1. If he will make a statement on the future of services at Barnet and Chase Farm Hospitals Trust. (151788)

Proposals for on how to change services to improve care for patients are for the NHS to decide locally. On 28 June, Barnet, Enfield and Haringey primary care trust launched a full public consultation on proposals to improve health care in the area.

While there are concerns about the nature of the consultation, it could provide a real opportunity to improve services in our area. There are fears that if there were movement of patients from Chase Farm to Barnet, the new improved services at Barnet would not be in place before any changes were implemented at Chase Farm. Can my hon. Friend assure me that new services will be provided before any changes are made?

Yes, I can. I am pleased by the welcome that my hon. Friend gives the proposals. I know that he has been closely engaged, meeting both local health service managers and his constituents. I assure him that it is very important that changes that result from the local discussions are made only once the services to which he refers are in place.

I understand that the Healthcare Commission report states that the trust does not have an identified budget for infection control training and that attendance at infection control training is being monitored. The Government said in 2004 that 1 million staff would get training in infection control. Why is that not happening, and is the Government’s decision to cut 10 per cent. from the education and training budget part of the reason for that failure?

As the hon. Lady knows, there has been a 9.4 per cent. increase in funds available to PCTs in the last financial year. I take it that she was referring to the Healthcare Commission’s report on hygiene standards at Barnet and Chase Farm—

indicated assent.

The hon. Lady did not specify that, but I am glad that that is the case. We are concerned about that, and the commission also expressed its concern. As a result of its report, the trust is investing an extra £500,000 in cleaning wards, screening patients before admission and a prudent antibiotic prescribing policy.

Changes at Chase Farm hospital will have implications for other local hospitals, especially North Middlesex hospital in my constituency, which is just about to start a new PFI. Will my hon. Friend give me some reassurance that any changes that will have an impact on the North Middlesex hospital will be taken into account when that PFI gets under way?

It is important that all elements of proposed changes, including the potential impact on PFI schemes, are taken into account when such service changes are proposed. I expect that my hon. Friend is already intensely engaged in the consultation process to ensure that his concerns about the impact on his constituency are made clear.

2. What progress the Government has made in increasing patient choice within the NHS. (151789)

Patients have a choice of four or more local hospitals for elective care and 114 other hospitals through extended choice. From April 2008, patients can choose any hospital that meets NHS standards and cost, beginning with orthopaedics this month. In June we launched the groundbreaking NHS choices information service.

I thank the Secretary of State for that reply and for writing to me about the regulation of Chinese medicine, which was helpful in setting a timetable. Does he accept that real problems are caused by the fact that demand from patients is out of sync with the supply of services, especially in complementary and alternative medicine? Primary care trusts are not listening to patient demand. The situation is well illustrated in London, where the Royal London homeopathic hospital, which provides a range of services that go way beyond homeopathy, is being cut. If the Secretary of State really believes in patient choice, which is to be his flagship with his new broom Front Benchers—[Interruption.] Well, there are some new brooms, because all the old Ministers were sacked—[Interruption.] Well, most of them—a large proportion—were fired. Will the Secretary of State please consider issuing guidelines to primary care trusts to take patient choice into consideration?

In preparing to reply to this Adjournment debate, I looked carefully at the points the hon. Gentleman made in his letter to me but I am not persuaded of the need to issue guidelines at this time. It is clear to me that many more patients want the benefit of complementary and alternative medicine and therapies; indeed, the most recent survey showed a high percentage of patients looking for that. What general practitioners do is very much a matter for them; for instance, I understand that in the Newcastle primary care trust area 69 per cent. of GPs deal with complementary and alternative medicines, so I see no need to issue guidelines at this stage, but I agree with the hon. Gentleman that such medicines are becoming an increasingly important part of GP prescriptions.

The technology driving some of the new health service systems has started to bite and is having a huge impact on our ability to improve patient choice, as well as delivering many other health benefit outcomes. With the departure, shortly, of Richard Granger, who has done such a splendid job on behalf of the NHS, will my right hon. Friend ensure that his replacement is of that calibre and that there is no shift in the Government’s drive to improve health IT systems?

I shall meet Richard Granger just before his departure. My hon. Friend refers to an important area, where, as he says, we can extend patient choice and use new technology for the greater convenience of patients, citizens and clinicians, which is why it is important that we get the right person to replace Richard Granger.

How does the Secretary of State square his Government’s supposed notion of choice with the large-scale closure of maternity units, especially midwife-led units, thereby depriving many women of choice, particularly in Romsey and the New Forest?

There are two issues, the first of which is choice, which we want to extend. An important GP survey was published today and I made a written statement about it this morning. The second issue is maternity care, and recently, with the full support of the profession, we published “Maternity Matters”, which makes it absolutely clear that—as in so many other aspects of medical care—we cannot simply defend the status quo. We need to ensure that we configure our services so that we save the lives of more babies; for instance, in Manchester—although there is still an issue of contention that has yet to be concluded—there are proposals by local health care specialists and local clinicians to save the lives of 40 babies a year. Such evidence cannot be disregarded.

Are not more than 90 per cent. of people who use our hospitals satisfied and think that the service is good? Those who have criticisms want basic things such as better catering and cleaner facilities?

Yes, I agree with my hon. Friend. In addition, many patients would like to choose how they are operated on—for instance, non-invasive surgery. If their consultant is not au fait with the latest techniques and cannot carry out non-invasive surgery, the patient should be able to say, “I’m sorry but that’s the kind of operation I want”. That would be good not only for patient choice but for driving up standards among clinicians.

As the Secretary of State knows, it is the Government’s promise that in two years’ time every mother should be able to exercise full choice about the circumstances in which they give birth, be it in a consultant-led maternity unit, a midwife-led birth unit or at home. Will the Secretary of State tell us how many additional midwives he believes will be necessary over the next two years to deliver that promise of choice?

I cannot say that at this stage because it depends on how things pan out in every area, but it is clear that an increase in the number of midwives will be needed. If we are offering that choice to every woman in the country, we must ensure that we deliver on it with the right staffing in the right places, which means that we cannot pull a figure out of the air, but there is an area of consensus—even between the Treasury Bench and the Opposition Front Bench—on which we can work to make sure that things are properly implemented.

I am grateful to the Secretary of State, but I am afraid that I cannot see how, locally, primary care trusts and hospitals can deliver the number of midwives that are necessary unless there is at least some work force planning to make that happen. The number of midwives, and the number of training places in midwifery, went down in each of the past two years, and the Secretary of State must know that in the past five years the number of live births has gone up by 13 per cent., whereas the number of full-time-equivalent midwives has gone up by only 5 per cent. We are therefore more than 1,000 short of where we need to be now, let alone where we need to be in order to extend choice in two years’ time. So will the Secretary of State promise today that he will go back and look at “Maternity Matters” and put some of the work force planning into “Maternity Matters” that simply was not there?

I think the hon. Gentleman is right in his assumption that we will need to get the work force right. He is also right that this is non-negotiable; it has to be in place by the end of 2009. He is also right in pointing out that there has been an increase in the number of midwives since we entered government. Putting all that together, I undertake to ensure that we have the proper work force planning in place at the right time to ensure that we can meet the commitments set out in “Maternity Matters”.

3. What discussions he has had with ministerial colleagues on reducing scalding injuries in the home. (151790)

I am not aware of any specific discussions with ministerial colleagues on reducing scalding within the home. However, the Department of Health supports policies and initiatives aimed at reducing and preventing the incidence of these injuries.

Keith Judkins, consultant anaesthetist at Pinderfields hospital in Wakefield and a member of the British Burn Association, tells me that every year 600 cases of first-degree burns are admitted to hospital, most of which involve children under five who have fallen into scalding hot bathwater, and each year 20 people die. A consultation to look at installing thermostatic mixing valves in the home is currently ongoing with the Department for Communities and Local Government. Will my right hon. Friend ensure that huge emotional and physical trauma costs, as well as the costs to the NHS, are taken into account in any analysis of whether to proceed with that measure?

I congratulate my hon. Friend, who has worked incredibly hard on ensuring that this campaign is drawn to our attention. I confirm to her that submissions will be made on that during the review of part G of the building regulations. I would go further and say to her that a vital role is also played by the third sector, and organisations such as the Royal Society for the Prevention of Accidents. We need to look again at how they are operating. None the less, I agree that both my right hon. Friend the Secretary of State for Children, Schools and Families, and the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), as part of his responsibilities for older people, need to consider how we can address the shocking figures that she draws to our attention.

Of course, elderly people are also affected by scalding, and one of the most effective ways of dealing with that is to get more help into elderly people’s homes. Does the Minister share my concern that this year, because of the underfunding of Shropshire primary care trust, the taxpayers of Shropshire, through Shropshire county council, will have to pay an extra £650,000 for community care? Will she agree to meet me and a delegation of other Shropshire MPs to discuss this issue?

Surely the hon. Gentleman will accept that the PCT in his area has actually seen an increase in funding. Surely he would also accept that in dealing with this very important issue we need to look at resources in local government, in the health service and in the third sector and ensure that there is a proper response to advice and support, particularly for the vulnerable. Surely he also accepts that he cannot come to the House and support a party that wants to cut spending on the national health service and then plead for more money for his constituency.

4. What discussions will be held with trade unions in the course of the NHS review conducted by Sir Ara Darzi. (151791)

Lord Darzi and I are already discussing a range of issues with staff, patients, the public and key stakeholders including the trade unions both locally and nationally to ensure their full involvement in the NHS next stage review.

I thank the Secretary of State for his response. I advise him that the work of the trade unions in the past 10 years in helping to put in place the NHS plan and “Agenda for Change” is a model that should be adapted in the review, so that the unions continue to play a comprehensive and supportive role in making the NHS even better than it is today.

I agree with my hon. Friend. Indeed, Lord Darzi was in his constituency yesterday, while visiting Gateshead PCT, which might be just outside his constituency. He has also met the leaders of all the major trade unions, and I very much agree with my hon. Friend that the trade union input has been positive throughout the NHS plan and all the events over the past 10 years. This is a huge opportunity for us to re-engage with the work force, which includes, of course, their trade unions.

Representatives of the midwives told the Oxfordshire health overview and scrutiny committee the other day that proposals to downgrade services at Horton hospital from consultant-led to midwife-led were utterly unacceptable. Will the Secretary of State and his team listen to the advice of the Royal College of Midwives and the Royal College of Nursing on those reconfiguration proposals, or will they simply be brushed to one side?

They will not be brushed to one side, and the hon. Gentleman knows full well that those proposals are local and are led by clinicians locally. I announced in my first week in this role that I would pass on all cases referred to me by the overview and scrutiny committee to the independent reconfiguration panel, which is clinician-led, because it is very important that those issues are driven locally, by clinicians in the area. The Royal College of Midwives, which has been to see me already, has very eloquent spokespeople on this issue, and they will be listened to—of course, they will—but as for my involvement, it is right that politicians stay back and allow those working in the health service and those responsible for health care to lead the proposals.

May I inform my right hon. Friend that one of my local newspapers claims to have a leaked e-mail from a middle manager of the Queen Mary’s hospital trust that sets out plans to downgrade accident and emergency services, close maternity and paediatric services and make cuts of £60 million? Such headlines will make it very difficult for Lord Ara Darzi to enter into a meaningful dialogue with local people and consult on the shape of future local services. What is Lord Darzi doing to address those speculative headlines, which are making it very difficult to have a meaningful dialogue about the future of our services?

I understand the point that my hon. Friend makes, because such headlines are totally unhelpful. [Interruption.] Of course, they are driven in part by the Conservative party’s opportunism. I shall give an example of the paradox. A couple of weeks ago, the hon. Member for South Cambridgeshire (Mr. Lansley) used an Opposition day to debate the very important issue of stroke care—it is absolutely essential that we debate such issues—and he quoted a National Audit Office report that came out in 2006 and said that, as a result of more efficient practice, £20 million could be saved annually, 550 deaths avoided and more than 1,700 people would fully recover who would previously have been disabled for life. We therefore have to change the health service to provide those kind of services. However, at the same time as pushing that, the Conservatives ask us for a moratorium on any change whatsoever. There cannot be such a moratorium, and we need to deal with the issues that my hon. Friend raises, not in headlines but in proper deliberative debate. That is what the Darzi review is all about.

Will the Secretary of State encourage Lord Darzi to engage one to one with all MPs in whose areas things are likely to change?

I will encourage Lord Darzi to deal on a one-to-one basis with all MPs. I am writing to all MPs to let them know where Lord Darzi, David Nicholson and the other 60 clinicians will be over the summer period, so that if any MP wants to turn up and perhaps give up a couple of days in Tuscany, he or she can go there and chat to him at leisure.

May I refer the Secretary of State to his Department’s press release on ministerial responsibilities? Under Lord Darzi’s name, it says:

“Lords business is being covered by a Lords Whip.”

I understand that Lord Darzi intends to spend little time in the other place, not to deal with any legislation and to answer few questions. Given that he is embarking on a fairly fundamental review of how the health service operates, dealing with the sort of issues raised by the hon. Member for Blaydon (Mr. Anderson), how on earth is Parliament supposed to hold him to account? Is this not precisely the sort of arrangement that the new Prime Minister indicated he opposed, whereby, effectively, Parliament is being sidelined?

With due respect to the hon. Gentleman, I do not think that that is the primary concern about health services. My belief is that Baroness Royall will cover many of the questions. She will be accountable on behalf of the Government. I know that the hon. Gentleman thinks a lot about these things. It is to everyone’s benefit to have someone of the reputation and skill of Lord Darzi, who will continue to practise two days a week, as well as meeting MPs individually and doing all the other things. He will continue to be a leading clinician in the health service and he will carry out the review, which will take up an awful lot of his time. It is innovative that not only do we have a clinician of his standing to lead the review—along with many other clinicians—we also have him as a Minister to ensure that, unlike with the Turner report or the Leitch report, we have someone in Government to carry the report through. That is of more interest to the public than who is answering questions in the Lords.

May I draw the Secretary of State back to the original question and ask him about his discussions with Unison in relation to the cuts around the country? Recently, the Secretary of State was quoted in the Health Service Journal as saying:

“We have listened a bit too much to the British Medical Association and not enough to unions like Unison.”

Interestingly enough, I agree with him. Perhaps he would like to listen to Karen Jennings, who is Unison’s head of health, and who said:

“These 600 compulsory redundancies will resonate across the NHS and strike fear into the hearts of local communities.”

The cuts are based on deficits, not clinical care. Will the Secretary of State step in and stop those cuts, which are affecting care in our hospitals?

First, may I welcome the hon. Gentleman, who is making his first outing at the Dispatch Box? I disagree profoundly with him and with other Opposition Members on this issue. As I understand it, they are asking for a moratorium on any change. [Interruption.] Yes, I read the seven steps. Step one was to have a moratorium on reconfigurations. Indeed—[Interruption.]

Order. Let the Secretary of State reply.

Indeed, the right hon. Member for Witney (Mr. Cameron), who I believe represents David Cameron’s Conservatives—I am not sure whether that is the same party as the one to which the hon. Member for South Cambridgeshire (Mr. Lansley) belongs—called at Prime Minister’s questions, on the back of the London review, for absolutely no further changes. Of course Opposition Members like to put out scare stories—that is part of their politics at the moment. However, the policy issue is that, with advances in medical science and new technology, and with changes in demography, we have to change our health service when it comes to issues such as stroke care, which we debated a couple of weeks ago, in order to save more lives. It would be perverse if we were to put a moratorium on saving lives.

5. How many accident and emergency departments are planned to be downgraded; and if he will make a statement. (151793)

Any proposals for major changes to services are for the national health service locally and are designed to improve care for patients.

There is a well-established and well-understood process for managing consultations on such proposals so that patients, staff, the public and other local stakeholders can have their say and help to inform decisions.

I am grateful to the Minister for that reply. Will he therefore undertake to publish the clinical basis on which the Government justify their decision to increase the minimum catchment area for an accident and emergency department from 300,000, as recommended by the Royal College of Surgeons, to 450,000, as recommended apparently by no one apart from his own Department, and explain how, by coincidence, that fits in with the proposed population that would arise if the accident and emergency department at Queen Mary’s Sidcup were to be closed, as revealed in a memo that was written by NHS officials and not by any Member of the House?

I suggest that the hon. Gentleman wait for the proposals that we are expecting from his local area. I am sure that once local health managers in his area publish those proposals, they will justify them on clinical grounds. A recent statement from the British Association of Emergency Medicine recommended that, in order to provide safe emergency services around the clock,

“there needs to be immediate access to intensive care, anaesthetics, acute medicine, general surgery and orthopaedic trauma”.

For the best use of resources, a figure of 450,000 was indeed mentioned, but this is not a one-size-fits-all issue. It will depend on the local circumstances. He should wait for the local consultation.

My hon. Friend may be aware that a not very sophisticated game is going on, with some members of some political parties in this House announcing that A and E departments are going to close when there is no question of them even being considered for closure. Immediately after an election, however, those same hon. Members suddenly announce that the departments have been saved. I hope that my hon. Friend will be a little less magisterial and a little more political and tell us firmly which A and E departments are going to close and which are unquestionably not going to. In that way, he will be doing us all a favour.

I do not think that I have ever been described as magisterial before, and I am always happy to be as political as Mr. Speaker will allow. Many of these decisions are made at local level and not by me, as my right hon. Friend the Secretary of State has made clear, but my hon. Friend is absolutely right to draw attention to the fact that an awful lot of stir-mongering and scaremongering is going on out there. I could quote a number of examples, such as the A and E department at the Hinchingbrooke health care trust in Huntingdon. The hon. Member for South Cambridgeshire (Mr. Lansley) confidently predicted that that facility would close but, following recent consultation, a decision has been taken not to close it.

Will the Minister acknowledge that there has been no scaremongering in respect of the Princess Royal hospital in Haywards Heath, which is part of the West Sussex PCT? It has been proposed that the hospital’s A and E department be closed and its maternity services withdrawn. Clinicians and local GPs feel that that would be unsafe and unwise, although they accept that other reconfigurations need to be made. Therefore, will he assure me that the PCT will be forbidden from going ahead with the proposals?

My right hon. Friend the Secretary of State has said already that he will pass on to the independent review panel any proposed changes referred to by local scrutiny committees. He and I have both said that it is very important for patients and local Members of Parliament to engage in the consultation process, and that clinical concerns about proposals should be made plain. However, the driving force behind all the changes is the objective of improving care for patients. The technology is changing and, to save lives, local care should be given where that is possible and necessary.

My hon. Friend is no doubt aware of last Friday’s shocking decision by the University Hospitals of Leicester NHS Trust to withdraw from the Pathway project, which will have a devastating effect on service provision in Leicestershire. What steps is he taking to reassure the public and local Members of Parliament that services will be protected? When was he told of the decision, and will he meet a delegation of hon. Members to discuss this very important matter?

I should be happy to meet such a delegation, and I have already offered to meet my hon. Friend and the former Secretary of State for Health, my right hon. Friend the Member for Leicester, West (Ms Hewitt). The decision is shocking, yes, but perhaps not so surprising, given that the project’s projected costs had spiralled considerably. I can well understand the concern that he expresses on behalf of the people of Leicester, but I am assured by the local health service management that the funds originally proposed to be spent on the project will still be available to improve services in Leicester, and I look forward to examining, with my hon. Friend and others, how that can best be done for the future.

I cannot even start to describe how angry doctors, nurses, unions and patients in Scarborough are after last week’s announcement of 600 job losses at Scarborough hospital. That is one third of the hospital’s staff. Will the Minister come to Scarborough this summer to see for himself the effects that the cuts are going to have, and to let us convince him that we need to maintain full A and E cover at that hospital?

As far as I understand it, discussions on the proposals that the hon. Gentleman mentions have not even begun yet, but I am sure that the Under-Secretary of State for Health, my hon. Friend the Member for Brentford and Isleworth (Ann Keen), who is responsible for the heath service in the north-east, would be happy to meet the hon. Gentleman and the delegation to discuss the issue. As we said earlier, a difficult, tough decision was taken last year by our predecessor team. For years and years, we had a system in which a small number of health trusts were allowed simply to roll over deficits from one year to another, and well-performing trusts had to bail them out from year to year, but that is not acceptable or sustainable. Tough and painful decisions have had to be made in some areas, but I am sure that my hon. Friend the Under-Secretary will be happy to discuss them with the hon. Gentleman.

Will my hon. Friend confirm that the emerging strategy used in some parts of the country, and particularly in the capital city, is for health authorities to require the diversion of trauma and complex emergency cases away from accident and emergency departments to private hospitals and elsewhere? That kicks the feet away from accident and emergency departments that are already threatened, and brings about the closures that the bureaucrats want.

No—and the decisions are best left to the people whose job it is to deliver high-quality care, at value, to their local communities in a safe and appropriate way. If my hon. Friend wants to write to me with any examples of cases where there are such fears, and where that is having an impact on the quality of patient care, I will gladly respond to him.

6. What recent assessment he has made of the effectiveness of the reconfiguration of the NHS. (151794)

The NHS is changing because medicine and treatments are changing. If we do not keep up with the times, services will not keep on improving. Local services are changing for the benefit of patients, and that is what the NHS is there to ensure. That may mean changes to how surgery is delivered, who is admitted to hospital, and how effective community care is. There are so many issues involved in reconfiguration, which can make a huge improvement to patient care.

Will the Minister give an assurance to my constituents, 9,000 of whom have signed a petition on the subject, that reconfiguration will not mean the closure of the Peter Bruff ward in Clacton and District hospital?

What is important to local people is the consultation. I am aware that the hon. Gentleman was involved in that and has met representatives from his primary care trust to discuss the issue. That is what I encourage him to do, because that is what he believes in. He believes in local accountability, and that is what he has in his constituency. As a founder member of the Cornerstone group, surely he agrees with removing decision making from Whitehall and making it into local accountability.

In order to maximise the effectiveness of the health service, we have to ensure that we use to the full the considerable talents available to us in the NHS staff base. Has my hon. Friend yet had a chance to look at the all-party pharmacy group report on the future of pharmacy, and has she been able to make an assessment of how pharmacists could take the pressure off general practitioners and accident and emergency departments to improve effectiveness and efficiency in the health service?

I thank my hon. Friend for that question. Of course the skills mix in the health service is crucial to the changes that we can make to patient care. The advancements that pharmacists have brought about for us by operating out of health centres in larger supermarkets, and by being there to advise on many health issues, has generally improved the health of patients. As my hon. Friend said, the skills mix is crucial to future work force planning and the delivery of care for NHS patients.

Last week, the Worthing Herald reported that Worthing’s accident and emergency department had 1,258 admissions. That equates to 65,500 people visiting every year. Under reconfiguration proposals—not scare stories—the PCT proposes to close that accident and emergency department, and it expects people to join the car park that is the A27 and go to either Chichester or Brighton. How many of those people does the Minister believe are timewasters who do not actually need an accident and emergency department in the hospital of the largest town in Sussex?

The hon. Gentleman raises an important issue on accident and emergency services, but how could I possibly know who was attending the accident and emergency department without looking at the figures? I would expect the local management and the local PCT to do that, and I would expect the local MP to conduct a responsible consultation to ensure that patient care is delivered appropriately in the accident and emergency department. That is why reconfiguration of the health service can be good for patients, as I am sure he would agree.

As NHS configuration depends not just on clinical judgments and local opinion but on the financial consequences of the tariff system, does the Department have any proposals to review the tariff regime, which almost certainly undervalues accident and emergency work relative to specialist surgery?

All areas are for review, all areas are being consulted on and everything must be looked at to make sure that we are delivering good, effective patient care.

7. What the average cost of in-vitro fertilisation treatment in the NHS was in (a) cash and (b) real terms in each of the past 10 years. (151795)

The Department does not collect information on that expenditure.

I am sorry to hear that because my right hon. Friend must be aware that there are claims that regulation has added greatly to the cost of providing that treatment. Will she comment on the fact that regulation adds greatly to the cost?

I agree with my hon. Friend that regulation, which is very important in this area for safety, does increase costs. In the NHS those would be met from the clinical budget. I confirm that I am taking steps to ensure that information on the provision of IVF by each primary care trust, including information on local criteria, expenditure, social access and work on IVF, is available to us. The Department will make available later today the details of that work, which is funded by the Department in partnership with the Infertility Network UK to address the very points that my hon. Friend raises.

Women in Basingstoke still have to wait until they are 36 years of age to receive IVF treatment. For some who cannot readily conceive, that will mean more than a decade’s wait. What is the value of NICE guidelines to the residents of Basingstoke when the Hampshire primary care trust can so readily ignore them?

I am sure that the hon. Lady is putting her powerful argument to the PCT as it decides its spending on IVF—[Interruption.] If she calms down for a moment, I will tell her that I sympathise with the concerns that she raises about inequitable access to IVF, which is why I am undertaking work to make sure that all the access criteria and other issues that are raised in regard to IVF are properly dealt with in the local area. She should return to her PCT and make her powerful case to it, as I will do as the Health Minister.

When the survey is complete, will my right hon. Friend publish information about when each PCT will meet the NICE guideline that was published years ago?

Certainly, that would have to be part of the consideration. Some PCTs offer one cycle, and there is dispute about whether it is a complete cycle, while others offer different types of treatment. Those are matters that we will need to consider.

I think that I heard the right hon. Lady refer to the need for the proper expression of criteria on the subject in the local area. As a matter of principle, does she believe that such treatment should be uniform across the country or the subject of local discretion?

I believe that it is the role of a Health Minister, along with those who advise NICE, to set the standards for equitable access across the country. That would always be mitigated by local decisions on expenditure after proper consultation, but the matter that needs to be addressed now is what is available, how much it costs and how it varies across PCTs, and then how to deal with an issue that is important to so many people in this country.

My right hon. Friend will know that the science and practice of IVF treatment has moved on. More and more, there is a desire for single embryo transfer, which would reduce health hazards and be beneficial for both mothers and babies. The point has been made around the Chamber today that until we have a clear statement from the Minister about what one full cycle is—whether that is three single embryo transfers and whether that would be universally acceptable—single embryo transfer will not happen.

I congratulate my hon. Friend and the hon. Member for South Cambridgeshire (Mr. Lansley), who are members of the all-party group on infertility, which today published an excellent report covering many of those areas and which I have had a chance to consider. With regard to her specific point, the Human Fertilisation and Embryology Authority is considering the matter and is to advise me of the precise points that are raised in the report. I will certainly make that information available to Parliament when I have it.

8. What action has been taken to ensure that people with a learning disability are safeguarded in the NHS since the publication of the National Patient Safety Agency’s 2004 report, “Understanding the patient safety issues for people with learning disabilities”. (151796)

We have taken a number of steps, including the NPSA published guidance on supporting adults who have learning disabilities and swallowing difficulties; the Healthcare Commission audit of learning disability services; our work on developing a response to the report from the Disability Rights Commission; the establishment of an independent inquiry following Mencap’s report, “Death by Indifference”; and our commitment to refresh the White Paper, “Valuing People”.

I am grateful for my hon. Friend’s reply. The health inequalities of people with a learning disability have been well known for many years, thanks to the work of the Government, Mencap, the DRC and many others. What plans do the Government have to introduce annual health checks for people with a learning disability, and how is the treatment of those people to be monitored and evaluated?

I agree entirely with my hon. Friend—that has been a source of concern for some considerable time. We have evidence that the system is nowhere near good enough in terms of access to primary and acute NHS care. There is a commitment on the table to regular screening of people with learning disabilities, particularly where they are at high risk of particular health conditions. For example, we have had discussions with GPs as part of contractual negotiations on the question of a guaranteed commitment to screening. Unfortunately, thus far we have not been able to reach agreement on that issue, but it remains Government policy. Ensuring that the NHS, at every level, takes its responsibilities to treat people with learning disabilities as it would treat any other patient is a top priority—that is non-negotiable. We need to look at all the levers that are available to us to ensure that primary care and acute services treat people with learning disabilities as equal citizens as regards accessing the health service.

It is common for people with Down’s syndrome to have heart defects—they are born that way. In 1997, it was very difficult to get those conditions treated in the NHS. Will my hon. Friend join me in congratulating the Down’s Syndrome Association on carrying out its vigorous campaign in the early days of this Government, which has helped to change the culture of the NHS and introduce training for medical students about people with all learning difficulties?

I agree entirely with my hon. Friend. The access of people with Down’s syndrome to specialist heart care is absolutely crucial to their longevity and quality of life. A constituent of mine, Mr. Alan Quinn, has a daughter with a learning disability and Down’s syndrome who recently went into Alder Hey hospital for such heart surgery and had excellent NHS care. He is regularly keeping me updated with her progress. There have been tremendous advances in that specialist support, particularly for people with Down’s syndrome, but we need to do a lot better.

9. What recent assessment he has made of the state of dental health in England. (151797)

I thank my hon. Friend for her question, which gives me the opportunity to say that oral health in England is the best since records began. The proportion of 12-year-old children with decayed teeth fell from 93 per cent. in 1973 to 38 per cent. in 2003. Over a similar period the number, of adults with no natural teeth fell from 38 per cent. to 11 per cent. of the adult population.

I warmly welcome my hon. Friend to her new role, which is richly deserved. Does she recognise the beneficial effects of fluoridated water to dental health, given the stark contrast between the good dental health of children in the fluoridated Birmingham area and that of those in the Manchester area, which is not fluoridated? What will she do to encourage strategic health authorities to promote fluoridation in areas where tooth decay among children is unacceptably high? After 2008, for the very first time, the British Fluoridation Society will no longer benefit from central funding. I am concerned that strategic health authorities are falling behind—

Order. I think that the Minister will manage a reply.

I thank my hon. Friend for her comments. I agree that fluoridation of water offers the best prospect of reducing inequalities in oral health. That is why we have amended relevant legislation to give local communities a real choice on whether to have fluoridated water. I congratulate her on becoming known as a champion by the British Fluoridation Society, and for the work that it has done. Strategic health authorities will have guidance from our Department, but the consultation will remain local. I am pleased to say that funding has been acquired until the point at which we look at the issue again, but I assure her that we shall monitor the situation carefully.

Oral hygiene in England is of the highest standard, partly because of the advances of medical science. However, does the Minister agree that unless we can find a way of reviving the provision of dental hygiene on the national health service—in a county such as Wiltshire, it is virtually non-existent—those high standards of oral health will inevitably decline?

I congratulate the hon. Gentleman on the work he has done in the area of dental care. Oral hygiene is paramount to the prevention of decay, and we have continued to train and re-train technologists and dental hygienists, and to encourage local PCTs to get involved in the commissioning of such work.

I welcome my hon. Friend to her new role. I am sure that she agrees that better dental health would be helped by better NHS provision, particularly in our poorer communities. I recently met a constituent who is training to be a dentist, and wishes to be an NHS dentist, but the practice she is placed with, which does NHS work, will take her on only if she solely does private work. That is because the NHS now pays for procedure, and newly qualified dentists take too long to do them. Is it not time that the Department considered requiring newly trained dentists to spend part of their career in the NHS? Otherwise, what is the point of the taxpayer paying to increase the number of training places?

My hon. Friend raises a good point. The contract that has been put in place recently is working well, but there is always room to consider everything and make progress, so I am very interested in his remarks.

The Minister’s predecessor, along with Teignbridge district council, the Teignbridge primary care trust, myself and a local dentist, helped to provide good quality dental care for anyone in Teignbridge who wanted it. I congratulate her predecessor’s work for the Department on that. The new Devon primary care trust, however, is telling dentists in Teignbridge that they have to take new patients from anywhere in the county, which will undo all the good work of her predecessor. Will she consider that issue and find a way to protect the services provided by the dentists of Teignbridge to local residents?

I suggest that as the local Member of Parliament, the hon. Gentleman engage in a serious conversation with the PCT and that a consultation is carried out with the local community. I am sure that that would help them to decide their future.

10. If he will make a statement on the provision of NHS dentistry in local health centres. (151798)

Primary care trusts salaried dentists already provide services for patients in some health centres and I agree that including a wider range of NHS primary care dental services would definitely benefit patients. The dental reforms launched last year give primary care trusts greater flexibility to locate NHS dental practices in health centres—a practice with which I firmly agree.

I congratulate my hon. Friend on her new position. Does she agree that one of the traditional problems with retaining dentists in the national health service is that some choose to build up a practice using the NHS, only to turn around and tell their patients that they are going private, and that if they want to keep their dentists they must go private, too. The Stapleford care centre in my constituency has retained the surgery and has dentists working there on condition that, if they leave the NHS, they must also leave the surgery. I commend that as a model of retaining dentists in the NHS.

I thank my hon. Friend for that information. Stapleford health centre should be congratulated. It is good policy and practice, and the way in which health care could and should be delivered in future, when health centres share not only dentists, but pharmacists and all the aspects of health care that the community requires. That forms part of some reconfigurations, and is certainly part of Lord Ara Darzi’s review.

The Norfolk local dental committee told me that the new dental contract is “a shambles”. It also stated:

“In order to receive funding, Dentists are required to meet Government targets that leave them without the time they would like to spend on patients to provide appropriate preventative care.”

How would the Under-Secretary answer dentists in my constituency who feel let down by the system?

The hon. Gentleman should engage with the dentists and the PCTs. I am happy to accept any correspondence from him and give any assistance, if I can.

In autumn this year, a new local improvement finance trust—LIFT—health centre opens in Yeadon in my constituency. Will my hon. Friend ensure that Leeds PCT takes all the appropriate steps to provide the two dental chairs that have long been promised to tackle the shortage of NHS treatment in the area?

I suggest that the PCT look at excellent examples that are in progress throughout the country. I am happy to direct the PCT to examine those at any time my hon. Friend likes.

11. What recent representations he has received on the funding of children’s palliative care and children’s hospices. (151799)

The Department has received 22 representations on the funding of children’s palliative care and children’s hospices in the past six months.

I know that the Under-Secretary will join me in paying the warmest possible tribute to those who work in and volunteer for children’s palliative care. I am grateful to the former Prime Minister for his personal help in getting the £27 million stop-gap funding and the review of funding for children’s hospices.

The Association for Children’s Palliative Care and the Association of Children’s Hospices want children’s palliative care services to be included in the national indicator for disabled children that is currently being developed as part of the public service agreements for the next comprehensive spending review. Will the Under-Secretary delight the House by saying today that he will consider that suggestion favourably? [Interruption.]

As my right hon. Friend the Secretary of State says, I always delight the House. It is a good sign when the Secretary of State says that, but I am not sure whether any other hon. Members would agree. Although I might delight the House with such a commitment, it could be a seriously career-limiting announcement. Of course, decisions about PSAs will be made in the context of our comprehensive spending review settlement. However, the £27 million that we have made available, the independent review that we have commissioned and our commitment to publish a national strategy on palliative care for children, alongside the significant investment in supporting disabled children and their families, mean that the specific needs of palliative care for children will have a high priority in the period ahead.

To be realistic, given that the Government have broken their promise and failed to fulfil their manifesto commitment to double investment for palliative care, broken the former Chancellor’s compact with the voluntary sector by using charitable gifts to subsidise NHS care, broken their promise to implement payment by results for palliative care and continue to insult children’s hospices by funding them at 4.5 per cent. compared with 32 per cent. for adult hospices, will the Under-Secretary now steal and implement our policies of equal funding for children’s hospices and a national tariff for palliative care?

The problem with the hon. Gentleman’s point is that the Conservative party makes all sorts of uncosted spending commitments while simultaneously suggesting that it will cut taxes if it ever returns to power. That is an entirely disingenuous position. When the Conservative party was in power, hospices were expected to depend far more heavily on charitable donations. The Government have started to make significant state investment available for hospices for the first time, including a recent major capital investment. There is much more to do, but we will take no lessons from the Conservative party on hospice funding.

12. What plans he has to improve infection control in the NHS. (151800)

We already have the hygiene code and an action programme to tackle health care-associated infections, including MRSA. However, the issue remains a priority, and we recently announced an extra £50 million to support local initiatives for front-line staff.

I thank the Minister for her answer and I am pleased to hear that the issue is a priority. May I draw her and the House’s attention to the situation in our care homes, where cases of MRSA and clostridium difficile have doubled in recent years? Does the Department have any plans to tackle that growing problem or is it another case where, as with the report on nutritional standards in care homes, the needs of our elderly people in care homes are not being met?

The needs of elderly people in our care homes are a high priority, and they always will be to me. We have doubled our teams to help in acute trusts. We need to look at the same co-operation with social services for care homes because the incidence of MRSA in them is far too high. We have a lot to do on training and skills to see how we can correct that.