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.
Is my right hon. Friend aware that there is widespread concern in the Wirral that the decentralisation of dermatology services will result in a deterioration in the quality of the treatment provided, a loss of critical mass, a loss of specialism, a loss of resource and a generally poorer service? Does he have plans to review the policy?
I do not agree with my hon. Friend, who wrote to me about the matter in June. What has happened in the Wirral is that some dermatology services are moving to local community-based services. That does not detract at all from the specialist dermatology units in hospitals in the Wirral, and I can give him the assurance that that will enhance dermatology services and not detract from them.
Our understanding is that the local PCT has decided to reduce the number of medical beds not to 10 but to 20 at Chippenham hospital, because it has cut delayed discharges by half and successfully introduced district nursing teams. The maternity unit at Chippenham is being expanded. The proposals have been backed by the Conservative Wiltshire county council overview and scrutiny committee. As the hon. Gentleman knows, because he has had a good briefing from the local PCT chief executive, the PCT is bidding for capital funding from the Department for a massive expansion of facilities at Chippenham hospital.
I am aware of the trends that the hon. Gentleman describes and I have had discussions with the relevant authorities. As he knows, there are strict controls on imported drugs, but we are speaking primarily about internet and mail order for personal use. The Medicines and Healthcare products Regulatory Agency is taking steps to monitor that and working with Her Majesty’s Revenue and Customs, international authorities, the Association of the British Pharmaceutical Industry and the British Medical Association. I will certainly consider the hon. Gentleman’s point about taking that further through co-operation in Europe.
I can tell my hon. Friend, who is a great champion of apprenticeships, that 5,000 apprentices are registered with the Learning and Skills Council in health-related apprenticeships, for example in dental nursing or as pharmacy assistants. We plan to treble that to 15,000 by 2010. I will look into the possibility of designing apprenticeships so that more women who wish to return to work can do an apprenticeship in the national health service.
May I draw the Secretary of State’s attention to a document obtained by Remedy UK? It is a survey of hospital trusts around the country, and it shows massive problems in recruitment—particularly at senior house officer level. It also shows a national shortage of doctors able to do locums. All that appears to be putting patient safety at risk: in Surrey, an NHS trust says:
“we had to run the service on several occasions without the required number of doctors”.
On top of all the problems last year, is that not more evidence of a failure of work force management and planning? What will the Government do about it, particularly given the risks to patient safety and patient care?
We are aware of the issue; the problem has been circulating anecdotally for some time. We do take it seriously; that is why at the beginning of February we asked the strategic health authorities to help us understand its extent and nature. It is worth bearing in mind the fact that we employ 120,000 doctors in England, and although some trusts have reported such issues, many have not.
There have always been problems in staffing some rotas in shortage specialties. The issue for us has been whether the nature and scale of the problem are different this year. The survey has given us a clearer idea of how to tackle the issue. On the point made by Remedy UK, I should say that this year we will move to three different starting points for junior doctors, rather than the single system that may well have had an effect on the figures cited by the hon. Gentleman.
My hon. Friend will know that the funding for his primary care trust, which covers some deprived areas in Manchester, has increased by 25 per cent. in the past few years. Our aim is to ensure that that process continues without taking away money from areas without those levels of deprivation. All areas must receive an increase in funding; those with specific health needs—they are usually in the areas of greatest deprivation—should receive more.
We have made an across-the-board allocation of 5.5 per cent. this year, because the Advisory Committee on Resource Allocation, the organisation that does the statistics for us, requested an extension before it could give us its new formula. We have made an across-the-board increase this year; next year, however, we will return to ensuring that issues such as deprivation are fully taken into account.
Does the Secretary of State agree with me that it would be unacceptable if a junior doctor who had been working in the national health service for several years post-registration could not complete their specialty training simply because of the lack of training places?
I would like to know the specific details. We would like all doctors in training to have a job at the end of that training. There is no absolute certainty that people training for any profession—to be architects, lawyers or even postal workers—will have a job at the end of their training. However, we want to ensure that people do have a job at the end of their training, which is why we try to get the statistics and figures right. If the hon. Gentleman has a particular concern about a specific doctor, I shall be happy to look into the matter.
As we have the Secretary of State here, may I ask him about the Budget? Last week in his Budget statement, the Chancellor did not say anything about the national health service, but according to the Red Book the future provision for NHS expenditure over the next three years was cut by £3.2 billion—that is, there will be £3.2 billion less in provision for the NHS in the next three years. Can the Secretary of State explain why?
The Chancellor was able to report record levels of investment in the national health service, rising to £110 billion at the end of this comprehensive spending review period. I am fascinated to learn that the hon. Gentleman is going to put another £28 billion into the NHS, as well as make the £10 billion in tax cuts to which his party is already committed.
Will my right hon. Friend join me in congratulating the Heart of Birmingham primary care trust on building a brand new primary care health centre in my constituency? Will he find time to come to the opening in the near future?
I would very much like to come to see my hon. Friend’s new health centre. [Interruption.] It may well be a polyclinic. The Conservative party spelled polyclinic “pollyclinic” in a recent press release. We are not building health centres for parrots, and my advice to the Opposition is that they should not criticise a policy they cannot spell.
Do the Government accept that people in rural areas already have to travel considerable distances to a GP practice, and the cost of getting there will increase in the near future? Does the Secretary of State accept that rural GP practices are particularly important and that the Government should place special emphasis on their survival? The role that they play in rural areas is important and we must not deprive those areas of facilities any further.
The hon. Gentleman is right about the importance of GP services in rural areas, not least because, if we expand the services available in GP practices in rural areas, patients would not have to travel long distances to hospital. I am meeting the Government’s rural adviser shortly to discuss GP services in rural areas.
The hon. Lady has been misinformed. We have provided the funding to each strategic health authority to meet the cost of the deep clean. They are not expected to divert money from other resources to it. We provided the money from the centre.
The hon. Gentleman has raised the matter with me. If he speaks to me at the end of Question Time, we will make arrangements for a meeting.
Is my right hon. Friend the Secretary of State aware that the all-party social care group recently completed an inquiry into the challenges that face the social care work force? Will he ensure that, when social care staff work in multidisciplinary teams, they are accorded due status and that the voice of social work is heard on behalf of their clients?
My hon. Friend is right to make that point. If we consider that more and more people stay in their homes, that we are moving care out of hospital and closer to home, and that we are keeping people out of institutionalised care, the contribution of social care is increasingly essential and every bit as important as that of the NHS. The professionals who work in those different agencies should be afforded the same value and respect. We need to start blurring some of the professional titles and focus on the needs of individual patients and families.
The Secretary of State knows that everyone in my constituency anxiously awaits his decision to approve the new PFI hospital at Pembury. Will he reassure me that we will have that decision, as planned, by the end of the month?
Yes. My right hon. Friend the Secretary of State has today given final approval for the scheme to reach financial close. He expects the formal contract for the new hospital to be signed shortly. Construction of the new facilities is due to begin in late March and the first patients are scheduled to be admitted in early 2011, with the project completed by 2012.
Self-harm is a key indicator that someone may go on to take their own life. What steps are the Government taking to provide counselling and support for self-harmers?
My hon. Friend raises an important point. As she is aware, we have a national suicide strategy in this country that has been effective in reducing suicides. We have made significant progress. She is absolutely right to raise the particular problem in her constituency and to demand action to deal with it. The number of young people who have died in a relatively short period of time in her constituency is frightening. It is very important that the relevant authorities in that area respond in a positive and collaborative way. We certainly have to take self-harm far more seriously than perhaps we have in the past.