres

2. If she will make it a requirement for independent sector treatment centres to pay a levy towards the costs incurred by the national health service in training staff. (138337)

The first wave of independent sector treatment centres was designed to provide extra capacity to help cut waiting times for NHS patients. Six of these are now providing training as well. All phase 2 schemes will require training to be made available as part of the contract.

I am grateful to the Secretary of State for that answer, but it does not detract from the fact that these private health centres are privatisation of the national health service by stealth. Will she not agree that every patient who is forced to go to one of these independent centres will help to undermine the financial stability of local hospital trusts—[Interruption]—and laughing is not the answer?

The hon. Gentleman is wrong on every count. Independent sector treatment centres are not privatisation by stealth or any other means. Patients are not forced to go to ISTCs and, indeed, we are extending patient choice. From 1 July, patients needing orthopaedic treatment will have a free choice of more than 200 hospital and treatment centres all around the country. I would have hoped that the hon. Gentleman would support that and also support the fact that more than nine out of 10 patients said that their NHS hospital treatment was either good, very good or excellent. We should be proud of that, and I am sorry that the hon. Gentleman is not.

Does my right hon. Friend agree that independent treatment centres, alongside fantastic NHS staff, have contributed enormously to the reduction in waiting lists? Our staff are fantastic as a result of the quality of their education and training. Can my right hon. Friend assure me that in future contracts for the independent sector, we will try to ensure that we train the staff we need so much for our wonderful NHS?

My hon. Friend is absolutely right and I can give her the assurance that in the second wave contract, training opportunities will be required from all the independent sector treatment providers. Indeed, the ISTCs will be expected to appoint directors of clinical and medical training, who will work with the post-graduate deaneries and other parts of the NHS family in order to ensure that the best possible training opportunities are available to doctors and other health care professionals.

Working on the same principle, would the Secretary of State care to estimate how much it would cost the British taxpayer if we were to refund all the foreign countries that had invested in training their own staff who are now working in the British national health service?

I certainly cannot make that estimate, but the hon. Lady raises an extremely important point. As she probably knows, we were the first country in the world to adopt an ethical recruitment policy in our national health service. That means, for instance, that we do not take nurses from South Africa or other parts of Africa. We try to ensure that, just as medical professionals come to Britain for training from some other countries, we support the poorest countries, particularly in Africa, that desperately need to train and keep their own health care professionals.

Will the Secretary of State promise that she is still very much in favour of this experiment? I would like to see these centres in the Reading area, where they would expand capacity and help people in my area who cannot get the treatment that they need at the moment. Will she promise not to rig the system against them in the way that many Labour Members seem to wish to do?

The right hon. Gentleman is simply wrong on that point. It is clearly right that independent sector treatment centres should make training opportunities available; that is one of the lessons that we learned from wave 1. I completely agree with him, however, that the centres have helped to cut waiting times for NHS patients in many parts of the country, and all the treatment that they provide is on the NHS and free at the point of need. That is what matters to patients.

How does the Secretary of State square what she has just said about having an ethical policy on recruiting from Africa with the fact that the Government have issued work permits for 50,000 nurses and doctors from Africa since 2000? Is it not clear that they are coming to agencies in order to get round the ban on direct recruitment to the NHS?

As I have just said, we have stopped the process of direct recruitment—[Hon. Members: “Ah!”] No, we have stopped the process of direct recruitment into the NHS of nurses from developing countries in Africa and elsewhere. There is, however, a real problem with some agencies that recruit people from those countries. I am not sure what level of regulation the right hon. Gentleman is suggesting, but that practice is difficult to control. We try to ensure, however, that they sign up to exactly the same principles as we have agreed for the NHS, and that people who come in through that route are not subsequently re-employed in the NHS.

NICE

3. If she will make a statement on the progress of the National Institute for Health and Clinical Excellence. (138338)

Since its establishment in 1999, NICE has consolidated its position as the leading source of evidence-based guidance on specific health interventions and on broader care pathways. It has deservedly earned international recognition for its work.

I am grateful to the Minister for his response. I have always supported NICE and I still do. It is perfectly obvious that we need a central assessment point for new medications and treatments. Is he satisfied, however, that there is a sufficient flow of information and discussion between NICE and the companies and patient groups involved in the assessment process? Does he think that that process could be made more transparent?

My hon. Friend is absolutely right to suggest that, in the context of modern science and health care, if NICE did not exist, we would have to create it. We are currently conducting an overall review of the way in which NICE reaches its conclusions; it began in April, and is due to report to the NICE board in November. In 2005, we introduced what is known as a single technology appraisal process, which enables NICE to speed up some of its decision-making processes. In addition, best practice guidance was issued to the NHS in December 2006, stating that if a clinical decision is made that a patient requires a particular form of medication, there is no requirement for the primary care trust to wait for the conclusion of the NICE appraisal to ensure that the patient has access to that treatment. Overall, NICE has been a tremendous success, but we are also in the process of reviewing its function, as is appropriate at this stage.

Is the Minister aware of the use of miniature telescopic eye implants as a cure for age-related macular degeneration? This operation is available in many parts of Europe and in the United States, and one operation has been successfully completed by Brendan Moriarty, an eye surgeon in my constituency. Will the Minister urge NICE to look into this new operation as urgently as possible, as it will help people to retain their sight?

I have a good deal of sympathy with the hon. Gentleman’s point. Macular degeneration is a real issue for an increasing number of our constituents. I was not aware of that specific intervention, but I think it right for us to reflect on what the hon. Gentleman has said, and then to decide whether the evidence that we have is sufficient for us to refer it to NICE as one of its priority considerations. Now that the hon. Gentleman has raised the issue, we will certainly have a look at it.

Why is it that although the chief medical officer’s recommendations on the prevention of hospital-acquired thrombosis were almost universally welcomed, shortly afterwards the NICE guidelines on the same topic seemed to contradict the original, leaving many health professionals aghast? Will my hon. Friend undertake to look into the matter, and ensure that no confused messages are being received by hospitals about a policy that could prevent 25,000 deaths?

I will certainly look into the matter. It is important that, where possible, there is no ambiguity in the message that we send clinicians and primary care trusts on the front line. I cannot comment at this stage on whether there was a difference of opinion between the chief medical officer and NICE, but I will commit myself to investigating that, and to ensuring that whatever message is appropriate is clearly conveyed.

I agree with the Minister that NICE is one of the successes of the Government’s health policy over the past 10 years, but is it not time, as part of the review to which he referred, to look again at the principles according to which Ministers retain control of the agenda of issues that NICE examines? Should not NICE have an opportunity to set aspects of its own agenda?

I think that if we are to conduct a fundamental review now that NICE has existed for some time, one of the issues that ought to be reviewed is the relationship between Ministers and the organisation, as well as the relationship with Department of Health officials. We need to ensure that we get the responsibilities of the respective decision-makers absolutely right. It is important for clinicians and primary care trusts to be clear about the position, but transparency is also important, so that patients know what to expect at a time of technological advances and increasingly complex conditions often associated with people living longer.

May I refer my hon. Friend to the NICE review of the drug Alimpta, which is used to treat mesothelioma? Specialists fear that the original decision to refuse NICE approval was based on a failure to understand the clinical evidence, and in particular the fact that the drug is efficacious in prolonging both life and quality of life. Those are important considerations for people who will certainly die of mesothelioma.

NICE is actively considering the issue. I understand that, according to the guidance, those who are already receiving the treatment are entitled to continue to receive it, but no final decision has been made. I suggest that my hon. Friend and others make representations to ensure that NICE reaches an appropriate conclusion.

NICE does a good job for the Government in rationing health care in a rational way, but is not one of the key requirements of rationing that it should be explicit and transparent? As everyone else now recognises that a treatment that costs more than £30,000 per quality-adjusted life year will not be approved by NICE, will the Minister confirm that that is also his understanding? Such transparency would help politicians to accept that that is what is happening.

No, I will not confirm that. It seems to me that the appropriate context for such a judgment and such a debate is the review, which seeks to be clear about NICE’s function. It also seems to me that we either believe in the need for an organisation such as NICE, in the context of a modern NHS and massive advances in technology and science, or we do not. The use of words like “rationing” by the Liberal Democrats does not accord well with this debate.

NICE was established to deal with the problem of postcode lotteries, but a key problem is that many new drugs awaiting appraisal are subject to terrible regional variations and lack of funding. A recent freedom of information survey by the Conservatives showed that people in England are going blind because cash-strapped primary care trusts are not funding Macugen, which has been approved in Scotland. Some PCTs have been turning down all requests for Macugen although they come from clinicians, with the average PCT funding only two patients, despite an estimate by AMD Alliance that 100 patients a year in every PCT could benefit. Will the Minister now investigate, as a matter of urgency, why his own guidance to PCTs that funding should not be withheld simply because NICE has not issued guidance is being so readily flouted, before new drugs such as Lucentus suffer the same fate?

We have moved to respond to the concerns that have been expressed as NICE’s function has been developed. For example, we introduced the new single technology appraisal process in an attempt to speed up the process. We have also issued best practice guidance to primary care trusts, which makes it clear that where a clinician believes that a licensed drug is an appropriate way of treating a condition, there is no requirement to wait until NICE has concluded its appraisal process. The right way forward is a combination of speeding up the process and being absolutely clear about what we expect from primary care trusts. Members cannot have it both ways. We either devolve responsibility, power and decision making to the local level or we command and control from offices in Westminster and Whitehall. We cannot have a contradictory approach.

National Treatment Agency

One GP sits on the board. His full-time job is director of public health for the south-west but he brings his knowledge and experience to the board. A GP in the National Treatment Agency for Substance Misuse clinical team liaises with the Royal College of General Practitioners and others to support effective delivery of policy and promotion of good practice within the primary care setting.

The evidence from Sweden and France, as examined by my primary care trust, is unequivocal. Drug treatment is far more effective if primary care and GPs are put at the centre of it. Is it not time that we move towards having a bigger GP presence on the NTA so that primary care is in the mainstream of drug treatment in this country?

I congratulate my hon. Friend on the work he has done in his area to achieve direct access to drug treatment services through GPs in the primary care setting. The “Bassetlaw Direct Access” drugs service has had tremendous results, with an 83 per cent. retention rate. I agree with my hon. Friend that GPs’ experiences should be represented. However, we are also trying to make sure that we embed substance misuse as an issue in the medical colleges; on 30 April we published curriculum guidelines on substance misuse. We are also improving the opportunities for GP practices to provide access to drug treatment, particularly in rural and semi-rural areas. However, we will endeavour to do more.

Is the Minister aware that the NTA values the contribution that GPs make in working with drug addicts and saving lives? However, how many GPs have been struck off by the General Medical Council for over-prescribing?

I will have to get back to the hon. Gentleman on that specific point, but the most recent figures—those for 2004-05—show that the number of GPs participating in shared care schemes for providing treatment to drug users has increased in the last 10 years from 20 per cent. to 32 per cent. Clearly we need to do more, but that is a good sign. We must embed the culture of understanding drug treatment in the earliest days of training. That is why providing the guidance to the medical colleges on 30 April was an investment in the future. I hope that more GPs will see this as one of the health roles that they should play in their communities.

NHS Finances

5. What recent assessment she has made of the effectiveness of measures put in place to improve the NHS financial position; and if she will make a statement. (138340)

Restoring financial balance in the NHS was our top priority in 2006-07. There is now a stronger system for assessing the financial position of all NHS organisations and we are confident that these measures will help the NHS further to improve its financial position. At quarter 3, the NHS overall reported a small surplus, and we expect the final position to show further improvements.

I thank the Minister for that reply. The Government changes to the resources, accounting and budgeting rules have removed £6.3 million of projected debt from my hospital trust in Morecambe Bay, leaving it in the surprise position of having a break-even budget for the forthcoming year. So far so good, but the Westmorland general hospital stands to lose its excellent heart and stroke unit as a result of an acute service review that took place last summer, which was in part driven by the short-term financial pressures. Now that those pressures have been—

I think that I can guess where the hon. Gentleman’s question was going. I also detected some hint of gratitude in his words for the extra £6 million for his trust this year, which will help to ease the financial position, and of course bring benefits to patients in his area. As he knows, a Cumbria-wide review of health services is being undertaken, which is expected to go out to public consultation in September. I hope that he will understand that I cannot make any concrete statements today about the precise proposals that will be made in that review, but I am sure that local health service planners will hear his words.

When the Conservatives were in power, there was a consistency to NHS funding: all the health boards and authorities were in financial difficulties. Today, only a small minority have financial problems. Does my hon. Friend share my puzzlement as to why that is the case?

It is not something that the Conservatives like to talk about, but when they left power the deficit, as a percentage of overall NHS expenditure, was far higher than anything seen in the last financial year. My hon. Friend is correct to say that the problems of overspending are now concentrated in a small number of organisations. It is the transparency of the financial regime that this Government have introduced that has enabled us to focus on that overspending and put in place measures to tackle it. As a whole, the NHS is benefiting. Last week, the Healthcare Commission reported that nine out of 10 patients say that the care they receive is good, very good or excellent, and that was in a year in which we have tackled the financial difficulties in parts of the NHS.

Given that health trusts such as mine in mid-Essex are having to take some difficult decisions to improve their financial position, could the Minister give an assurance that he and his colleagues will be sensitive when determining future independent treatment sectors—which may benefit patient care in some parts of the country—so that they do not cause a setback to those trusts that can fulfil their commitments and targets but would be adversely affected if the decisions were not taken sensitively?

The hon. Gentleman’s trust has benefited from the reversal of the resources accounting and budgeting rules as they affect NHS trusts. As predicted at quarter 3, his trust will post a surplus this year. Any changes to local health care will have to be carefully considered, but I can tell the hon. Gentleman that we will make changes when they are in the direct interests of patients. There is evidence to show that where independent sector treatment centres have been introduced, they have had the effect of challenging local NHS trusts, and waiting lists have fallen dramatically as a result. I would hope that the hon. Gentleman would support any solution that produces the best results in terms of access to the system for his constituents.

Is the Minister aware that the Royal College of Nursing has estimated that it would cost £60 million to pay the full award proposed for nurses by the pay review body? Does he accept that that is a price worth paying, and if not, does he have a strategy for dealing with the industrial dispute that may occur?

I know that my hon. Friend works hard on these issues and I hope that he agrees with me that the position of nursing staff under this Government is considerably better than what we inherited in 1997. I also hope that he accepts that the decision taken in respect of public sector pay was a decision taken across the public sector, with the exception of the armed forces, with regard to maintaining the strong economy that this Government have also produced. While those are difficult decisions, I hope that my hon. Friend will accept that they are taken for the best of reasons.

Over the past two years, my local primary care trust has received above average increases in spending, which are tremendously welcome and have helped to close the gap between the Government’s own target funding formula and the actual amount of money that the trust receives. Would the Minister agree that it would be folly to allow that process to go into reverse and that it is therefore important that the North Somerset primary care trust continues to get above average funding settlements in future?

That is an excellent question. It was missing the “Vote Labour!” bit at the end, but I think that it would have come if the hon. Gentleman had carried on. Yes, we are extremely proud of the money that we have put into PCTs like his around the country, and I am absolutely confident that the huge improvements in health care in recent years will be sustained. An extra £8 billion is going into the NHS this year, and that will produce substantial improvements for patients. I hope that he will continue to support the Government in working towards a well funded and improving NHS.

My hon. Friend will be aware that proper financial management has ensured that no PCT in the north-west will be top sliced this year to subsidise poor management in other areas. He will know too that many north-west PCTs receive less than the formula funding says they should. How is it that they can stay within budget, while others receiving more than their formula funding overspend?

I pay tribute to my hon. Friend for the persistent way in which he has raised matters relating to PCT finance. He is absolutely right: for reasons of basic fairness, we need the maximum health resources in areas where health inequalities are greatest and where ill health is entrenched—such as the borough that he and I represent. Also, I thank him for congratulating the north-west strategic health authority on ensuring that PCTs in the area are not being top sliced. That will enable PCTs such as his and mine to get on with the job of improving public health in our borough. The next funding allocation round will deal with the question of whether we can make further progress towards bringing all PCTs nearer their target allocations, but I shall bear in mind what my hon. Friend says.

This year, the Oxford Radcliffe NHS Hospital Trust must save £23 million, so will the Minister give some guidance about PFI repayments? Next year, the trust will have to make PFI repayments worth between £30 million and £36 million. Will the Department take PFI repayments into account when it sets the total sum for trust budgets, or will trusts have to make cuts to meet those repayments in future years?

When trusts plan new hospital developments, it is crucial that the decisions taken be sustainable and affordable in the long term. The Government have been reviewing all PFI schemes to ensure that they are precisely that—affordable, and the right size for future requirements. When spending is allocated to local health economies, we must take account of the population’s relative age, health need and deprivation. We will continue to do that when we make allocations to PCTs.

Medical Training Application Service

6. What recent representations she has received on the performance of the medical training application service. (138341)

The Department has received over 1,300 letters on the topic of Modernising Medical Careers and MTAS this year. Department officials have also had meetings with, and representations from, many organisations, including the royal colleges, the British Medical Association and Remedy UK.

What lessons does the Secretary of State believe there are to be learned from the recent actions of the BMA’s outgoing chair, Dr. James Johnson?

James Johnson’s resignation is a matter for the BMA. It would not be appropriate for me to comment.

Most of the House will welcome the service that James Johnson has given over recent years, to the BMA and in other ways. My question to the Secretary of State has to do with MTAS. Does the Department recognise that examination candidates who want to check whether their marks have been added together correctly— or whether their papers have been marked at all—should get an appropriate response before the end of round 2?

The hon. Gentleman refers to the Information Commissioner’s recent ruling. As a result of the commissioner’s letter to the Department, a meeting is being arranged between him and appropriate officials to agree the way forward.

I am aware that the Secretary of State has apologised for the way in which MTAS was carried out. In my meetings with junior doctors, who are extremely concerned about the situation, it became clear that they have a strong commitment to, and belief in, the national health service, so will my right hon. Friend indicate how we can reassure those doctors that they are indeed valued?

My hon. Friend is absolutely right about the enormous commitment of junior doctors, and other health care professionals, to the NHS. In relation to recruitment to medical training, I stress that the interviews in round 1, which include an interview for every applicant, are nearly complete and, subject of course to the outcome of the judicial review, job offers will start to be made as soon as the result of the judicial review is known. By sorting out the very real problems and distress that have arisen this year, we will indeed be able to reassure junior doctors in particular about how much we value them and to ensure that they have a good future in the NHS.

Ministerial mismanagement led to the computer chaos that is the medical training application service, which has failed to deliver a fair, open, transparent and efficient selection process for junior doctors, and even threw in for good measure a massive breach of personal security. Can the Secretary of State tell us today how many available training posts there are now for junior doctors and how many applicants there are? If we have those two facts, we can calculate how many thousands of junior doctors will not get a training place this August.

As I have said before, across the United Kingdom there are about 32,700 eligible applicants in the MTAS system, of whom more than 30,000 are already employed in the NHS. There are 23,500 training posts in total, including the GP training posts for which recruitment is separate from MTAS. Let me stress again that thousands of the applicants are currently employed by the NHS in non-training posts and all those jobs—in total, more than 30,000—will continue to be needed to ensure that patients continue to receive the excellent care the NHS provides.

What is my right hon. Friend’s assessment of the article in The Independent today that argues that we should not get excited about the MTAS situation, because due to the expansion in the number of doctors in our medical schools under the Labour Government there will be greater competition for some of the best training jobs?

My hon. Friend makes an important point. I thought that the editorial in The Independent this morning was a breath of fresh air and rationality when the media have not really been characterised by accurate or rational reporting on this subject. The reality is that there are more junior doctors, and indeed other healthcare professionals, in training for the NHS than ever before. There has always been intense competition for the specialty training posts that lead to a consultancy for successful applicants. That competition is intense this year, but more doctors and even better trained doctors, with the best of them becoming consultants, is all good news for patients.

Does the Secretary of State agree that the ability to speak in Welsh is a valuable occupational qualification for doctors working with children and older people—

Yes—and some in England. Where was that valuable occupational qualification addressed in the application form or in the application process?

I am sorry, but the hon. Gentleman will be disappointed to learn that we do not propose to make Welsh an occupational qualification for doctors in England.

Junior doctor rotation has always been a difficult time, and over all the time when I was involved in the health service many a junior doctor did not get the specialist job he or she wanted. We have heard about the intense competition due to the massive increase in doctors in training, so to go on from what has been said already, will my right hon. Friend indicate what support is available for junior doctors who are trying to get through the process at present?

My hon. Friend is absolutely right that at this point we should focus on the solutions, rather than simply restating the problem. As I have indicated, job offers for round 1 will be made, subject to the outcome of the judicial review and as soon as we know that court judgment. Detailed information on that process is going out to applicants very shortly. Once we have the court judgment from the judicial review, we will be able to give applicants further details of how round 2 —the next round of recruitment—will be organised and the support that will be available to applicants throughout that process and beyond, as we look to the end of that further round of recruitment.

The Secretary of State will be aware that the statement of Nicholas Greenfield to the judicial review proceedings last week disclosed that on 25 April there was a report to the review group that disclosed that there were serious flaws with the software within MTAS. Was she informed of those serious problems at that time? If so, why did she not tell the House of those problems in her statement on 1 May? Is it not outrageous that in her statement last week she made no reference to the fact that she had no option but to abandon MTAS, because the system was not working?

The hon. Gentleman, I am afraid not for the first time, has simply misrepresented the position. First, MTAS has not been abandoned. It has been reopened to the postgraduate deaneries, which can continue to use it for the recruitment process. On the issue of the software, as I told the House last week, because of the continuing concerns of junior doctors—[Interruption.] Perhaps the hon. Member for North Norfolk (Norman Lamb) should listen to the point that I am making, because it is important. Despite the security improvements that have been made to MTAS, because of the continuing concerns of junior doctors, we decided not to use it for the process of matching applicants to job offers. One of the concerns expressed by the junior doctor representatives on the review group related to the fact that the new software that would be needed to match the applicants to the jobs had not been completed and, because of the other problems, there would not be time to test it properly. That was part of the background to what I told the House last week about the continuing concerns that led us to decide not to use MTAS for the job offer process. That was a perfectly sensible decision. There is no question of misleading the House and I hope that the hon. Gentleman will not repeat that allegation.

Will the Secretary of State now tell the House how many additional training posts the review group has asked the Department of Health to provide for? This is the fifth time in over two months that I have asked the Secretary of State to make a commitment to provide for additional training posts and she still has not done so.

I am afraid that the hon. Gentleman will have to wait until we have the outcome of the judicial review. I will then announce how many additional training posts will be made available for round 2 and other details of round 2.

The Secretary of State will recall that on Sunday James Johnson said that the medical training scheme had been characterised by policy failures. Who does the Secretary of State hold responsible for those policy failures?

As I have said in the House before, Modernising Medical Careers has been a joint effort by the Department of Health, Ministers, the royal colleges, the British Medical Association, the work force deaneries and many others, all of whom have been involved in addressing the problems that were highlighted many years ago by the BMA itself when it rightly called for a new system of training to replace the thoroughly unsatisfactory old system whereby senior house officers became known as the lost tribe because they simply did not have the support that was needed. We know perfectly well that the implementation of the application and recruitment system for this year has not worked properly. We have had a lot of problems with it—we hardly need to say that in this Chamber. We are sorting that out and I take responsibility for doing so.

Children's Diets

7. What steps her Department is (a) taking and (b) planning to take to encourage the consumption of fruit and vegetables by children. (138342)

The Government have a number of programmes in place to improve the diet and awareness of healthy eating among children and young people. These include the new school meals standards, the healthy schools programme, healthy start, 5 a day, and the school fruit and vegetable scheme.

I thank the Minister for her response. Does she agree that much could be done to tackle child obesity and health inequalities if she was to work with colleagues in the Department for Education and Skills to build on the excellent initiative of providing free fruit and veg to schools and deliver free, compulsory, nutritious school meals for all children?

My hon. Friend makes a good point about tackling inequalities. I was pleased that the 2005 health survey for England showed that the number of children eating fruit and vegetables was increasing, with the number eating at least five a day going up to 17 per cent. from 10 per cent. in 2001. I am also pleased that the Department for Environment, Food and Rural Affairs household expenditure survey, which was published in January, shows that there has been the biggest increase in expenditure on fruit and vegetables for 20 years—it is up by 7.7 per cent. However, we can do more. This Government have given local authorities the power to decide whether they want to provide free school meals, and that matter is best dealt with locally. I am proud of our joint work with the Department for Education and Skills which has meant that more than 89 per cent. of schools are now taking part in a voluntary programme called healthy schools.

Since every woman I have ever known, from my grandmother onwards, has tirelessly tried to persuade their offspring—and indeed their husbands—to eat more vegetables, what makes the hon. Lady think that her increasingly Orwellian Department will be more successful?

Well, clearly we support families making choices. I am pleased that families are increasingly making healthy choices for their children and themselves. I do not want to get into the hon. Gentleman’s family background in relation to this—

I will leave others to comment on that. However, we must get the balance right when the Government are trying to intervene in areas that are their responsibility. We expect children to attend school; that is part of the law—[Interruption.] Even grammar schools. Given that we require children to go to school, it is part of our endeavour that when food and drink are provided at school, they should be the healthiest available. We must achieve a step change through which parents are enabled to make the right choices for their children. More and more parents are doing so with our support, rather than any lecturing.

On Friday, I am visiting Ellenbrook primary school in my constituency to open its healthy schools vegetable garden. Will my hon. Friend congratulate the school on not only promoting healthy eating, but teaching children how to grow the herbs, fruit and vegetables that will be used in their school meals every day? Does she think that other schools should follow that example?

My hon. Friend cites a really good example of a project that is seeking to achieve on several fronts. It is encouraging an understanding of the need to eat healthily and getting children out there to grow food, thus increasing their understanding of where it comes from. Alongside that, it increases physical activity at school. I am pleased to inform the House that from September, we will start a joint project with DFES and DEFRA: the year of food and farming. We will make links with local producers to find out what we can do to encourage more schools to purchase more locally the fruit and vegetables that can make a difference. Learning about how food is grown and its production to the point at which it ends up on the plate can make a difference to an understanding of a healthy diet.

Why does the Minister think that the recent evaluation of the school fruit and vegetable programme by the National Foundation for Educational Research found that it had no lasting impact on what children were eating, that only 27 per cent. of children achieved the five-a-day target, and that only a third of children were aware of what that target was—no doubt some thought that it referred to cigarettes? In any case, two thirds of the fruit and veg in the programme comes from overseas and half contains more than one type of possibly harmful pesticide. Some £77 million later, is this another costly, headline-grabbing, ill-thought-out Government initiative that has gone pear shaped?

The hon. Gentleman raises several questions. I understand that the article that appeared in The Sunday Telegraph a few weeks ago was based on a report that examined figures from about three years ago. We are evaluating the scheme at present and we will publish the figures shortly. However, the indicators show that both the consumption and purchase of fruit and vegetables are going up. The school fruit and vegetable scheme serves 2 million four to six-year-olds. Next time I get letters from Conservative Members asking me to extend the scheme, I will refer them to the hon. Gentleman.

Patient Choice

Next month we shall be launching a new online information service, NHS Choices, that will give patients easy access to information about conditions, treatments and hospitals. It will help the public to make informed choices about their own health, including when and where they receive treatment.

I thank my right hon. Friend for her answer, but I hope that we have made improvements and alleviated some of the teething problems that were experienced last year. A constituent came to see me over choose and book. She was referred to a dermatology department, and when she rang to make the appointment she was asked which hospital she wanted. When she asked for her local hospital, she was told that the waiting list was too long and was referred to one 20 miles away. When she said that she would prefer to wait a bit longer, she was told that that was not possible. The matter was eventually sorted through the patient advice and liaison service, but surely choice means that patients, if they wish, should be able to choose to wait a little bit longer to go to their local hospital.

My hon. Friend is absolutely right, and I hope that we have now made that crystal clear to NHS hospitals. A local hospital is obliged to treat all patients who choose to be treated there if that is clinically appropriate, and if a patient wants to wait longer than, for instance, the current six-month maximum target for in-patient treatment, of course they are free to choose to do so—provided they are told that when they make their booking. The way that we are extending choice for patients is in accordance with what patients themselves have said they want, and we know from experience over several years that it is a way of ensuring that hospitals respond by giving patients faster and better care.

Patient choice means being treated with dignity, so what confidence can we have in a Government who may parrot choice, but whose claim to have delivered it to patients wishing to avoid mixed-sex wards is strongly contradicted by experience and by data published by the Healthcare Commission?

As I think the hon. Gentleman knows, the commitment that we made to ensure that everyone had single-sex sleeping accommodation, bathrooms and toilets did not extend—because it could not—to accident and emergency, and to medical admission units. That is one reason why there is a real difference between the reports that we have had from the hospital trusts and the reports of patient experience. Nevertheless—the chief nursing officer recently published press guidance on this—we have identified those hospital trusts that are really struggling to meet the commitment that patients are entitled to expect, that in, as it were, normal wards, they should have single-sex sleeping accommodation, bathrooms and toilets, and we are giving the NHS extra support, and indeed holding it accountable for delivering that. But I regret that the hon. Gentleman did not mention that the same Healthcare Commission survey found that even more hospital patients are satisfied or very satisfied with the care that they have had from the NHS in the last year.

Local Involvement Networks

Great. From our public consultation, we know that many people want to have a greater say over their health and social care services. The establishment of local involvement networks—LINKs—will give people far more opportunities to have a stronger voice over their local services.

I thank the Minister for that answer, and the enthusiasm with which she gave it, but she will have been told, as I have, that one of the tools that members of patient and public involvement forums value most is the ability to inspect hospitals or other health care facilities, including, where they think it necessary, without notice. Given that those powers and that ability will be circumscribed for local involvement networks, and in the case of inspections without notice, removed altogether, does she not think that it is inevitable that the public will have less confidence in LINKs to protect their interests than they did in PPI forums?

No, I do not think that they will, because I think that LINKs will actually be very powerful bodies in terms of their ability to get responses from primary care trusts when they raise particular issues, and their ability to look at social care institutions. We wanted to avoid confusion between the inspection roles of the statutory regulators and the powers of LINKs to go into trusts to view the services. That is why we have made a change, to enable them to do that. However, it is important to recognise that when LINKs go into, for example, day care centres under social services, notice needs to be given to people who go to such centres for, in a sense, respite care. We want to make sure that that work does not disturb either staff or patients. However, LINKs will be able to make reports after they have entered premises and to demand replies from PCTs and others.

In my area we have a group of very dedicated people who were involved in community health councils, who then became involved in the various patient and public involvement organisations and who want to be involved in the LINKs. However, they are conscious that we are not reaching out to a wider electorate of people who want to get involved in such work. How can we spread the word and get new people involved in these organisations?

That is the challenge. We know from consultation that people want to have a greater say. Through some of the draft guidance that we have issued we have looked at how to involve more people. We also have some early adopter sites, which are considering in particular how to widen the range of people who are involved to include voluntary sector and other patient groups.

Mental Health

The Department collects data on occupied bed days, not on the number of individuals that that represents. In 2006-07, there were 19,988 hospital occupied bed days on adult psychiatric wards of patients aged 16 or 17, and a further 201 hospital occupied bed days on adult psychiatric wards of patients aged under 16.

I thank the Minister for that answer. What plans do the Government have to protect centres of excellence for the treatment of adolescents with severe mental health conditions, such as the one that is being closed at Cassel hospital, Richmond. I understand that it is being closed because PCTs across the country are not prepared to pay for out-of-area placements.

In providing that more specialised care, we want PCTs to consider the requirements in perhaps a wider area than the PCT area, because sometimes quite small numbers of children require that type of intensive specialist care. However, I feel that often children are sent too far away from home. Some out-of-area provision is necessary, but we want to make sure that such provision is commissioned more effectively and can deal better with the situation that affects small numbers of children. We want to make sure that they can have treatment closer to home than is sometimes the case now.

I thank the Minister for the reassurances on that very issue that she gave during Committee stage of the Mental Health Bill. What discussions will she have with the new coalition on mental health services, which supports the modernisation agenda, so that we can make the positive changes that she wants?

My hon. Friend refers, I believe, to the fact that approximately 85 per cent. of those who work in mental health services have now withdrawn from the Mental Health Alliance and are realigning themselves to make sure that some of the steps that we want to take to modernise mental health legislation can go forward. I thank him for his contributions in Committee, where we had a lot of discussions about what we want to do to improve those services and, in particular, about age-appropriate accommodation.

NHS Data Disclosures

The strongest safeguard is the professionalism of NHS staff themselves, but the modernisation of NHS IT also provides the opportunity to deploy state-of-the-art security safeguards, particularly for confidential patient information. In the rare cases where NHS staff do breach patient confidentiality, they are subject both to disciplinary measures and to the legal penalties provided under the Data Protection Act 1998; professional staff also risk losing their licence to practise.

Three weeks ago the Department of Health made an unauthorised disclosure of the personal details of junior doctors, which was a disgrace. More recently, the Public Accounts Committee severely criticised the main health IT system, which is already running two years late. Apart from the usual bland assurances that we get from the Secretary of State, what guarantees can she give us that patients’ personal medical records will not be disclosed, and as her Department is clearly incapable of running or commissioning anything properly, will she take independent advice on the matter?

The electronic patient records and other aspects of connecting for health have nothing whatever to do with MTAS; they have all been organised with the highest level of security safeguards, and that has been independently verified. The right hon. Gentleman is simply scaremongering, and instead of doing so—[Interruption.] The Conservative party already opposes identity cards. Is the right hon. Gentleman telling us that he will now oppose electronic patient records?

Nappies

12. What support or guidance her Department gives to maternity units to give new mothers access to reusable or biodegradable nappies. (138347)

It is for individual national health service hospitals and trusts in England to determine the practicalities of promoting the use of reusable and disposable nappies in their maternity units. For the rest of the United Kingdom, that would be a matter for the devolved Administrations.

I thank the Under-Secretary for his response. Having just become a new mum, I am keenly aware of the special access that manufacturers of disposable nappies have to new mums when they are in hospital. Given nappies’ contribution to landfill, will he look at ways to level the playing field, and will he at least encourage samples of biodegradable and reusable nappies to be made available in hospitals? Once people start using a product, they are more likely to continue using it.

We have to be careful not to encourage too much of a nappy state. We give first-time mothers a pregnancy book and a birth to five book, both of which discuss in some detail the case for and against each kind of nappy. It has to be said that a report by the Department for Environment, Food and Rural Affairs found that, in the end, in terms of overall environmental consequences, there was very little difference between disposable and reusable nappies. I understand that the Minister of State, Department of Health, my hon. Friend the Member for Leigh (Andy Burnham), is happy to host a meeting with the Nappy Alliance to discuss the matter further.