T1. If he will make a statement on his Department’s responsibilities. (184121)

The responsibilities of my Department embrace the whole range of NHS social care, mental health and public health service delivery, all of which are of equal importance.

The primary care trust is the important backbone of how funding and services are delivered. Will the Secretary of State tell me why a postcode lottery exists in a PCT area? One part of the PCT area in my constituency does not get incontinence pads whereas the constituency next door, which is in the same PCT area, does get them. The postcode lottery should not exist, so can he put it right?

May be I will pay a visit to Chorley and talk to my hon. Friend’s PCT, because that is where the root of that problem lies. He will know that, just in the past four years, his PCT has received a 30 per cent. funding increase. We also recently announced a 5.5 per cent. increase across the board. If that money does not buy incontinence pads for people who need them, some serious questions need to be asked of his PCT.

T2. Research has found that as many as 100,000 people who are living in care homes with dementia might be being prescribed anti-psychotic drugs. They might be being prescribed drugs that have not been licensed for the treatment of dementia. Surely it is time that those people, who find their lives shortened as a result of those drugs being prescribed to them in care homes, should not be treated as people who have been ill managed and should not be placed in chemical straitjackets, but should be treated with dignity. (184122)

That is not an acceptable situation. Indeed, as part of our adult social care review we must examine the issue of the prescription of drugs. That will be part of the national conversation leading up to the Green Paper later this year. The issue concerns Members on both sides of the House, because, as the recent Commission for Social Care Inspection report and the Wanless report showed, we must take long-term measures. Medium-term and short-term measures are important too, but we must take long-term measures to ensure that our adult social care system is equal to the NHS service that we provide

T6. In the last three years, the Medicines and Healthcare products Regulatory Agency has issued nine withdrawal notices for counterfeit imported products. The British Medical Association and Revenue and Customs have said that the problem stems from the internet. What is the Minister doing to address the issue with those organisations and how can she co-operate with foreign agencies to stop it happening? (184126)

I can let my hon. Friend know that the Department is working with the two agencies that he mentioned both inside the UK and in European Union discussions. Access both on the internet and through mail order is increasing, and patients cannot be assured of safety or effectiveness. I had a meeting only last week with the MHRA about further steps that could be taken to provide the necessary protection.

Last week, just two days after the extraordinary admission that the Government have been perpetuating for the last 11 years the myth that we would eradicate mixed-sex wards, the Mental Health Act Commission reported

“a truly scandalous and tragic situation”—

with vulnerable women being frightened for their safety. Last year, the “Count Me In” census reported that 58 per cent. of women in mental health units are in mixed-sex wards. In two years, there have been 19 alleged rapes and more than 100 alleged sexual assaults.

Will the Secretary of State make a renewed commitment today to eradicate that outrageous situation in our mental health units?

I will give that commitment, because I think that in some ways it is even more important to eradicate mixed-sex accommodation in mental health care than it is in the NHS. As far as the NHS is concerned, in this year’s operating framework we made it clear that we want to make progress towards eradicating mixed-sex accommodation. To be honest, we are responsible for some of the difficulties in the sense that our manifesto spoke of mixed-sex wards, whereas the guidelines—including the guidance from the previous Conservative Government—talk of mixed-sex accommodation. I agree with the hon. Gentleman that eradication is even more important in mental health care than it is in the rest of the NHS, and I am happy to give the commitment that he seeks.

T3. Given the revised guidelines on the treatment of wet age-related macular degeneration issued by the National Institute for Health and Clinical Excellence in December, does the Secretary of State agree that it is unacceptable that Northamptonshire primary care trust is still treating AMD patients as low priority and effectively telling them either to seek private treatment or to go blind? (184123)

If the situation is as the hon. Gentleman describes it—and I have no reason to doubt him—it is scandalous. It is clear that the local PCT should assess the health needs of its local community and ensure that cost-effective and clinically safe treatment is available. The hon. Gentleman has raised the issue several times in the House and I commend him on that. I will certainly take up his specific concern about the priority given by his PCT to this issue.

Yesterday I received some answers to written questions that I had tabled to the Department on dental fluorosis in children. Those questions were prompted by the mother of a seven-year-old child whose adult teeth were starting to come through very discoloured and with the enamel missing. The mother was distraught, because the dentist had just said casually, “Oh, that is because she was swallowing toothpaste and wasn’t rinsing her mouth.” Should we not do more to warn patients of the dangers of children swallowing toothpaste? This girl will not be able to have anything done about her teeth until she is 16.

I agree that we should do more, and we are. Fluorosis, the discolouration to which my hon. Friend referred, is caused by children eating lots of toothpaste. Guidance has gone out from the chief dental officer to the parents of very small children saying that the amount of toothpaste on the toothbrush should be about the size of a pea. That guidance contains graphic illustrations, too, to ensure that young mothers in particular are aware of the dangers of putting too much toothpaste on the brush. That is not to say that that is potentially fatal, but it does cause problems with fluorosis. My hon. Friend is right to draw attention to the need for that guidance, which went out only a couple of weeks ago.

On the GP contract, the Secretary of State must be aware that Members on both sides of the House will be disappointed that the Government and the BMA seem to be in dispute when they have shared objectives, including the objective of ensuring quality service and access for the patients. Given that under the existing contract primary care trusts can commission extended opening hours as a local enhanced service, will the right hon. Gentleman tell the House how many PCTs have commissioned those extended opening hours?

I am not sure about the number of primary care trusts, but the percentage of the population who have access to such services is about 10 per cent. I have seen primary care trusts around the country—Kingston was a recent example—which have introduced Saturday openings. Incidentally, the people who come to surgeries on Saturday mornings are the very people whom the BMA claims are happy to go to their surgeries mid-week—older people and young mothers with children. They find it very convenient to go to the surgery on a Saturday morning.

We have tried hard to reach an agreement and we are still keen to reach one. We have not torn up any contracts or gone gung-ho at it. We have made a reasonable set of proposals that are good for the patient, the health service and the GPs. I hope that GPs will accept those proposals in the individual ballot that is being sent out from the BMA.

The Secretary of State has accompanied his proposal, as he puts it, with the threat that he will impose a contract rather than complete negotiations. Does he recall the last general election, when we suggested that GPs should be commissioned with additional funds to open on Saturday mornings? The Government did not accept or endorse that proposal. Will the Secretary of State explain how he can pursue his dispute with the BMA when he does not know how many primary care trusts are already commissioning extended opening hours? Does he know how many GPs are offering extended opening hours, whether they are commissioned to do so or not? How can the Secretary of State go on the radio and accuse GPs—

Order. May I say that these are topical questions and are really for the Back Benchers? We cannot have several supplementaries from those on the Front Benches.

Let me say briefly that I have not issued any threats to anyone. We are determined to move ahead with greater access from April. If the BMA does not agree to the proposals, we will need to consult on the proposals that we will impose. To start that process, we must start the consultation now. The hon. Gentleman may want to run away from the argument, but we believe that patients deserve greater access. If we cannot achieve that by negotiation, we will have to impose a solution. To do so, we will need consultation, which must begin now in order to introduce that solution in April.

T5. The Secretary of State will be aware that the Bluebell surgery in Colchester occupies dilapidated temporary premises that would disgrace a third-world country. Alongside it, completed in August last year, is a purpose-built new surgery and community centre. Will the Secretary of State, this day, chase whoever is responsible to get that new facility open, as it has been standing shut for the past six months? (184125)

I am always happy to listen to Liberal Democrats who tell me that we ought to push down more autonomy to the local area and not interfere from the centre, yet ask me to intervene this very day. I shall find out what is happening in tribute to the hon. Gentleman, who I know is a fine constituency MP—[Interruption.] Well, I am in a good mood. I shall let him know the result.

T4. I am sure that the House would be grateful for further information about fluoride and the Secretary of State’s announcement today. Is it a fact that fluoride is a poison that is dangerous if it is absorbed in too great quantities? Is it a fact that it works topically to prevent tooth decay as administered via toothpaste? Does the Secretary of State believe in such mass compulsory medication given the concerns about fluorosis that we have already heard? (184124)

Fact No. 1: fluoride has been in the US water system for the past 60 years, and in Birmingham’s for the past 40. Fact No. 2: Birmingham is the 360th most deprived area in the country, but the incidence of dental decay there puts it 30th in terms of good dental health among children. We have been around this course many times. On a free vote, Parliament voted overwhelmingly that water companies had to put fluoride in the water if local people required it. I want to kick-start that process, and all the facts are in favour of greater fluoridation.

T10. The Secretary of State will be aware that people needing long-term or lifelong treatment, such as those who suffer from diabetes, get free prescriptions. That is quite right, but will he address the anomaly that means that transplantees must pay for their prescriptions? Will he agree to meet organisations representing transplantees so that the question can be discussed and addressed? This is a serious anomaly and very unfair, as the people involved pay out large sums of money each week. (184130)

Some 88 per cent. of patients do not pay for their prescriptions. If the group that my hon. Friend mentions is not among them, I shall be happy to meet a delegation to discuss the problem and see what the facts are, as a precursor to seeing whether any action is necessary.

T8. The Secretary of State refused to meet me to discuss the fact that he is closing a hospital in my constituency. Will he tell me, across the Floor of the House, whether he thinks that it is acceptable to close a hospital and not require the local ambulance trust to publish an independent report on journey times to the two accident and emergency departments that are affected? (184128)

The hon. Gentleman and most of the House will be aware that the health ombudsman and all the local health trusts in his area support the reorganisation in Bristol. He has lost the argument, and his campaign did not succeed in the judicial review. We think that it is better—and the official Liberal Democrat position is in agreement—for local communities and health trusts to make decisions, as that is in the best interests of people in the area.

The Secretary of State prayed in aid the American experience in respect of putting fluoride in the water supply, but Ministers will know that the American Dental Association has advised that fluoridated water is not safe for making up infant milk formula because it causes fluorosis. Is he not concerned about that, and what does he propose to do to keep children’s teeth safe?

May I repeat again that the science supports fluoridation? Parliament did the same, on a free vote. Whenever the public are tested on this question, they believe that there should be fluoridation. There is absolutely no clinical evidence whatsoever that links fluoridation with anything other than fluorosis. Fluorosis is a discolouration of the teeth, and there are perfectly simple ways to deal with it. The major things that we should be talking about are prevention of decay—and fluoride will be extremely helpful in that—and tackling health inequalities. One of the biggest health inequalities is in dental health, and fluoride is there, available and waiting to assist in that process.