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.
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 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.