1. What assessment he has made of levels of access to NHS dentistry. (184142)

Some 27.9 million people in England saw an NHS dentist during the two years ending on 30 June 2007. We are committed to improving further access to NHS services. We have increased central funding by 11 per cent. for 2008-09 and are requiring the NHS, through the operating framework, to increase the number of patients able to access NHS dentistry year on year. Given that prevention is better than cure, today we are launching guidance to strategic health authorities on consulting with their local populations on water fluoridation, which is known to reduce tooth decay. A central budget totalling £42 million over the next three years has been established to meet the capital costs of fluoridation.

Under the current contract, dentists are paid the same for fitting one filling as they are for fitting 10. Some are refusing to treat patients with the poorest teeth. Does the Secretary of State think the arrangement the best way to improve NHS dentistry, particularly for high-needs patients?

The new contract was the best way forward. In fact, an NHS dentist is not allowed to refuse to treat patients with the poorest health. Under the old system, there was an absolute incentive to drill and fill. If a dentist moved away from the locality, the local patient population lost out. The famous queues in Scarborough happened under the old system, not the new. Although the new contract has taken time to settle down and although it was not popular with the profession—sometimes we have to do things not popular with the profession if they are necessary to help patient care—we have made improvements in dental care.

Despite the fact that the local population is growing rapidly, Milton Keynes primary care trust has successfully used the new funding formula to fund the opening of new NHS surgeries. Today on the NHS Choices website it is possible to find access to at least half a dozen NHS surgeries in Milton Keynes. Is the Secretary of State rolling that example out across the country, given that it appears that some other PCTs seem not to know how to use the new system effectively?

My hon. Friend has seen huge advances in Milton Keynes, and we have also seen those around the country. Every PCT now has a free helpline for people to ring if they want to access dental treatment. There has been a 20 per cent. increase in the number of dentists since 1997 and there is a 25 per cent. increase in the number of training places at not only the existing dental schools, but the two new ones that we are building. Access to NHS dentistry is getting better all the time.

I doubt whether the Minister will agree with me completely—[Hon. Members: “Hear, hear.”] There is an impression that I have a small interest in this subject. The Secretary of State may not agree, but I personally believe that access should be measured according to the numbers of dentists prepared to offer national health service treatment, regardless of whether the patients accept such treatment or choose to go private. Regardless of what the Secretary of State has said about the contract, it has hurt a lot of dentists, particularly the experienced ones. Many have moved out. What could and will the Secretary of State be prepared to do to the contract to attract those highly experienced professionals back into offering national health service treatment?

I pay tribute to the hon. Gentleman, not least for his work on fluoridation over the years. In response to his question, yes, there was an initial drop—this was a very controversial change; Governments have to do things that are controversial if they believe that that is in the interests of patient care. Of the disputes around the country, only 14 remain to be resolved. As regards the new dentists coming through, I find, without any inference as to the hon. Gentleman’s age—he looks to me like one of the younger crop—that there is a difference between the younger dentists and their enthusiasm for the brave new world under this contract and some of the older dentists. I would like those who have left to come back, but it is a decreasing problem given the number of new dentists coming through.

Does the Secretary of State recognise, though, that some PCTs have been slow and have given insufficient priority to commissioning dental care services? Having said that, does he agree that the single most effective way of reducing inequalities in oral health is to fluoridate the tap water in selected areas?

On the first point, my hon. Friend is right about some sluggishness in PCTs in commissioning these services. That is why we have made it a tier 2 issue in the operating framework this year and increased funding by 11 per cent. On the second point, I pay tribute to the work that she too has done on fluoridation over the years. I entirely agree, as do the British Medical Association, the British Dental Association and every reputable scientist who has considered it, that extending fluoridation is the best way to close health inequalities.

Following the comprehensive spending review, the Secretary of State announced targeted funding for additional GPs in areas where there was a shortage. Has he any proposals to do the same to recruit dentists, because in places such as Rochdale and the north-west there is a real shortage and they are not reaching people at the moment?

As I mentioned, we have a 25 per cent. increase in the number of undergraduate students coming through. We have built two new dental schools, one in Plymouth and one in Preston, which will open this year. That will do an awful lot to resolve the problems. However, I am interested in looking at any possible solutions if we have the equivalent of under-doctored areas, so I would not rule out considering such ideas.

Will my right hon. Friend join me in congratulating Durham PCT and Associated Dental Practices, which has opened the new Pelton Lane Ends surgery in my constituency, bringing dental health care to 3,600 patients, in some cases for the very first time?

I am pleased to join my hon. Friend in congratulating the new dental practice. Following the comments of my hon. Friend the Member for Milton Keynes, South-West (Dr. Starkey), that once again shows that progress is being made right around the country.

The 3 million residents of this country who do not have access to an NHS dentist will be astonished by this complacency. The report by Citizens Advice is much more interesting than some of the comments coming out from the Minister’s office. With £2.6 billion of taxpayers’ money being spent on NHS dentistry and people pulling their teeth out with pliers and using superglue to put their caps back on, why is the Secretary of State so complacent?

Anybody pulling their teeth out with pliers needs more medical care than a dentist can provide. The hon. Gentleman may have seen the splendid letter from the Under-Secretary, my hon. Friend the Member for Brentford and Isleworth (Ann Keen), which was sent to all Members of the House to counter this ridiculous nonsense going around about dental services—ridiculous nonsense that unfortunately Conservative Front Benchers have taken to parroting.

2. What assessment he has made of the potential contribution of nurse-family partnerships to the development of Nottingham as an early intervention city. (184143)

The family-nurse partnership early intervention pilots target support towards the most vulnerable first-time mothers, primarily under the age of 20. For the very first time, we are starting early in pregnancy and continuing until the child is two years of age. We would be very happy to receive a good-quality bid from Nottingham and any other bidders for the next wave of pilots. We will assess the quality of all bids against the published criteria.

The health partnership and the PCT in Nottingham are well aware of this issue and are doing excellent work on intensive health visiting. OneNottingham, the local strategic partnership, regards that as key to breaking the intergenerational nature of deprivation in our city and the underachievement that goes with it. Does the Minister agree that this Government should have a long-term ambition that every young mother and child should get the level of intensive health visiting that they need as a way of breaking that cycle and reducing the massive bills of social failure that come as a consequence of not being properly parented in those first couple of years?

I welcome my hon. Friend’s support for the family-nurse partnership programme, and I congratulate him on his work to develop early intervention and prevention in Nottingham. I am aware of the interest that he has shown over the years, and he is a strong advocate. Health visiting and universal care for children, with qualified clinical nurses, is critical. I welcome the interest shown by all PCTs and local authorities in the intervention that family-nurse partnerships can offer. However, my hon. Friend will understand that as the bidding process is under way it would not be right for me to support any particular area.

3. If he will make a statement on the funding of cancer services in (a) Bedfordshire and (b) England. (184144)

The national health service has seen unprecedented increases in funding for cancer services. Such spending has increased from £3.4 billion in 2003-04 to £4.35 billion in 2006-07. In 2006-07, Bedfordshire primary care trust spent £17.9 million on cancer services. As the hon. Gentleman will know, it is for individual primary care trusts to decide the level of funding that they allocate locally for the diagnosis and treatment of cancer patients in their local population.

More than three times as much is spent per cancer patient in the constituency of the hon. Member for Nottingham, North (Mr. Allen) than is made available for my constituents. When will the Government bring in a truly fair funding formula that will mean we are no longer two Englands—a phrase that independent academics recently referred to in the Health Committee—when it comes to health care?

On spending, it has been agreed by Members of all parties that local primary care trusts know the needs of their area best. We have already extended breast screening to all women between the ages of 50 and 70; we have introduced bowel cancer screening programmes, which are the first in Europe to target both men and women; and we have seen major reductions in waiting lists.

I can tell my hon. Friend that none of my constituents has complained about access to cancer services in Bedfordshire, although there is always a wish to see improved services. Does she agree that one of the drivers that helps to underpin improvements in cancer services is an effective system of patient and public involvement? Therefore, does she share my concern that on 1 April the Bedfordshire PPI forum will be abolished with no likely replacement LINk system in place?

My hon. Friend would have a serious point if local involvement networks—LINks—were not in place. LINks will only strengthen the patient’s voice, not only in the health service but for social services. I always agree with the idea of involving patients and the public. That is why our cancer reform strategy has been so successful; all stakeholders including all the cancer charities were involved and it has been welcomed by those charities.

The Minister is right to say that decisions must be taken locally, but is she not able to see that a PCT can take decisions on spending only according to the money it is given? The issue raised by my hon. Friend the Member for South-West Bedfordshire (Andrew Selous) is that the variables and differentials in certain areas have widened so much that it is not possible for an area such as Bedfordshire to compete or to give necessary treatment to its patients. That distinction in the variables in the formula has now stretched so far that is affecting access to care. This is a matter of justice.

The hon. Gentleman’s point concerns me, because there has been an increase of over 5.5 per cent. for all PCTs. I encourage him to engage more fully with his PCT to look at how certain areas are operating the very best practice. I know that results within the hon. Gentleman’s area for the incidence of cancer and its outcomes are still very good indeed.

My hon. Friend will be aware that Luton has serious health inequalities, which have persisted over many years, while at the same time receiving funding well below its fair funding target. Things are starting to improve, but will my hon. Friend ensure that Luton gets its fair funding target at least, and that its health inequalities are properly addressed?

It is my belief that no one is more than 2.5 per cent. away from their target. I urge my hon. Friend to work closely with his PCT and to keep discussing the issue. It is critical to all hon. Members to have the equity that we all want for our constituents.

Expenditure on cancer services in the UK now matches that of many other European countries. Yet despite the significant investment by British taxpayers in cancer services—an extra £693 million over three years—UK five-year survival rates have not accelerated and are among the worst in Europe. If the UK achieved the European best cancer survival rates, more than 34,000 lives would be saved every year. Why has the extra expenditure not improved survival rates?

I cannot be clear that that information is the most up to date and I urge the hon. Gentleman to check the figures. There is an increase in survival rates and improvements throughout the cancer sector, as all experts and charities have recognised. We still have some difficulty in this country with people being aware of what to look for, so that when they present at their general practice the GP can diagnose quickly. More work is being done on raising awareness. However, I urge the hon. Gentleman to check the facts.

4. What consideration he has given to amending the regulatory regime for tanning salons. (184146)

The Department of Health is reviewing options for the regulation of tanning salons with stakeholders, including the Health and Safety Executive and Cancer Research UK. It is important to consider ways in which to strike the balance between consumer safety and choice. We will focus initially on the harm to young people who use sunbeds.

The Minister will be aware that recent research suggests that sunbeds may be responsible for 100 deaths every year from skin cancer. Is not it time that, perhaps with the support of the Health and Safety Executive, a full review is conducted of commercial salons, with a view to drawing up legally enforceable guidelines for their management and operation?

I stress the importance of striking the balance between consumer safety and choice, while ensuring that the potential harm to those who use sunbeds, including young people, is made clear. The figure that my hon. Friend cites for the increase in deaths that are attributed to sunbeds is shocking. The review will consider several matters, including the recommendations of the World Health Organisation and restricting the age of those who use the beds. We will also ensure that correct information about the dangers is available to those who use sunbeds, and we also need to consider the role of local authorities.

It appears that demand for services from the beauty industry such as tanning, Botox injections and teeth whitening is increasing—[Interruption.] I have no interest to declare. [Hon. Members: “Shame!”] I know.

When the services go wrong, it can be physically damaging and stressful for those involved. Will the Minister’s review go wider than tanning to include the whole beauty industry, including the fillers that are put into people’s faces, to ensure that it is properly regulated?

The specific review to which I referred is, following from the cancer strategy, to consider sunbeds and the connection with skin cancer.

The hon. Gentleman raises another important matter: access to treatments that are normally paid for privately and may have health consequences for the individuals involved. The MHRA—Medicines and Healthcare products Regulatory Agency—covers several of those matters, but he is right to make the point about whether fuller advice to individuals who seek such treatments is available and where it should be available.

What updates does the Minister have on any discussions between the Department and the Department for Work and Pensions about the publication of leaflet IND(G)209 on sunbeds?

I think that my hon. Friend is referring to the review that the Health and Safety Executive conducted to look specifically at guidance on controlling the health risks of using UV tanning equipment—at least I sincerely hope that that is the reference number. If that is indeed the leaflet to which she referred, it will be published shortly.

5. If he will take steps to encourage the development in the NHS of patient-centred practices as employed at the Royal London homeopathic hospital. (184147)

The Department is investing around £3 million to build capacity for research into complementary and alternative medicine, to strengthen the evidence base. As the hon. Gentleman will know, it is for health care organisations to make informed decisions on the funding and commissioning of services for their local communities, based on evidence, safety, effectiveness and the availability of treatments from suitability qualified practitioners.

Is the right hon. Lady aware that, despite the support that she has described, one fifth of PCTs have cut services in integrated health care in the past two years? One problem in particular is the possibility of Camden PCT withdrawing support for the Royal London homeopathic hospital, despite its employing integrated services which have cut the costs of treatments for some conditions, such as irritable bowel syndrome, by between 50 and 100 per cent. Will she look carefully at the problems there and perhaps issue some guidelines?

I am sure that the hon. Gentleman will agree that primary care trusts have the responsibility to commission the very best care that they can for their local populations. In considering the role of complementary and alternative therapies, PCTs need to take account of the evidence on clinical and cost-effectiveness. I am aware that a number of PCTs are reflecting on precisely those points, which is influencing the contracts that they place. However, for a member of a party that supports local decision making, it ill behoves the hon. Gentleman to question it when things do not quite go his way.

In this country we use a lot of recycled water, but I am surprised that water, which supposedly has a memory, does not have a memory of the faeces that were in it and thereby make us all sick. My right hon. Friend has referred to research, but against that background is she aware of any peer-reviewed medical research that indicates that homeopathic medicine works through anything other than a placebo effect?

I am aware that some—including, it appears, my hon. Friend—are not impressed with homeopathic medicine. However, when I referred to complementary and alternative medicines, I was referring to a much broader base of practices. The whole point of the research is to build up the capacity to make evidence-based decisions about complementary therapies.

The Minister says that the decision is for commissioning authorities. However, if the Government believe in evidence-based commissioning as they say they do, is there not a role for them in issuing guidance or at least in asking the National Institute for Health and Clinical Excellence to issue guidance, so that PCTs do not spend resources on treatments that have no effectiveness? If the effectiveness of treatments such as homeopathy is zero, there can be no cost-effectiveness to them.

I am sure that the hon. Gentleman will be aware that the recent Select Committee on Health report on NICE made recommendations about the shortfall in good quality research evidence on the cost-effectiveness of different types of public health interventions, including complementary therapies. The Government will respond to that report in due course. The issue for the Department is to ensure that PCTs are aware of the evidence where it is available. We would certainly wish to consider where it is appropriate for NICE to consider complementary therapies alongside other treatments.

6. What progress has been made in agreeing the GP quality and outcomes framework. (184148)

We are seeking to reach agreement with the British Medical Association to use resources from redundant indicators in the quality and outcomes framework for improving patient satisfaction, with access as a key indicator of quality. We are also proposing to use other resources within the contract to fund extended opening by practices. The BMA has decided to poll its members on the package. We hope that GPs will support our proposals to improve services for their patients.

I wonder whether the Secretary of State has seen the recent evidence showing that only one in 10 women who have suffered a fragility fracture have been referred for a bone scan to discover whether they have osteoporosis. The figure for men is one in 50. I am sure that the Secretary of State is aware of the cost-effectiveness of early diagnosis of osteoporosis. Will he therefore ensure at an early stage that performance indicators for osteoporosis and incentives are built into the quality and outcomes framework? Does he agree that it would be foolish if money that could be available for osteoporosis was diverted into more flexible surgery hours, given the potential savings to the NHS from preventing secondary fractures?

I pay tribute to my hon. Friend for his work on the all-party osteoporosis group. Let me make it absolutely clear that this is part of some of the misinformation flying around about the very complex area of the quality and outcomes framework points. There has never been any incentive within the framework to treat osteoporosis. We are dealing with a number of points in the system—and therefore money paid to GPs—that are now redundant. We all agree that they are redundant. We want to use those points for greater access. The BMA has suggested that they be put towards issues such as osteoporosis, virtually as a piece of propaganda to strengthen its position—[Hon. Members: “Ooh!”] The word propaganda is obviously an unparliamentary term.

I say to my hon. Friend—who I know takes a deep interest in this issue, as do many others—that this is not about our not putting money into these areas. We just do not believe that GPs need to be incentivised in such areas. We believe that we should put more money into the national service framework for older people in order to tackle osteoporosis; and we should fundamentally ensure that people can get to their GP, which is the first step to dealing properly with any ailments, including osteoporosis.

What consultation with patients and the public has taken place in the discussions on the GP quality and outcomes framework?

We have dealt with patient groups throughout the process. I mentioned that some points are redundant, and I do not think that there is any argument that GPs should be incentivised to do things that they should already be doing—for instance, writing out a person specification for job adverts to recruit staff to their practice. There should not be incentivisation for things that should be done as a matter of course. There is no disagreement with patient groups about that. About 6 million people in our patients survey said that they want improved access to their GP in the evenings and on Saturdays, which is why we are seeking to reach a negotiated settlement with the BMA.

Is the Secretary of State aware that no one would deny the need for the Department to ensure good value for money in the health service? It is unfortunate that a very inexact contract was prepared for general practitioners. Does he accept that, whatever developments there are, the introduction of private health care, particularly from America, where I am sorry to say the state is unable to provide adequate health care for its own people, would not only undermine the confidence of general practitioners in the national health service, but would cause grave doubts for many hon. Members who believe that this is a service worth preserving?

I do not agree with my hon. Friend that the contract was a mistake or inexact. In fact, during the period leading up to 2004, we had a crisis in GP recruitment. We could not recruit undergraduates from medical schools and we had an ageing group of GPs. A huge shortage of GPs was the big worry at that time, but our medical schools are now full—that problem has been resolved. I also do not agree that GPs who are called out at 4 o’clock in the morning should be expected to deal with patients and difficult cases at 9 o’clock when their surgery opens. The issue about working hours applies to GPs as well as others.

On my hon. Friend’s second point, we are not seeking to introduce private practice into these areas. We are seeking to negotiate with the BMA for greater patient access. We want to bring more GPs into under-doctored areas, which have been appallingly treated in the past. The basic point is that customers and patients should get the service that they deserve. I hope that that will be in our present GP practices, but, if not, we will provide those practices in some other way.

rose—

Order. May I say gently that I must be able to call Back Benchers whose names are on the Order Paper?

This is a short question, Mr. Speaker. Did the Government miscalculate the number of points that GPs would earn in the quality and outcomes framework?

What we are quantifying in this instance is about £200 million for the number of points that are being moved around the system. There is no disagreement about that; the disagreement is about where to spend the money.

7. How he plans to make individual budgets available to social care users over the next three years; and if he will make a statement. (184149)

Local authorities will receive an annual social care reform grant in addition to mainstream resources over the next three years to support the radical transformation of social care in every area. Personal budgets for the vast majority of those receiving public funding are at the heart of that vision.

On Sunday I visited the Patey day centre in my constituency, which provides help for sufferers of dementia. I welcome the Government’s announcement of the first ever national dementia plan, which I hope will stress the importance of enabling sufferers to stay in their own homes for as long as possible. Does my hon. Friend agree that individual social care budgets are vital to achieving that aim?

I entirely agree. It is important that at long last we, as a society, are bringing dementia out of the shadows by establishing the first ever national dementia strategy. It will reflect the fact that dementia affects an increasing number of families, and is a pretty horrendous disease to cope with. The purpose of family budgets is to give families maximum control, power and choice over the care that is provided. They are in the best position to decide on the best way of responding to their own needs. When family members are not there to help people exercise that control and choice, advocates will be available to ensure that a personally sensitive service is provided.

Is the Minister aware of the dilemma faced by many seriously disabled people who reject the highest level of care available because it involves a transfer from social services and direct payments, which give them control over their lives, to the national health service, where they do not have that?

The hon. Gentleman has raised an important point. We are committed to a fundamental review of the care and support system this year, to assess our ability to achieve a fairer funding settlement that redefines the respective responsibilities of state and citizen. One of the issues that we must consider is the relationship between the national health service, local government and the voluntary sector in every local community.

Will my hon. Friend consider the problems faced by disabled people who, on engaging carers, effectively become employers? When my hon. Friend the Member for Erith and Thamesmead (John Austin) and I met disabled lobbyists recently at the House, they described their difficulties and the need for guidance and advice. They also pointed out that the different rates paid by local authorities can create problems of recruitment and retention. Will my hon. Friend consider providing some guidance?

I agree with my hon. Friend. One of our reasons for organising a fundamental review of eligibility criteria is the inconsistency of decisions on funding to meet people’s needs, both within and between local authorities.

My hon. Friend referred to the difficulties experienced by people receiving direct payments who employ their own staff and take responsibility for their own care. As we incorporate the new arrangements in the mainstream social care system, one of the challenges for the Government is to ensure that we take account of all the barriers and obstacles that prevent people from exercising self-determination. The belief that disabled and older people have a right to self-determination is entirely consistent with the long history of our party’s values.

If—as we all agree—the use of individual personal budgets and direct payments for social care needs to be massively expanded, they need to be widely available. What is the Minister’s response—and let us have some action, rather than yet another review such as the one that he mentioned—to last week’s report from the Commission for Social Care Inspection? The commission found that in 2005-06 alone seven out of 10 local authorities restricted their services to people with substantial or critical needs, that there was a wide disparity in the levels of care and help provided even in the same areas, and that as a result 281,000 people in need of help were receiving none while another 450,000 were receiving less than they needed.

The action that the hon. Gentleman calls for is the social care transformation that will begin in every local authority area in April; it will last three years and it is funded by half a billion pounds of social care reform grant. At the heart of the agenda will be personal budgets for the vast majority of people receiving public funding; information, advice and advocacy for everybody, irrespective of their means, including self-funders, who are all too often left on their own; and a shift to prevention and early intervention, so that we move away from current eligibility criteria, under which, for example, it appears to be nobody’s responsibility to do anything about an older person who is lonely or isolated. From 1 April there will be a three-year transformation agenda in every local authority area, and later this spring the Prime Minister will announce a new deal for carers. That is action.

8. How many paramedics there are in east Lancashire; and how many there were two years ago. (184150)

The data are not collected for east Lancashire. However, there were 1,175 paramedics in the North West Ambulance Service NHS Trust in 2006. The figures for 2007 will be available in March but, nationally, paramedic numbers have risen steadily over recent years, from 6,245 in 1996 to 8,222 in September 2006.

It is regrettable that the figures for my area are not available because blue light accident and emergency services moved from Burnley to Blackburn on 1 November, which has prompted huge local concern that the transfer is not delivering the benefits that we were told to expect. Is my friend satisfied with how the move has gone, and will he meet me and other concerned Members from east Lancashire to discuss the problems in my area?

I am always happy to meet Members. If my hon. Friend has specific examples or evidence of where he thinks the reorganisation has not gone well, I will happily look into them even before we have a chance to meet. I do not think it makes sense, however, for Ministers in Whitehall to second-guess the way that local health services and ambulance trusts organise their services. I am sure that my hon. Friend is aware that three additional ambulances have been taken on to help with the reorganisation. The accident and emergency services were not centralised in Burnley, and I am, of course, aware that concern was expressed there in particular, on account of that fact, but, interestingly, the figures do not point to a large increase in the number of people presenting themselves in Blackburn instead; there has been only about a 5 per cent. change.

9. What recent discussions he has had with other Government Departments on the public health effects of smuggled tobacco. Tackling the problem of tobacco smuggling is a major priority for the Government. The illicit trade in cheap tobacco is helping to sustain high levels of smoking, particularly in deprived communities and among young people. My officials are working in co-operation with a range of organisations and stakeholders locally and nationally to tackle the problem. (184151)

My local authority health scrutiny commission met last week to discuss that issue. It is a problem in my area because much of the local smuggled tobacco is counterfeit, which means that it is full of dangerous chemicals, and much of it is targeted at young people. As a consequence, health conditions are worsening because of those poor-quality cigarettes and young children are getting health problems at an earlier age. Smoking cessation programmes have been a success story, so can my right hon. Friend give any encouragement to my area about the possibility of those programmes being extended, in particular to children—

Order.

My hon. Friend raises an important point about access to smuggled tobacco, particularly in areas of high deprivation where smoking levels among adults and young people remain high compared with the rest of the country. It is necessary to establish co-operation between the local authority, trading standards, the local health providers and local community groups—I am glad to hear that that has started in his local area—to get across a clearer message about the damage that smoking tobacco, whether contraband or not, does to health.

10. If he will make a statement on levels of recruitment and retention in maternity services. (184152)

As the birth rate continues to rise, more midwives will, of course, be needed. We are working closely with the Royal College of Midwives and the national health service to ensure that the local maternity work force are in place to deliver Maternity Matters. Extra funding totalling more than £330 million will ensure that mothers get the best possible care and a full range of choices.

Does the Minister accept that financial resources are the key to getting additional midwives in practice and delivering on the Maternity Matters strategy? She named a figure that is to be devoted to maternity provision. In order to the meet the strategy and the guarantees that the Prime Minister gave me in this House only a few days ago, will she bring forward that additional cash so that it is available very quickly?

We are working closely with the NHS and the Royal College of Midwives on the plans for how the money will be delivered. We are also working towards a conference in the spring, the aim of which is to see how we can bring about the much-needed return of experienced midwives practising out in the community. I am confident that a larger midwifery work force will be in place this year.

May I welcome my hon. Friend’s comments about the extra Government money for maternity services? The George Eliot hospital in Nuneaton, which has a very good birthing unit, has been given some excellent reports and commendations. It has got through the bureaucracy of an acute services review, so the baby unit is staying, as is the special care baby unit, but services are operating in a 1960s building, which is now very unsuitable. Will she urge that some of the extra money be invested in a new birthing unit for that hospital?

My hon. Friend raises an excellent point about the work being done in buildings that have sometimes had years of neglect. We must show our NHS midwives and doctors respect, because practitioners and clinicians have been asked to practise in these buildings, and of course mothers have been asked to give birth in them, which is why the reconfiguration is so welcome. Leadership is essential in maternity care. The UK is the safest country in the world in which to deliver babies, and we should all congratulate our NHS staff.

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.