1. What steps the Government is taking to encourage women to attend breast and cervical screenings regularly. (194621)

Our cancer screening programmes are renowned as being among the best in the world, with some of the highest uptake levels. It is estimated that the breast and cervical screening programmes save around 6,000 lives every year. The cancer reform strategy, published last December, set out improvements to the programmes so that more women will be included and more women will be made aware of the benefits of screening, particularly in poorer communities.

Does the Secretary of State accept that despite the good work that is being carried out, only 70 per cent. of women between 50 and 70 are regularly being screened—once every three years—and there are huge discrepancies across the country? Have not the Government failed to meet their targets on this and, in so doing, are they not letting the women of this country down?

No, we are not, but the hon. Gentleman identifies a problem that was contained in the cancer strategy. There are variations around the country. I am sure that he will join me in congratulating his own PCT in Havering, where 79 per cent. of eligible women have been screened in the last five years. He is right about the disparities, which is why the cancer strategy asked all strategic health authorities to work with PCTs to identify how they can have more consistency and, in particular, how to get to those poorer communities. Even in the areas covered by institutions such as King’s College hospital in London, which has a wide reach, there are still pockets of communities that those institutions are not getting to. That is a very important part of the cancer strategy.

Will my right hon. Friend comment on this matter? Where screening detects the existence of cancer and where women are forced to have mastectomies, medical advice suggests that it is far better to have reconstructive surgery at the same time as the removal of the breast, but this is not routinely offered in all circumstances. Will he ensure that that is now part of the routine exchange between doctors and their patients?

I am happy to look into the point that my hon. Friend raises. It has not been particularly registered with me yet, but it is an important area and I will look into it.

Is the Secretary of State aware that most NHS oncology units now offer a range of complementary services in support of their work with cancer? Is he further aware that many of those links were developed at the Royal London Homeopathic hospital, in particular the use of acupuncture, and that PCTs have been withdrawing their support for that world-famous hospital? Will he now issue guidelines to PCTs, stressing that the Royal London Homeopathic and the other hospitals, such as Tunbridge Wells, threatened with closure offer a wide range of services, in line with Government policy?

I understand the hon. Gentleman’s interest in this area, but it is for PCTs to contract the right care for patients and for them to make decisions. There are many who do contract in respect of homeopathic medicines and it is important that we leave them free to decide what is best for their communities.

According to The Lancet, the five-year survival rates for cancer sufferers in Britain are among the worst in Europe. Detecting cancer early is vital for improving the survival rate, so why are some women waiting up to 12 weeks to receive the results of their cervical smear?

We have screened 3.4 million women since 2006-07 and we are reducing the number of deaths from cancer by about 2 per cent. a year. We started off well behind the rest of Europe, but as the cancer strategy is pointing out, we are now catching up, although we need to do much more. Much of that is about early diagnosis, but I accept the problem of women being called back within a proper time if their screening determines that there is a problem to resolve. We have made enormous strides on that and we believe that we have a record of which we can be proud in this country.

2. What steps he is taking to ensure that drug addicts referred for out-of-area treatment have a fully developed care plan and that the referring agency retains responsibility for the client through subsequent stages of their treatment and rehabilitation. (194622)

Following the issuing of guidance in 2007, the National Treatment Agency has been working closely with the local partnership in Weston-super-Mare, and the National Offender Management Service is working closely with the relevant probation service to resolve the difficulties identified by the hon. Gentleman.

I thank the Minister for that reply, but outside the probation service—in terms of medical referrals for addicts going for treatment in places such as Weston-super-Mare—will she commit here and now to the principle that the referring agency sending the addict for treatment retains responsibility for that addict throughout their programme of treatment and rehabilitation, rather than just allowing them to be abandoned into the care of local services after one or more of the initial steps in their treatment has been completed?

I absolutely agree with the hon. Gentleman on his important point, particularly with regard to the experiences of communities in Weston-super-Mare. I intend to follow this through, because treatment plans are an important part of the process and of supporting individuals. First, I will speak to my colleagues in the Ministry of Justice, specifically about referrals through probation services. Secondly, we will work with the NTA, the local authority and the local partnership to ensure that we address other referrals to the area in the way he suggests, because that is the only way to ensure that the treatment plans are delivered and work. I commend him for working so hard on this issue for so long.

The January National Audit Office report on community sentences drew attention to the shortage of alcohol misuse treatment courses. Should not the NHS be working with the probation services locally to make sure that rehabilitation for alcohol misusers is available everywhere in the country?

We expect the local area partnerships, including probation services, local authorities and the primary care trusts, to develop the relevant strategies, treatment and support for their communities, including treatments in residential places for those with alcohol misuse problems. If my hon. Friend has specific issues concerning his area that he wants to draw to my attention, I will be happy for him to do so, and I will follow them through.

According to the Government’s own figures, since 1997 deaths due to misuse of drugs have increased by almost a quarter and we have also seen the street price of class A drugs almost double. Is the Minister concerned that the fully developed care plans are not really happening and that the lack of integration is causing some of those deaths, and what will she do about that?

As I am sure the hon. Lady knows, there has been a 13 per cent. fall in drug-related deaths since 2001, and the number of people in treatment is now at record levels. I am sure that she would also like to congratulate the Government on the extra resources they are putting into drug treatment, and in particular into ensuring the delivery of effective treatment. Ten years ago, there was no treatment, but there is treatment now, and we must ensure that it is effective and co-ordinated. That is the Government’s objective.

Is my right hon. Friend aware that people from as far afield as Bournemouth are being referred to private drug clinics in my constituency, causing concern to both local police and the drug action team? What action does she intend to take to ensure that there is proper supervision and regulation of such clinics and a constant, proper treatment plan for individuals?

If there is a referral from a probation service outside my hon. Friend’s area, the guidance is clear: that probation service needs to refer to the relevant probation service with a care plan. On treatment centres, the Commission for Social Care Inspection is responsible for registered care homes and making sure they are properly provided for; the Healthcare Commission is responsible for making sure that registered hospitals come up to standard; and her local authority is responsible for all other registered treatment centres. If my hon. Friend is concerned about these matters and feels that the local partnership is unable to deliver that co-ordination, I will be happy to receive representations from her and put them to the NTA.

3. By what means individual budgets will be allocated to social care users over the next three years. (194624)

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.

What can be done to ensure that the organisations that deliver these services for vulnerable people are properly trained and have knowledge of health and safety, that police records are checked and that the organisations are capable of doing the job that we are going to pay them to do?

My hon. Friend is right to raise those issues. Personal budgets put maximum power and control in the hands of people using services and their families, recognising that they are best placed to make choices about where they want to get care from and allowing them to control their own care and support. Of course, we also must ensure the right balance between giving people that power and control, and appropriate protection in terms of the quality of the support that people receive.

The Minister will be aware that it is much more expensive to deliver these services in rural areas. What assessment has his Department made of the impact on delivering this social care policy of the 2p extra per litre from this autumn? I understand that it will have a big impact on those making visits and delivering these care services, particularly in rural areas.

Of course, this matter relates to how local authorities receive their finance from the Department for Communities and Local Government. Account is taken of a variety of factors when deciding about the allocation of those resources. When local authorities commission services from care agencies or organise services through them they must make adequate resources available so that domiciliary care agencies, or residential and nursing homes, can offer the quality care that people have a right to expect.

We congratulate the Minister on the pilot schemes that have been conducted whereby disabled people in particular have had personalised budgets. Can he assure the House that older people, some of whom have mild difficulties and experience some confusion, will not be disadvantaged by what I see partly as an atomisation of these funds to people who may not have the power of advocacy shared by everyone, which means that they may not do particularly well and could be overlooked completely in the new scheme of things that he has planned?

Of course, my hon. Friend raises an important point. First, the principle is that we should assume that individuals have the ability to make choices and exercise self-determination about their lives. Where someone clearly has difficulty making such choices because of disability or their health, family members are often better placed to make decisions about care and support than professionals ever will be. If family support is not available, what matters is that we put in place professionals and advocates who can ensure that money is spent in the best interests of the person. All the evidence from the individual budget pilots suggests, first, that where people have more control, they get better quality of life outcomes in terms of what they want in order to live an independent life and, secondly, that we get much better value for public money.

Many of these social care users are either in residential or nursing care homes, many of which are under extreme financial pressure. What can the Minister do to speed up payments to the homes?

I say to the hon. Gentleman that, with all due respect, we cannot have a set of policies that aim to provide maximum devolution, localism and control located in local communities, rather than top-down diktats from Westminster and Whitehall, and then ask Ministers to interfere in decisions that properly belong with local authorities. We want local authorities to use their commissioning responsibilities to ensure that they incentivise and encourage high-quality care that puts dignity and respect at its heart, particularly for older people, and that they close down homes that cannot offer that quality and dignity to older people. It is important that local authorities treat providers fairly, but those decisions have to be taken at local level.

What guidance is given to local authorities to ensure that maximum flexibility is allowed to those in receipt of individual budgets? The Minister will know from correspondence that when people have moved from the part of my constituency in the Lancashire county council area into the Blackpool council area they have found that the budgets that they have been allocated cannot be transferred and that some of the care that they have purchased is not the sort that the other local authority will allow. We need uniformity around the country.

My hon. Friend has been a champion for older people and for social care generally since she was elected to this place and was a distinguished chairman of her local authority social services committee, and she raises an important issue. It is one of the reasons why we are conducting a fundamental review of the eligibility criteria—we know that people’s entitlement to services can be very different depending on where they live—and why we are committed this year to a fundamental consultation involving people throughout the country on the nature of the future care and support system for older people, disabled people and people with mental health problems. We face significant demographic pressures—an aging society—and different expectations, in that people want to live in their own homes and have independent lives, so we need to have a debate and then a new funding settlement on care and support in the future.

When direct payments were introduced, my local authority drew up a service level agreement with the Shaw Trust to act as a management agency, supporting people with learning disabilities to manage their care packages. Does my hon. Friend agree that such a management agency will be vital for local authorities to help vulnerable older people manage the money to manage their care?

My hon. Friend is absolutely right. The encouraging news is that in 2004, 20,000 people were using direct payments, but by 2006 nearly 60,000 people were using them. So, contrary to the myth, the system is incredibly popular when people are given a genuine choice. Having said that, when personal budgets and payments become the norm and part of the mainstream of the social care system, we will have to build systems in every locality that enable people to exercise that choice and control. One of the issues that we will have to address is minimising the bureaucracy and the red tape, including payroll, human resources and employment law.

4. What the average waiting time for hospital treatment was at the end of April 1997, and on the most recent date for which figures are available. (194625)

The average waiting time for hospital treatment has fallen from 13 weeks in March 1997 to less than five weeks at the end of January 2008. By December this year, no one should have to wait for longer than 18 weeks from the time of GP referral to treatment. By contrast, in 1997 it was not uncommon to wait for more than two years and people died languishing on waiting lists.

I thank the Minister for that answer, but it was not an answer to the question that I asked. Since 1997, the average waiting time for hospital treatment has increased by 20 per cent. Why does it take 20 per cent. longer under this Government to receive treatment than it did under the Conservatives?

I did answer the question that the hon. Gentleman asked. He has made the mistake of not analysing a recent misrepresentation of a particular statistic on the BBC website that took the median weight for people who had actually had their treatment. The reason—[Interruption.] Wait for it: I can explain it to the hon. Gentleman. The reason why the median increased up to 2004-05 was that all the people who had been waiting for an extremely long time under the previous Government were now getting their treatment. Previously, those people were not even included in the figures. So it is entirely misleading for the hon. Gentleman or anyone else to suggest that average waiting times have increased under this Government. Of course they have not, and it is complete nonsense.

Waiting lists will, to a large extent, depend on the configuration of services, and the Minister will know that in north Oxfordshire we are anxiously waiting to discover what is going to happen to proposals for the Oxford Radcliffe NHS Trust and the configuration of services at the Horton hospital. Can any Minister explain to me why it was not possible for the independent reconfiguration panel to publish its proposals today, when we have health questions, instead of on Thursday, just before the House rises for the Easter recess? If they had been published today, Ministers could have been held accountable, but as it is we will not be able to ask Ministers questions about those proposals for more than a month.

The hon. Gentleman appears to suggest that the independent reconfiguration panel should set its timetable for the convenience of Ministers. I would have thought that that was exactly what he would not want. He will have to be a little more patient, because it is an independent panel and we do not set its timetable. I am sure that he would be very critical of us if we were to do so.

5. What discussions he has had with counterparts in devolved administrations on promoting organ donation. (194626)

All four UK Health Ministers have accepted the 14 recommendations of the organ donation taskforce and will work together to promote organ donation. The taskforce believes that implementation of the recommendations will increase donor rates by 50 per cent. over five years and enable around 1,200 additional transplants each year.

I thank my hon. Friend for that answer. As we await the organ donation task force report, which is expected later in the summer, I urge the Minister to ensure that the organ shortage in the UK is tackled and solved on a UK-wide basis and not on one that is decided by regional assemblies and Parliaments.

My hon. Friend is absolutely right. We have worked closely so far in partnership with devolved Administrations. I want us to move to a UK-wide approach to these issues. We should remember the human nature of the issue. People all over the UK are waiting to have transplants right now. We need more organs. It is important for both people’s lives and their quality of life that we significantly increase the availability of organs in the future. It is about people’s quality of life.

6. What steps he is taking to improve provision of care to the elderly. (194627)

A number of steps are being taken to improve the provision of care to the elderly, including a three-year social care transformation programme, the first ever national dementia strategy, the new deal for carers, the extension of our dignity and care campaign, CSCI’s review of social care eligibility criteria, the introduction of star ratings for care providers, the review of the adult protection framework, Lord Darzi’s NHS next stage final report and public consultation that will lead to a Green Paper on the future of care and support.

I compliment the Minister on producing a series of policy documents. The sadness is that there is a huge disconnect between the policy and its delivery. An elderly lady in North Yorkshire was discharged from hospital last week into the care of North Yorkshire social services. She was not able to make a cup of tea, to eat or to get to the toilet. Five days later, she is back in hospital with a broken wrist and dehydration. When will the Minister make two clear criteria for care of the elderly? First, nobody should be discharged from hospital unless they have 24-hour access to support. Secondly, the elderly in particular should receive rehabilitation before they are discharged into their own homes without any support at all.

The hon. Gentleman raises a serious point. I take personal responsibility for ensuring that he is well looked after in his retirement. The serious point is that the experience of that elderly lady in North Yorkshire is entirely unacceptable. The relevant local authority and health services need to get their acts together. There is no excuse whatsoever for older people being discharged from hospital and left without appropriate care in their homes. That is why we are reviewing the eligibility criteria and why, from April, we will radically transform the way in which social care is carried out in every part of the country, including Yorkshire. We are reviewing the eligibility criteria, as they mean that far too many older people are left alone without adequate care and support. The hon. Gentleman is right. Of course, we need to ensure that national policy supports an improvement in people’s experiences. Equally, we need better local leadership to take responsibility for closing the gap between health and social services.

As my hon. Friend knows, most elderly people want to stop in their own homes. We want to support them. Given that we are going to have individualised budgets, does he not realise that he has to come to a decision and make it a duty on every local authority that provides social care to maintain a list of the providers of services so that elderly people have the information to make a confident decision about whom they will purchase their services from?

I agree entirely with my hon. Friend. Older people and their families tell us time and again that they do not have high-quality, easy-to-access information that enables them to make very difficult choices about their care or the care of a vulnerable relative. That is why at the heart of the transformation of the social care programme in every local authority area will be a new approach to information, advice and, where necessary, advocacy. That need for high-quality information and advice must apply to people who fund their own care as well as those who receive public funding.

A big issue in the care sector is the staff turnover rate, which is as high as 25 per cent. in domiciliary care, with as many as half those leaving the profession, or possibly more, doing so for good. As well as the severe implications for continuity of care, which the Government acknowledge is very important, there is a clear cost implication. Training costs £980 per person and in 2004-05 local authorities spent £20 million on advertising for vacancies and £151 million on agency staff. This is a problem: what does he intend to do about it?

May I say to my good friend that he raises a really important issue, because we need to address the status and value of people working in social care? The work force tend to be low-paid and low-skilled, and that is one reason why the Government are investing a large amount in training. It is important that some of that money gets through to the private sector, as 75 per cent. of social care is provided by organisations in the private and voluntary sectors rather than by local authorities. Moreover, in the new care and support system that we will need in the future, it is vital that we get right the leadership, management and commissioning of the work force.

We must also have the right front-line staff. Last night, I was fortunate enough to give out awards to the heroes who, every day of the week, make a massive difference for the most vulnerable people in our society. However, we do not have enough such people, and we need to do better with our work force.

Is my hon. Friend aware that Northamptonshire county council is withholding the extra funds provided by the Government to pay for increased care for older people, and not passing the money on to care homes? Is that happening elsewhere? What will the Government do to ensure that the funds that they provide to pay for old people’s care are not withheld by local authorities and used instead on internal bureaucracy?

It is for local authorities to decide the level of fees that they are willing to pay to providers, but it is difficult to justify zero per cent. increases when everyone knows that, at the minimum, care providers must take account of inflation. Increasingly, we want local authorities to use their commissioning power to reward with premium rates those homes and domiciliary care agencies that offer quality and dignity, and to be much tougher on those services that achieve only the minimum standards and that do not offer the dignity and respect that older people in particular deserve.

7. What representations he has received from general practitioners on extended opening hours. (194628)

I have received representations from GPs and the British Medical Association, as well as from patients and patient groups. I am pleased that the BMA has agreed new arrangements for GP practices to be open in the evenings and at weekends. The new arrangements will benefit patients, the NHS and GPs.

I thank the Secretary of State for his answer. Do the Government have any plans to force GPs to open for a set number of hours? Does he agree that forcing them to open for extended hours in the evening when there is no demonstrable need would have a knock-on impact on the general quality of primary care services?

The answers are no and yes: no, we will not force any GPs to open longer; and yes, there would be an adverse effect if we were to do what the hon. Lady suggests. Our negotiations with the BMA were based on getting GPs to open for an extra half an hour for every 1,000 patients on their books, which would mean that an average-sized practice would be open for an extra three hours a week. A much smaller practice would not be open for so many extra hours, while a much bigger one would be open for more. Our formula takes into account the fact that in many areas—rural areas, for instance—there is no need or demand for GPs to be open longer.

In the ballot that was held, 92 per cent. of GPs who voted accepted a system that will not force them to do anything that they do not wish to do. However, the system will ensure that the taxpayer’s money that is there to incentivise GPs will, among other things, give them an incentive to open for longer. That is what the patients in the vast majority of our communities want.

Does my right hon. Friend agree that the flexibility to which he has referred should reflect the fact that a town may have a walk-in centre that also provides health services? In his discussions with the BMA and GPs, has he been able to make it clear that there will be no financial disincentive for GP practices in areas where such walk-in centres exist? Sometimes, as is the case in my area, a GP practice and a walk-in centre are located in almost exactly the same premises.

My hon. Friend makes a good point. Along with the BMA, we will be implementing the process. The BMA has made it clear that now that it has the ballot result it will work with us. Our ambition will be to ensure that there are no unintended consequences. My hon. Friend is probably right to say that the availability and accessibility of walk-in centres are fine as they are. As a result of the process, we expect about 50 per cent. of GP practices across the country to be open for longer. That will get the balance right and probably, with the 250 new GP practices that we are introducing across the country, which will be open from 8 am to 8 pm—150 of them, seven days a week—it will give the required choice to customers who want to visit their GP later in the evening or on Saturday mornings.

May I confirm what the Secretary of State has already said? Many GPs in my constituency have contacted me to say that most of their patients are either the elderly retired or mums with young children and there is simply no demand to open practices until 8 o’clock at night. I encourage the Secretary of State not to impose a one-size-fits-all solution on areas such as mine in South-West Devon.

I do not accept the argument that patients who are mainly older people and young mothers do not want surgeries to be open for longer. To me, that is in the same category as the comment of a BMA representative, who said that accountants did not open more than five days a week so why should GPs. The evidence is that where surgeries are open for longer—for example, in Tower Hamlets, where they recently opened on Saturday mornings, or Kingston, where there has been such a service for much longer—the people who visit them on Saturday mornings are indeed elderly people and mothers with young children, who welcome the choice of going there either in the week or on Saturday mornings. I really think we shall find that there has been a bit of a myth, although I accept the hon. Gentleman’s point about rural areas, which relates to my original answer.

It is now accepted that the Government originally mismanaged the GP contract negotiations, leading to an overspend of £1.76 billion. To address that imprudent miscalculation, the Government have reneged on agreements, including renegotiating the GP contract and unlawfully capping GP pensions. GPs are demoralised and disengaged; 97 per cent. of GPs have no confidence in the Government’s handling of the NHS—

Order. The hon. Gentleman must not make a speech. He should ask a question, but he has not asked one so far. Perhaps the Secretary of State could try to answer, because I have to get down the Order Paper and I am getting rather fed up with Front Benchers taking too long.

I think Opposition Members are on the wrong side of the argument about GP access. They are also wrong to say that the new contract in 2004 was an error—[Hon. Members: “Oh.”] Or erroneous? That contract was designed to address a situation in which GPs were largely leaving the service and no medical graduates wanted to be GPs. We were facing a huge shortage and, incidentally, under the old arrangements, GPs were disgracefully underpaid and worked for too long. I think we did exactly the right thing. Yes, one of the consequences is—

Would you do the same again?

Yes, because now GPs work 17 per cent. less—the number of hours they work has fallen by 17 per cent.—

Order. I am going to be even-handed. I call Mr. Hollobone.

8. If he will make a statement on access to NHS dentistry in (a) the area covered by Northamptonshire teaching primary care trust and (b) England. (194629)

There was an increase of 7 per cent. in the number of dentists in Northamptonshire in the year to March 2007. In Kettering itself, there were 44 per cent. more dentists in 2006 than in 1997. Nationally, there are 4,000 more dentists than in 1997, and investment in NHS dentistry has more than doubled.

According to the NHS information centre, the number of patients in Northamptonshire seen by their dentist has fallen by 13,000 since the new dental contracts were introduced. Given that Northamptonshire is among the one third of primary care trusts that have yet to undertake a needs assessment of children’s orthodontics, what measures will the Minister take to ensure that children in Northamptonshire who need orthodontic treatment will get it?

I certainly urge the hon. Gentleman’s primary care trust to get on with that work. There is no excuse now for any primary care trust in the country not to do so, given the increased investment in dentistry: there is an 11 per cent. increase this year and in the next comprehensive spending review period. There is a requirement in the current operating framework for all PCTs to increase, year on year, public access to NHS dentists. There is no excuse for any PCT, including the hon. Gentleman’s, not to improve its results.

Will my hon. Friend join me in congratulating Plymouth PCT, which only a short time ago had 12,000 patients outstanding on its waiting list, who had to wait anything up to 18 months? It has turned things around, and before Christmas—the situation may have further improved by now—it had about 500 patients on its waiting list who were waiting only up to 12 weeks. Does he share my hope that the Peninsula dental school, which in a couple of years’ time will be doing—

Order.

I am happy to congratulate Plymouth PCT, and I also congratulate my local PCT, which has halved the number of people waiting for NHS dentistry in the past 12 months. The south-west is one part of the country that historically has had problems, but they have been addressed, partly by the Government’s creation of new dental schools, including one in Plymouth, for the first time in more than 40 years.

Yet again we have heard a Minister deny that there is a crisis in NHS dentistry. However, the Patients Association recently published a report entitled “The New Dental Contract—Full of Holes and Causing Pain?” Whom should we believe: the Government or the Patients Association, which tells us that there is a crisis in NHS dentistry?

I would rather listen to the testimony of hon. Members of this House, speaking from experience of their constituency, and to the facts. Given the introduction of the new contract, and the new investment that is now coming on stream in dentistry, I am afraid I have to tell the hon. Gentleman that not for much longer will he be able to say in the House that NHS dentistry is in crisis.

10. How many targets he has set on the procurement of services. (194631)

I understand that the hon. Gentleman’s question relates to primary care. There are a number of national requirements, such as being able to see a GP in 48 hours and book appointments ahead. There are also new requirements this year for new GP-led health centres, new GP practices in the areas with the greatest need, and more convenient opening times for the public.

On 4 July last year, the Secretary of State told the House that he would give the NHS a

“sustained period of organisational and financial stability”

and said that

“there will be no further centrally dictated, top-down restructuring”—[Official Report, 4 July 2007; Vol. 462, c. 962.]

Does the Minister not accept that there is a centrally dictated, top-down method of procurement for the alternative providers of medical services—GP practices? That contradicts the Secretary of State’s welcome words. Why does the Minister not accept that PCTs are in the best position to decide how best to expand capacity and choice in primary care?

The hon. Gentleman is wrong: there is no top-down diktat from Whitehall on how the new health centres should be procured. That is up to primary care trusts in each area. In his own area, the primary care trust is at the moment out to consultation on where best to put the new health centre. He talks about stability in the system; his own primary care trust has seen a 20.1 per cent. increase in its funding in the last two years, and it is getting a 5.5 per cent. increase in the next financial year.

11. What assessment he has made of the impact of his Department’s proposals for polyclinics on the provision of general practitioner services in rural areas; and if he will make a statement. (194632)

Local primary care trusts are responsible for organising services in their area. They are currently talking to local people and NHS staff about how the new GP-led health centres can best be provided to meet local needs.

I have to say that the Minister’s answer gives me only very modest reassurance about the intentions of the Department of Health. I implore him not to allow PCTs to have a one-size-fits-all answer, because although polyclinics may be very worth while in some parts of the country, in other more rural parts the local GP service—the smaller service, which perhaps does not offer all the services that are available at the polyclinic—is much more welcome, and much more appreciated by the people who use it, than a polyclinic at much greater distance would be.

I entirely agree that there should not be a one-size-fits-all diktat from Whitehall, and that is exactly why we are leaving it up to local primary care trusts to decide, at the local level, what is the best model for them to use in providing the new services to which we are committed. However, a health centre or polyclinic, or whatever people want to call it, opened recently in a rural area in Devon, near my constituency, and it is very popular. It offers complementary medicine—the hon. Member for Bosworth (David Tredinnick) is no longer in the Chamber—and a number of other services that patients welcome and benefit from. In some cases, such centres can reduce hugely the number of unnecessary admissions to local acute hospitals, which eases pressure on them.

If the Minister comes up to my large rural constituency, he will be able to see how best to introduce polyclinics. Will he allow us to keep the title “health centre” rather than “polyclinic” for both Warsop and Harworth?

Yes. We should not get hung up on definitions. One person’s health centre is another person’s polyclinic is another person’s community hospital. I am aware that there is a good one in my hon. Friend’s constituency. It is not my area, but I am sure that one of my hon. Friends will be delighted to come and visit it.

T1. If he will make a statement on his departmental responsibilities. (194611)

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.

T2. It is only just over a year ago now that the Government produced their consultation paper on community hospitals, giving broad support for hospitals, despite which Kennett and North Wiltshire primary care trust announced deep and damaging cuts in Chippenham hospital in my constituency. It announced that the number of beds in Chippenham hospital would go down from 43 to 30, which we all opposed. Will the Minister explain why the PCT announced today that there would be not even 30 beds but 10, which is not viable from an economic or a medical standpoint? (194612)

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.

T3. Is the Minister aware that there is a problem with prescription drugs being ordered on the internet from overseas and imported into the United Kingdom through the post? That is fuelling a growing trend, particularly in sleeping pill addiction, sometimes with fatal consequences. Will she consider speaking to the Foreign Office and the Home Office to set up a special unit to address this dangerous trade? (194613)

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.

T6. Will my right hon. Friend describe what he is doing to ensure that there are opportunities for young people, and particularly for older women eager to start work after having children, to take up apprenticeships in his Department and the wider health service? (194616)

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.

T7. One of the undoubted successes of the past 10 years has been the flow of money into areas such as mine, where medical need is higher than in other parts of the country. However, do my right hon. and hon. Friends on the Front Bench accept that we still have some way to go to make sure that patient need is what determines funding—not simply historical patterns, particularly those imposed for grossly partisan political reasons by a previous Conservative Government? (194617)

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.

T8.Last September, the Prime Minister announced that all hospitals would receive a deep clean to help to tackle the scourge of superbugs such as MRSA. My hospital trust—the Heart of England NHS Foundation Trust—has estimated that it will cost between £600,000 and £700,000 to deliver the deep clean. Why is the cost having to be met from front-line services when the Government asserted that that should be done with new money? (194618)

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.

T4. Three out of 10 pregnant women carry the group B streptococcal bacterium, which is the most common form of life-threatening condition in new-born babies. Will the Minister with responsibility for public health agree to meet me and Group B Strep Support, which campaigns for routine screening for that condition? (194614)

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.