The Secretary of State was asked—
Doctors
The estimated number of junior doctors who will complete their specialist training in England in 2007, and who are therefore likely to be looking for permanent posts, is 5,400. That number also includes those doctors who may choose to take a voluntary break before applying for posts.
The Department of Health made a complete hash of negotiating the GP contract, giving doctors a great deal of extra money for doing what they were in many cases doing already. Does the Secretary of State agree that the contract has now attracted a great many doctors from overseas with the result that home-trained doctors are now unemployed in their thousands? When is the Department going to acquire some commercial sense and look after taxpayers’ money properly and have better regard for doctors trained at taxpayers’ expense who now have no prospect of a permanent placement?
The right hon. Gentleman is confusing several different issues.
On the GP contract, I do not accept that it was a bad deal. The contract reversed the trend whereby we were losing GPs because, by and large, medical graduates did not want to be GPs. The latest statistics show that 100 per cent. of GP training posts have been filled. The contract also incentivised GPs to look at preventive health issues for the first time—taking patients’ blood pressure, for example—so prevention as well as cure is now their concern.
That contract has in no way led to the situation that I think that the right hon. Gentleman is getting it confused with. I accept that there is an issue about the fact that there are 10,000 international medical graduates trained as undergraduates abroad who are seeking positions in postgraduate training in this country, but we are seeking to resolve it.
We are in the position of having several thousand UK graduates who after seven years of training—and, in many cases, with substantial debts—are without work. They now face all the associated costs—both economic and human—that go with it. One of the worst indictments in the MTAS report related to the lack of centralised work force planning. Will the Secretary of State therefore reassure the House that he will ensure that such planning is introduced so that we never again face the scale of loss and injustice that we have seen in recent months?
Also apropos the previous question, no one will be unemployed when our employment guarantee ends on 31 December. The question from the right hon. Member for Wells (Mr. Heathcoat-Amory) was about British-trained doctors. There are 3,600 UK undergraduates who have not accepted a training post for 2007 and about 1,650 posts are still to be filled, though our undergraduates will be competing with international medical graduates. However, the sum total of all that is that, at most, we expect 100 people to be unemployed, because the vast majority of those applicants are already working in a job in the NHS. That is not to undermine the important points that my hon. Friend raised about MTAS and the distress caused to junior doctors this year.
The interim report on MTAS by Sir John Tooke—an excellent piece of work—set out a number of recommendations, which we are examining. They relate to the system in 2009 rather than in 2008, so we need to ensure that the lessons are learned for next year as well. It is a valuable piece of work and when we receive Sir John’s final report, I know that it will ensure that the problems that we faced this year are not repeated in future years.
There will be opportunities—perhaps for the Select Committee—to discover who was responsible for how the modernising medical careers initiative and the medical training application system developed. However, looking forward from now, will the Secretary of State make it plain who should be gathering evidence of where there are too few applicants in some specialties—as with applications for anaesthetics in London, for example?
Strategic health authorities should be doing that. The hon. Gentleman is absolutely right. In trauma and orthopaedics, there is only a 95 per cent. fill rate; in paediatrics, 95 per cent.; and in psychiatry, 94 per cent. Jobs are there if some trainees are prepared to pursue a career other than their originally intended one, but the information should be gathered by the SHA. As my hon. Friend the Member for North-West Leicestershire (David Taylor) said, we need to be much better at work force planning. If we follow Sir John Tooke’s advice, we will get to a satisfactory end. One final point to note is that John Tooke himself said:
“Modernising Medical Careers (MMC) was an honest attempt to accelerate training and assure the fundamental abilities of the next generation of doctors”.
It was not the concept of MMC that was at fault—we are now in a far better place than under the old opaque and unfair system—it is just that we need to ensure that the problems of this year are not repeated in the future.
Until the mess that Ministers made of modernising medical careers, junior doctors were rightly accommodated free of charge in hospitals. Now we discover, after Ministers slipped it through on the sly—unannounced to MPs or to the doctors themselves—that doctors in their first year, who do not have the option of renting privately as they are required to move every few months from hospital to hospital around the country, are to be forced to pay rent to each hospital. Is there no depth to which Ministers will not sink in hammering our junior doctors?
There are many depths to which we will not sink—[Interruption.] I guarantee that they are diminishing all the time. I was unaware of the particular issue that the hon. Gentleman raises, and I will look into it. Sir John Tooke points out that the profession was also in favour of the basic principle of modernising medical careers. There was a real consensus on the need to move to a much more open system. Before that system was introduced, we had no national data telling us about shortages in differential specialties. It is the right road to pursue, but I shall look into the question of doctors being charged rent.
I was shocked to hear that the Secretary of State did not think that the new doctors’ contract was a bad deal. We have now learned that salaries have increased by 25 per cent. and productivity has decreased by 15 per cent. If that is not a bad deal, could the Minister tell us what is? I cannot imagine a worse situation for my constituents in Northampton.
I think that the hon. Gentleman is talking about the GPs’ contract, not MMC. Before 2004, GPs were retiring and not being replaced; medical graduates did not, by and large, want to be GPs; GPs were not incentivised in any way to look after their patients’ well-being, and the profession was not paid decent money and deserved a new contract. I completely disagree with the hon. Gentleman and his Front-Bench colleagues who believe that we should return to a situation in which GPs are called out at 5 o’clock in the morning out of hours, and are then expected to treat people properly at 9 o’clock in the morning. I disagree that the GP contract was a mistake, and we intend to build on it to ensure that GPs are much better incentivised to increase access to health care, which is another public priority.
Abortion
It is accepted parliamentary practice that proposals for changes in the law on abortion come from Back Benchers and that decisions are made on the basis of a free vote. The Government’s view is that the Abortion Act works as Parliament intended.
Bearing in mind the recent majority Select Committee report on the draft human tissue and embryos Bill recommending changes to the current law for abortion on demand, with the signature of only one doctor merely relating to the length of gestation, as well as allowing nurses to undertake the procedure, how will the Government ensure that the health of women is protected from subsequent well-documented and researched psychological damage, including higher suicide rates? Will all post-abortion sequelae be taken fully into account?
The requirement for two doctors signatures was believed necessary when the Abortion Act 1967 was passed, to ensure that its provisions were observed and that they safeguarded women. I note the Science and Technology Committee’s report that the British Medical Association and Royal College of Obstetricians and Gynaecologists believe that there is no need for two doctors’ signatures in the first trimester, and I am sure that Members of Parliament will want to take that into account when and if they vote on the issue in the House.
My Bridgend constituency had a significantly higher-than-average number of abortions in 2005 among 18 to 25-year-olds. That was dealt with through improving the availability of local pregnancy advisory services and contraception and sexual health clinics to young people. Is not the need to improve the availability of advice and contraceptive services to young people rather than to amend the law?
I agree with my hon. Friend on the two important points that she makes. First, where access to abortion is required, it is important that that is undertaken as speedily as possible within the requirements of the Act. Some 89 per cent. of abortions are conducted under 13 weeks. She is also right that, alongside ensuring that the provisions in the Act are working as Parliament intended, it is also necessary to ensure that advice on sexual health is made available to young people and to others to ensure that they have every opportunity to control the point at which they become pregnant.
I put it to the Minister that reducing the 24-week upper limit and insisting on directional counselling—in other words, trying to tell women what to do, lest they otherwise would not do it—would be a thoroughly retrograde step for this House to take and that a far better reform of the abortion law would be to ensure much more equitable access to first-trimester abortion across the country and a proper and prudent extension of the range of professionals who can undertake that necessary procedure.
I understand that feelings on this issue are held strongly by Members of Parliament, and that they have differing views. But the point that the hon. Gentleman makes is right—where access to abortion is required, it is vital that it is as speedy as possible to ensure the health of the woman. Under the present arrangements, proper counselling and advice is given to women, and any attempt to delay access to abortion further increases the pressure on the woman and her health. If the matter is debated in the House, I am sure that those matters will be given careful consideration and the Committee’s report will be looked at carefully by all Members.
Does my hon. Friend agree that, as less than 1 per cent. of abortions take place at more than 20 weeks and that those cases are usually women in difficult and vulnerable positions, lowering the limit would not be the right way forward and would not help to reduce the number of abortions? Does she also agree—
Order. One supplementary.
The studies that have been conducted on the operation of the Abortion Act, as amended in 1990, focusing specifically on the question of survival have demonstrated clearly that at 21 weeks none survive, at 22 weeks 1 per cent. survive and that at 23 weeks 11 per cent. survive. When abortion is allowed under the circumstances provided in the 1967 Act, as amended in 1990, the issue is how to ensure that the process is conducted speedily and in a way that safeguards the woman and the decisions that she has taken. I am sure that the House will give that careful consideration if and when it debates the issue.
Would the Minister accept that the best way to reduce the number of abortions in this country would be to reduce the number of unwanted pregnancies by improving access to contraception and sex education, rather than seeking to deny access to a very small number of extremely vulnerable women who present late for abortion within the current law?
I agree entirely. What is crucial is that information on sexual health and sex education are provided in a comprehensive fashion to ensure that every person understands the responsibilities that they will undertake in parenthood. There is also a requirement to ensure that the services that the Government provide on contraception are appropriate and widely available.
Maternity Services
Proposals for the reconfiguration of services and the responsibility to provide the appropriate level of very high-quality maternity services are a matter for the NHS locally, working in conjunction with clinicians, patients and other stakeholders. The safety of mothers and babies is our top priority. In April, we published “Maternity Matters”, which sets out how we will deliver local provision of safe, high-quality maternity care for all women and their babies.
Is the Minister aware that, under proposals tabled by two separate and unconnected primary care trusts, two of the three hospitals that supply maternity services to my constituents—the Eastbourne district general hospital and the Princess Royal in Haywards Heath—will see those services disappear? The third hospital, the Royal Sussex in Brighton, is already at capacity and regularly turns mothers away because it cannot handle the extra casework. Is she going to take action to intervene, or will she provide mobile facilities for mothers who cannot make it to the nearest hospital?
Yesterday, I met Nick Yeo, the chief executive of both the East Sussex Downs and Weald PCT and the Hastings and Rother PCT, so I am well aware of the hon. Gentleman’s concerns. The local health overview and scrutiny committee has referred the consultation process to the Secretary of State for Health, and the Independent Reconfiguration Panel is currently considering the referral.
But is the Minister aware that when asked about maternity services on 6 November this year on BBC Radio 2, the Secretary of State said that
“you shouldn’t be going 20 miles, 20 miles is a bit far”?
Will she therefore abandon today the absurd and dangerous proposals that, in my area, will involve pregnant mothers travelling 21 miles over the extremely poor roads between Eastbourne and Hastings?
I am sure that the hon. Gentleman has experience himself of remarks sometimes being taken out of context. The consultation in his constituency ended on 27 July and the PCT is evaluating the responses to that consultation. Therefore, we have to wait, but I am happy to see him at any time he wishes.
My hon. Friend will know that the reorganisation of maternity services in Greater Manchester is one of the largest, if not the largest, in the whole country. She will also know that the report of the Independent Reconfiguration Panel gave an absolute assurance that no change should take place to local services until community midwifery and community paediatric services were fully in place. Can she repeat the importance of that guarantee now in view of the fact that, last week, the health authority published a timetable that would appear to make it extremely difficult to fulfil the promise of the IRP?
I can say to my hon. Friend today that the safety of mothers and their babies is our priority at all times and the views of clinicians and midwives are always taken into account.
Is the Minister aware of the magnificent work done by the Support the Princess Royal campaign in Haywards Heath to save the maternity services mentioned by the hon. Member for Lewes (Norman Baker)? Is she also aware that because of the Government’s outlandish housing targets for the north of Sussex, the population is growing at such a pace that to have the idea that it would be sensible to downgrade maternity services at the Princess Royal is really an act of folly? Will she receive a delegation from the Support the Princess Royal campaign to discuss this matter with them?
The hon. Gentleman raised this issue in an Adjournment debate of which I took serious note. As I have said to the House, the views of clinicians and the safety of mothers are paramount at all times. If he wants to bring new evidence to me, he should by all means do so.
If the Minister is serious that clinicians’ views and the interests and safety of mothers and babies are paramount, why is a proposal being made to downgrade maternity services at Chase Farm hospital without the clinical evidence? Why is it that that unit, along with the others mentioned in the House today, are close to the level that the Royal College of Obstetricians and Gynaecologists recommends should be kept open?
There is no evidence at all that the clinicians’ views in any of the reconfigurations are not being taken seriously. Safety for mothers is paramount, and that is why we have the safest record in Europe and one that is even safer than that of the United States. That point is on the record. We have to say that reconfiguration sometimes causes distress through the consultation, but the consultation will proceed at all times by taking into account the safety of mothers and babies.
Is the Minister aware that on the first Sunday in June, the maternity units at Brighton, Eastbourne, Worthing, Hastings and Haywards Heath were all full and stopped admitting pregnant mothers? With a rapidly growing population in Sussex, and with units already at capacity, is it not madness to be suggesting that there should be fewer units, rather than maintaining those that are there now?
I am sorry to keep repeating this, but there is no other answer. We have to look at the safest practice for mothers and babies, and clinicians are asking us to do so. I am sure that the local health economy has taken these points into account.
Would the Minister accept that the quality and safety of maternity services very much depends on the midwifery profession? I declare an interest as an honorary vice-president of the Royal College of Midwives. I know that the Minister is aware that there is a shortage of midwives in both the community and hospitals. Will she seek to do something to increase the number of midwifes to benefit maternity services throughout England, including in Sussex?
I am sure that the Royal College of Midwives is very pleased to have the hon. Gentleman as an honorary vice-president. Being a friend to midwives is always a popular thing to do. I assure him that 1,000 extra midwives are being recruited. We are looking seriously at return-to-practice courses for midwives who have left for a variety of family reasons. I agree with the hon. Gentleman that more needs to be done, but that is what we are doing, and I look forward to working with him to achieve that.
Is the Minister aware that my hon. Friend the Member for Eastbourne (Mr. Waterson) is leading a march through the streets regarding maternity services in his area? Is she also aware that according to a recent survey by the Royal College of Midwives, two thirds of midwives say that they have considered leaving the profession, while almost half those people state that increased work load and having to compromise care are the main reasons why? How does the Minister expect to fulfil the Government’s aspirations of choice when people in the maternity services are demoralised, when more midwives are leaving than joining, when the birth rate is up 12.5 per cent.—
Order. I have got to say to the hon. Lady that she must not make a speech from the Dispatch Box. She is asking a supplementary question.
Perhaps I could give some general tips on marching because I marched throughout the ’80s and ’90s when the Conservative Government were in power. We were constantly marching and raising money for services. Many members of the profession were leaving then, but members of the profession today are pleased to be involved in the review in which the NHS is participating, and they will be celebrating 60 years of the NHS with us next year.
Connecting for Health System
Progress with NHS computer systems is measurable in hospitals, general practices and pharmacies across the NHS in England. Despite the challenges associated with all large IT programmes, the connecting for health system is bringing benefits to doctors, nurses and, most importantly, patients.
I thank the Minister for that answer, but hospital patient administrations from the supplier, iSOFT, are still not in place. After an £80 million bung from the NHS, financial meltdown, an investigation of the company and a takeover by the Australians, can the Minister guarantee that hospital software ordered from iSOFT is written, workable and ready for roll-out by 2008, or are we being a tad optimistic?
Progress is good, as the Health Committee accepted in its recent report. There have been delays, but any cost overruns are being borne by not the taxpayer, but the private suppliers. When the private suppliers have been unable to deliver the goods, they have been replaced by other private suppliers.
Is any further training taking place in the national health service—in both the primary and acute sectors—so that people are able to use the connecting for health system?
Yes. One of the criticisms in the Health Committee’s report—we responded to it in full yesterday and almost entirely accepted it—was about the need for better clinician engagement. That is certainly going on across the health service. It is worth the House acknowledging the enormous benefits for not only patients, but health service staff, from having proper IT systems that are integrated and can deliver better patient care.
My hon. Friend will know that to maximise the usefulness of all our health service professionals, especially in primary care, it is essential that we make maximum use of the expertise of pharmacists. What plans has he to ensure that pharmacists will soon have read and write access to patient records, so that we can maximise everyone’s skills in primary care?
Pharmacies’ use of IT for e-prescribing is increasing all the time. My hon. Friend will have to wait a little while, until we publish our pharmacy White Paper, for us to say more about that, but he is right to say that there is enormous potential for pharmacists to deliver better services to patients if they have full access to IT and their access is interoperable with the rest of the health service.
Gastro-intestinal Cancer Treatment
My hon. Friend the Member for Exeter (Mr. Bradshaw), in his capacity as a local constituency MP, has passed on concerns raised by his constituents. The organisation of services is best decided locally, and the Devon overview and scrutiny committee has recommended formal consultation on the proposals.
The Minister will be well aware of the well regarded provision of keyhole surgery in the treatment of gastro-intestinal cancer, as performed by the Royal Devon and Exeter hospital. He will also be aware that in his NHS next stage review interim report, Lord Darzi states:
“Localise where possible, centralise where necessary.”
Does the Minister not agree that it is quite unnecessary to move the provision of that treatment from Exeter to Plymouth, and will he hold urgent discussions with the Devon primary care trust to point out the error of its ways?
No final decision has been made. The local authority has said that, even before it decides whether to refer the matter to the Independent Reconfiguration Panel, it wants to consult locally. I urge the hon. Gentleman to engage fully in that consultation, which will take place before any final decision is made. I should also point out that there is a contradiction in saying that it is inappropriate for the Government to issue central diktats and directions from Westminster and Whitehall while demanding central Government intervention in local decision making.
You have to link your question to Devon.
I will, Mr. Speaker.
When considering the reconfiguration of gastro-intestinal cancer services in Devon and, indeed, elsewhere, will the Minister bear in mind the innovative straight-to-test GI cancer assessment service pioneered by Dr. Madhotra at Milton Keynes, which has drastically cut the time taken to get patients through diagnostic services? That is clearly relevant to the examination of GI cancer services everywhere.
That was ingenious and innovative, like the doctor my hon. Friend mentions. Her point is incredibly important, because it underlines the fact that developments in medicine and technology and the genius of clinicians are changing the health service all the time, so to maintain services as they were before those changes occurred would be a complete nonsense. That is why calling for a moratorium on any change in the NHS is irresponsible.
Hearing Aid Assessments
The median waiting time for a diagnostic audiology assessment, including hearing assessment, is 52 weeks at the Medway NHS Trust, which includes the area of Gravesham. The average for England is 16 weeks.
Does the Minister think that the Government will hit their own target of six weeks to initial assessment by 2008, given that now some of my constituents are waiting up to 12 months? Has he thought about the distressing effect of such waits, especially on the elderly?
The length of waiting times in the hon. Gentleman’s local trust and in some others is entirely unacceptable. That is why we have a target of a maximum wait for assessment of six weeks to be achieved everywhere by March 2008. It is also the reason why, in March, I issued the new audiology framework, which is essentially a strong message to every trust in the country that they must reduce waiting times to the level achieved by the best PCTs, which is already happening in many parts of the country.
Is my hon. Friend aware of North Staffordshire primary care trust’s use of mobile facilities, particularly in Leek? It massively reduces waiting times, both for assessment and for fitting devices.
That is exactly the kind of innovative and imaginative process that was suggested in the framework that we issued in March. In every locality, the most effective way of reducing waiting times for assessment and the fitting of hearing aids should be deployed. Where that imagination and innovation is to be found, we need to learn about it, and we need to ensure that it is mainstream throughout the system. As the hon. Member for Gravesham (Mr. Holloway) said, not having access to appropriate hearing services is distressing for people, and it affects their quality of life; that is why the issue is so important.
The Royal National Institute for Deaf People estimates that over 500,000 people are waiting to have hearing aids fitted. In many parts of the country, people are waiting far more than a year to have one fitted. Will not those who are waiting feel badly let down by last week’s announcement that the 18-week target will not be quite as watertight as we were all led to believe? Is not that yet another instance of manipulation of Government targets, as the Government knew full well that they had no chance of meeting the target?
It seems eminently sensible that when we set targets, we take account of practical issues such as the fact that patients sometimes fail to turn up and fail to co-operate with the clinicians and the health service. It would be nonsense to tell hard-working NHS professionals that they had failed to meet a target due to circumstances outside the control of either the trust or the professionals and clinicians involved. Think of the damage to morale that that would cause. The announcement made last week is entirely sensible, and it will not affect the fact that we will get waiting times down for audiology services in every part of the country.
Hospital Cleanliness
Deep cleaning will occur in all hospitals starting this winter, and it will be completed as soon as possible thereafter. Resources will be allocated through the strategic health authorities. Trusts’ deep clean plans will vary according to local need, and trusts will be able to identify what additional training is needed to ensure that their local programme is delivered to the appropriate standards. All trusts will submit costed deep clean plans to their lead primary care trust, which will monitor performance against the plan, according to normal performance management arrangements. Strategic health authorities will take an overview of progress across their area and will report to the Department. We will assess the progress and impact of the programme.
Given the importance of tackling hospital-acquired infections, perhaps the Secretary of State will explain why it has taken the Government 10 years to come up with a rigorous cleaning programme, say how many fewer cases of MRSA we can expect in our hospitals as a result of the initiative, so that we can test whether it has been successful, and say how deep cleaning compares with using environmental cleansing equipment, such as Steris’s vaporised hydrogen peroxide equipment, to tackle the disease.
The deep clean is one of a series of initiatives. The issue is the subject of huge public concern. We are the only country in the world that has mandatory comprehensive surveillance, and the only country in the world that knows exactly what the situation is with our health care-acquired infections. As a result, we are able to tackle the issue through a series of measures—not just through the deep clean, but through the “bare below the elbows” policy, which has been used at the Royal Marsden hospital for many years, just as deep cleans have been used in many hospitals for many years. It is a case of ensuring that every hospital follows best practice.
There are other initiatives, of course, such as the new powers that we are giving the care quality commission—an issue that we will discuss in the debate on the Gracious Speech. There is pre-screening for MRSA for all people coming into hospital, whether for elective or emergency surgery. There is a whole series of other measures, which means that we have a comprehensive programme to address the problem, which affects all countries around the world.
Does the Secretary of State accept that what is needed for clean hospitals is not just deep cleaning but an assurance that we will continue to clean them, and thus a motivated, well-funded work force? Will he learn the lessons of the 1980s, when the Conservatives reduced the number of ancillary workers in England from 177,000 to 60,000?
I agree with my hon. Friend about the need to ensure that there are proper cleaning facilities. He may wish to know that spending on hospital cleaning has increased from £403 million in 2000 to £662 million in 2006-07, which is an increase of almost 65 per cent., so it is essential to ensure that there is investment in cleaning services as part of a range of measures to tackle those problems.
My constituent and friend, Doug Gregory—a wartime Mosquito pilot who was awarded the distinguished flying cross—has just survived his latest brush with death in Southampton general hospital, where he contracted C. difficile after a routine operation. Is it not a disgrace that people go into our hospitals and find themselves fighting for their lives under such circumstances in the 21st century?
I express my commiserations to the hon. Gentleman’s constituent, but let us get this into context: there have always been health care-acquired and associated infections.
Not on this scale.
We do not know what the scale was, as the simple fact is that it was never measured and no figures were produced. Indeed, people who have worked in the health service for many years suspect that it was far greater in the past than it is now. Turning to the serious point made by the hon. Member for New Forest, East (Dr. Lewis) about clostridium difficile, there is a question about hand cleanliness, and it is soap and water that work rather than an alcohol rub. The big problem, however, is a certain complacency about prescribing antibiotics. We can engage in political cut and thrust, but the message that we must all give our constituencies is that this issue is about washing hands and ensuring that they are clean; it is about ensuring that there is responsible prescription of antibiotics; and it is about ensuring that patients who unfortunately acquire those infections are isolated as soon as possible and given cohort nursing. Those are the three major rules, and it would be good if we all ensured that that is the message that we give the public.
While questions remain about the scientific evidence and the Government’s analysis and monitoring of the Prime Minister’s deep-cleaning policy, Ministers cannot escape the fact that the Government are responsible for infection control. Centrally controlled process-driven targets, high bed occupancy, lack of focus management and financial deficits all exacerbate the prevalence of hospital-acquired infections. Given that 111 trusts have not complied with hygiene standards, it is clear that Government policies have not worked. When will the Government implement a search and destroy policy, and ensure that the Healthcare Commission specifically analyses, measures and reports on C. difficile rates?
I disagree completely with the hon. Gentleman about the reasons for the problem, particularly, as once again, the lame excuse that targets have something to do with the failures at Maidstone and Tunbridge Wells has been trotted out. [Interruption.] The hon. Member for Guildford (Anne Milton) says, “Read the report”, but the exact words of the chairman of the Healthcare Commission were:
“Targets or their equivalent are an inevitable feature of a modern 21st-century healthcare system, in the sense that some standard or measure to be achieved must be part of the management of any organisation providing healthcare. The obligation to meet targets cannot be used as an excuse for failing to meet other management objectives.”
Indeed, he made exactly that point in the text of the report on Stoke Mandeville a year ago, so to suggest that patients have a choice—they must wait on long waiting lists, or take eight hours to get to accident and emergency, and if they are not prepared to do so, they must put up with hospital-acquired infections—is nonsense. The second point I would make—
Order. That would not be fair to those who took part in the ballot and whose names appear on the Order Paper.
Skin Cancer
SunSmart, the national skin cancer prevention and sun protection campaign, is run by the charity Cancer Research UK on behalf of the UK Health Departments. The Department’s officials are in regular contact with the charity, which has a dedicated SunSmart website and produces resources and information that include advice relevant to teenagers.
I appreciate the Minister’s answer. I recently met representatives of the Teenage Cancer Trust, who have been supportive of my campaign to restrict or stop the use of sunbeds by underage children. Will my right hon. Friend meet other child cancer charities to raise awareness of skin cancer in young people and to highlight the dangers of overexposure to the sun and of sunbed use?
I congratulate my hon. Friend, who has been tenacious in pursuing that important campaign. As she knows, organisations such as the Teenage Cancer Trust are doing excellent work in this area. I have already arranged to meet my hon. Friend, and I am happy to leave it to her discretion whether she brings representatives of the children’s cancer charities to that meeting or suggests an attendance list for a subsequent meeting when I can discuss the issues that she raises.
Topical Questions
The responsibilities of my Department embrace the whole range of NHS, social care, mental health and public health service delivery, all of which are equally important. I am delighted that in the Gracious Speech there are two Bills for which my Department has responsibility—the Health and Social Care Bill and the Human Fertilisation and Embryology Bill. I am also pleased that my Department is leading on the Green Paper on the long-term reform of the funding of the social care system, as announced in the pre-Budget report.
I congratulate the Secretary of State on taking urgent action on the obscene payout to the chief executive of the Maidstone hospital. That is only the tip of a rotten iceberg in the health service, with a considerable number of officials getting outrageous payouts and then often sliding into other jobs in the NHS or consultancy contracts. That is damaging to the NHS across the country and to staff morale. What is he going to do about it?
My right hon. Friend is right to be concerned. Three things—first, in relation to other trusts, I have asked the chief executive of the NHS to write to all trusts pointing out that any payments to be made above and beyond contractual obligations must be cleared through the strategic health authority and cleared by Her Majesty’s Treasury. Secondly, on redundancy payments, all staff ought to receive the same deal on redundancy. If the redundancy agreement is for x times annual salary, that applies to people at the highest level as well as at other levels in the health service. The third point on which I have asked for action is that the period of notice should not exceed six months for someone in a senior position. It could well be less than that, but it should not be more than that. A combination of those three steps can address an issue for Members in all parts of the House—that public money should not be squandered on large and unjustified payouts for senior executives. It rankles with staff in the NHS and it brings the vast majority of very good managers in the NHS into disrepute quite unfairly.
The NHS dental practice in Ambleside in my constituency serves 3,000 NHS dental patients across a geographical area of more than 90 square miles. The PCT in Cumbria is planning to close down the Ambleside practice in March next year, when the current dentist retires. Given that already 50 per cent. of my constituents do not have access to an NHS dentist, does the Secretary of State agree that the PCT in Cumbria should ensure that the NHS dental practice in Ambleside remains open?
The PCTs have an obligation to ensure that there is proper dental provision in their areas. We are spending another £450 million on dental care. We have discussed new contracts, but under the old contract if a dentist decided to pack up and leave or go to the private sector, the local community lost that dental service. Under the new procedure and contract, the PCT is obliged to ensure that proper NHS dental provision is available. If the hon. Gentleman would like to write to me about the issue that he raised, I shall look into it.
I understand the important point raised by my hon. Friend about Lucentis; it has been raised with me directly by a number of Members from both sides of the House.
On the deliberations of NICE, the final appraisal determination has not yet been made available. It is important that the consultation and procedures for appeal are properly followed; it is an independent organisation and must take the proper steps. My hon. Friend’s second point was about the particular experiences in his own area. I shall be more than happy to meet him to discuss the issues and see what action I can take.
Given the urgency of tackling the more than 6,000 deaths a year from hospital-acquired infections in our hospitals, why does not the Secretary of State take urgent action on the issue, rather than waiting 18 months so that a new quango can be set up? Whatever that quango might be able to do should be done now, because the problem exists now and people should not live in fear of dying from going to hospital.
If the right hon. Gentleman is referring to the care and quality commission, I should say that legislation needs to go through for the regulator to be given those extra powers. However, that does not mean that we should freeze everything in aspic. As was mentioned earlier, there are a whole series of initiatives. I did not mention the doubling of the number of improvement teams, nor the fund of money available to nurses at the front line so that they can access things, such as curtains and fittings, that they know very well need to be replaced. I did not mention that we are going to move from 2,000 to 5,000 matrons and that they will be given power over the cleaning contract and given whistleblower protection to report on such issues to the trust and beyond. The right hon. Gentleman is right to be concerned about the issue; it is a matter of concern to the public. However, there are a whole series of measures, none of which we need wait 18 months for.
My hon. Friend is right to raise that issue of concern. Publicly funded residents of private residential and nursing homes should be covered by the 1998 Act and I believe that that was Parliament’s original intention. The Department of Health is engaged at ministerial level in discussions with the Ministry of Justice; we shall look for an appropriate legislative slot to put that anomaly right. In the meantime, I shall consider what instructions we can give to the regulator to ensure that homes, including independent-sector homes, are regulated on the basis of their meeting the requirements of the 1998 Act.
Does the Secretary of State agree with his predecessor that
“Fewer beds are a sign of success”?
I am not aware of that quote, but I agree in the sense that the amount of time that people spend in hospital should be reduced. That is happening in health care services around the world. As the hon. Gentleman knows very well, it is now perfectly acceptable, with a whole range of new technology, to treat people closer to their home and to provide that if they do have to go to hospital, they spend less time there. A good example is that of cataracts. Ten years ago, the number of people waiting for long periods—more than a year—for treatment for cataracts was huge; that number has been reduced dramatically. Today, 5 per cent. of patients spend more than one night in hospital for a cataract operation; 10 years ago, it was 50 per cent. All those factors combine to say that the number of beds in a hospital, which was traditionally the way in which one judged that one had a decent health service, is increasingly becoming irrelevant.
I am surprised that the Secretary of State does not read the Daily Mirror—the quote was from 8 February this year—but I advise him not to agree with his predecessor, as that is probably a bad idea.
On 8 November, the Secretary of State’s Department published a study into infection control which said that high bed occupancy rates were considered to be a key factor that affected infection control decisions in about 70 per cent. of responding trusts. Will he tell the House when the Government intend to meet the commitment that he gave to the Public Accounts Committee in 2000 that by 2003-04 bed occupancy rates would average 82 per cent.? They are still more than 2.5 per cent. above that and, as we saw in Maidstone and Tunbridge Wells, that is directly contributing to deaths of patients.
We want to get bed occupancy rates down to that level, and we are not there yet, although the averages around the country are reducing. I do not draw that parallel between bed occupancy rates and rates of health care-acquired infections—[Interruption.] Well, there are hospitals around the country that have a fairly high level of bed occupancy and a very low level of health care-acquired infections, so I do not think that there is an absolute parallel between the two.
Tens of thousands of Welsh patients are treated in English hospitals each year. Does my right hon. Friend believe that Welsh MPs, of all political parties, should be able to lobby and write to him and his team and to speak and vote in this House on English NHS issues?
I certainly agree that they should be free to lobby. Indeed, one of my hon. Friend’s colleagues recently came to see me with a group of fellow MPs from England about an issue regarding services at the Countess of Chester hospital. He is absolutely right to draw attention to the issue, which I have taken up with my Welsh colleague. If he wants to come to talk to me about a similar problem, he is welcome to do so.
I gladly volunteer the regional Minister to go to visit the hon. Gentleman’s constituency.
I have had the opportunity to look at the report to which the hon. Gentleman refers. I entirely agree that under-age drinking is a crucial issue that we need to address as a Government because of the harm caused to those young people. I am sure that he agrees that we have made important progress in reducing access to alcohol for the 11 to 15 age group. None the less, harm is being caused to young people who are still drinking excessively, and we need to consider that and take proposals forward.
I would like to raise an issue with my right hon. Friend the Secretary of State. He has made it clear that when the National Institute for Health and Clinical Excellence is considering whether a drug should be made available on the NHS, primary care trusts should consider any application to use that drug on the basis of medicine rather than finance. However, concerns were raised with me about a recent case. An applicant who needs a drug went to the panel in the PCT, then went to appeal and lost. There is a sense that that person has no further right of appeal and no possibility of getting an independent judgment, separate from the PCT, as to whether a life-saving drug should be made available.
My hon. Friend is correct about the advice on what PCTs should do when considering whether to prescribe a drug. I am not familiar with the precise details that he raises, but if he sends me details, I shall be happy to meet him to consider appeals to the local PCT panels in order to determine whether there is an issue that needs to be addressed.
As the hon. Gentleman will know, the local health authority has undertaken a review of future requirements for beds in the community hospital and has announced that over the next year to 18 months it will open beds in those facilities to address the future need that it believes will exist in the local community.