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Oral Answers to Questions

Volume 475: debated on Tuesday 6 May 2008

Health

The Secretary of State was asked—

Abortion

1. How many repeat abortions there were in (a) Kettering, (b) Northamptonshire and (c) England in the last three years; and if he will make a statement. (203357)

The number of repeat abortions in Kettering and Northamptonshire combined in the past three years was as follows: 508 in 2004; 546 in 2005; and 599 in 2006. The number of repeat abortions in England in the past three years was as follows: 56,645 in 2004; 58,068 in 2005; and 59,687 in 2006.

Are not those figures truly appalling? Given that a third of all abortions are repeat abortions, what steps will the Government take to bring down those horrendous figures?

We are working very hard to ensure that women have access to abortion services as soon as possible, because evidence shows that the risk of complications increases the later in the gestation. We have made investment to improve early access, and primary care trust performance in this area has been measured as part of the Healthcare Commission’s annual health check. The latest data for 2006 show that progress is being made to increase early access; some 65 per cent. of national health service-funded abortions took place at under 10 weeks.

Unfortunately, a good proportion of the numbers that the Minister has just given to the Chamber relate to teenage pregnancies—I believe that 19 year olds are the age group that has the highest number of abortions in the country. Could she tell us what she has done in the wake of last summer’s Government-funded advisory report entitled “Sex, Drugs, Alcohol and Young People”, which concluded that British teenagers were in the grip of a sexual health crisis fuelled by a “celebrity culture” that condoned alcohol abuse, drug addiction and promiscuity? Can she say what her Department is doing to tackle those three issues referred to in the report’s recommendations?

My hon. Friend raises a very serious issue in relation to teenage pregnancy, and, all across government, Departments must take responsibility for dealing with it. Of course, sex education and contraception are paramount, so that we do not have teenage pregnancies and their consequences, which affect not only the girl, but the family and all concerned for the rest of their lives.

I am sure the Minister would agree that the number of repeat abortions is extremely disappointing, bearing in mind the likely impact on the health of the ladies involved. She will also be aware—perhaps she will agree with me—that for some people the number of repeat abortions is a good reason to tighten up on abortion laws and deny women the right to choose. Does she agree with me that, while it is regrettable that there are so many repeat abortions, that should still be permissible?

Again, the hon. Lady raises very serious issues, which this House will be considering shortly and in respect of which it is always this House’s decision to make. We need to re-examine the role of contraception and, in particular, that of long-acting reversible contraception, which I know many primary care trusts are pushing—it is for all PCTs to examine that option. National Institute for Health and Clinical Excellence guidelines on long-acting reversible contraception show that if 7 per cent. of women switched from the contraceptive pill to long-acting methods, thus doubling the proportion of usage to 15 per cent., the NHS could save £100 million by reducing the number of unplanned pregnancies.

That might be all right for mature women, but does not the Minister share my concern that the giving out and the encouraging of the giving out of the morning-after pill to teenagers is an incentive, almost, to promiscuity?

I would have to disagree with the hon. Gentleman. This is such a complex and serious issue, and it is for parents, those in education and all Departments to address it. It is in all our hands to try to prevent teenage pregnancies and to provide help. As I mentioned, the consequences, not only for the young woman, but for her family and for the young father, must be taken into account. Fathers and young men should be taking much more responsibility than they do at present, but that can come about only with good, positive education.

Premature Babies

In 2005, there were 435 premature births in England and Wales with a gestational age below 24 weeks; some 383—or about 88 per cent.—of those babies died before they reached their first birthday. No further information is currently available.

I thank my hon. Friend for that reply. She will be aware of the debate taking place on viability. Does she agree that, when considering this issue, population-based data, such as EPICure 2, are the most reliable available?

The House will be fully aware that we will shortly discuss those serious issues. The British Association of Perinatal Medicine, the British Medical Association, the Royal College of Nursing and the Royal College of Obstetricians and Gynaecologists issued a joint statement in April stating that there is no evidence of a significant improvement in the survival of pre-term infants below 24 weeks gestation in the UK in the past 18 years.

Although there are studies that claim to show improvements in individual hospitals, does the Minister agree that the reason the organisations that she has just cited are of the view that there has been no reduction in the threshold of viability below 24 weeks is that the best research, which looks at every birth rather than a selected sample—more findings have recently emerged—has failed to show any reduction since 1995? That is a good argument for keeping the time limit as it is.

I am sure that the Minister is aware that the EPICure 2 study averaged out every birth in the UK, wherever they took place and whether they were in a hospital with a neonatal unit or not. Does she agree that if a woman goes into premature labour in a hospital with a good neonatal unit, to which the baby is immediately transferred, the outcome for that baby is likely to be much improved?

The hon. Lady is consistent in her arguments: I am equally as consistent in saying that the evidence shows the contrary.

New Deal for Carers

3. What progress has been made in developing the new deal for carers; and if he will make a statement. (203359)

6. What progress has been made in developing the new deal for carers; and if he will make a statement. (203362)

7. What progress has been made in developing the new deal for carers; and if he will make a statement. (203363)

We have already given councils in England an extra £25 million to allow them to provide emergency cover for carers. We have committed to a further £25 million a year for the next three years. We are progressing work on the information helpline, which will give carers access to reliable information and enable them to access services and support for themselves and the person they care for. Finally, work on the revised national carers strategy is progressing well and we will publish the new 10-year strategy shortly.

I thank my hon. Friend for that reply. The fact that so many Labour Members have asked similar questions shows the high level of concern about this subject. What are my hon. Friend and his Department doing to help carers who are trying to balance work with their caring responsibilities?

My hon. Friend is right to raise this issue. We are seeing many changes in our society, with an increasing number of people struggling to bring up children while also caring for an elderly or disabled relative. An increased number of people have to balance their work responsibilities with child care and caring for an adult. That is why we have introduced, for the first time, the right to request flexible working for those who have caring responsibilities and we want to raise awareness of that right. Many employers acknowledge the importance of providing the necessary flexibility for, and supporting, employees who have difficulties with, for example, an ageing relative. One of the issues that the new carers strategy will address is the balance between working responsibilities and caring for an older relative.

My hon. Friend will be aware that many people do not recognise themselves as carers, even though they are looking after an adult child or an elderly parent, because that is just “what you do” when the need arises. Therefore, many people will not be aware of the facilities now available to support carers or of the new rights and support that will be available in the future. How will he ensure that the message about the good news—including that yet to come—will be put across to the people who need it most?

My hon. Friend is right. In an ageing society, in which people are living longer, and in a health and social care system in which an increasing number of people want to stay in their own homes rather than go into institutionalised care, more responsibilities will be placed on family members. An increasing number of people, who previously have had no experience of the health and social care system, suddenly find themselves having contact with that system because of an ageing parent. One of the challenges is to raise the status, value and recognition of carers in our society. We should support families who want to take responsibility for looking after an elderly relative or a disabled son or daughter, but we must ensure that people are fully aware of the range of available support.

May I welcome the consultation’s emphasis on young carers and the role that they play? The young carers whom I met recently say that they often feel isolated and weighed down with responsibility. They miss school and can miss out on a social life. What specific help will be targeted on that group?

My hon. Friend is absolutely right. We do not want any children to have their childhood stolen as a result of fulfilling inappropriate caring responsibilities. It is not for politicians to stop children wanting to love a parent who may be dependent because of illness. None of us should want to stop that, nor will we ever be able to do it, but we must ensure that no child is expected to fulfil inappropriate caring responsibilities. That is why for the first time we have made it clear to adult services that, when they assess the needs of an adult with an illness or a social care need, they must make sure that they are not leaving a child in that position. It is also why the forthcoming strategy must look into expanding the number of support groups for young carers. One thing that children and young people say is that it is much easier for them to talk to other young people in the same situation as themselves than it can be to talk to other teenagers, who find it alien.

Does the Minister agree that many adult services departments would like to extend the support that they offer to carers but are constrained by resources? Does he recognise that the recent local government settlement has made it very difficult for some local authorities to maintain even the level of support that they currently give?

If one looks at the local government settlement, one sees that there are specific grants to meet social needs and that £500 million has been set aside for the social care reform grant. In 1999, this Government introduced to local authorities the first ever annual carers grant: no such grant existed before, and it is clear that an unprecedented amount of money is going into supporting carers. However, we accept that there is a lot more to do, and that is why we will announce in the next few weeks a new 10-year strategy to enhance the support that we give to carers. It is also why we are going to hold an extensive public consultation on the future of the care and support system. It will look at the consequences of an ageing society and changing demographics, and seek to redefine a new, fair settlement for the funding responsibilities of the state, the family and the individual.

May I ask about another specific group—elderly carers? In my constituency, many people of considerable age spend a great deal of time looking after equally elderly relatives and friends. What plans do the Government have to support that group? The financial settlement to which my right hon. Friend the Member for North-West Hampshire (Sir George Young) referred means that the respite care and other support that they desperately need is not coming through. In future years, there should equal funding increases for both health and social care. That would be an example of joined-up government.

I feel another Opposition spending commitment coming on—I hope that the shadow Chancellor has been consulted. However, the hon. Gentleman makes the serious point that, in an ageing society, more people will end up caring for a husband or wife who will often suffer from dementia. That is why the national dementia strategy to be published later this year will be so important. The consultation with carers will inform the development of that national strategy, and as part of that we have spoken to thousands of carers up and down the country. They have said that their priorities are income and access to short respite breaks, but it is not just the amount of respite that is important. Quality also matters because carers will not use the respite care available to them if they do not feel confident about it. Moreover, carers have told us time and again that they need better information and advice to help them make the incredibly difficult decisions involved in getting the care and support that they need. The 10-year strategy will address all those issues. We will not be able to change everything overnight—no hon. Member would expect that—but we will be looking to make significant progress over the next three years.

Given that the Minister today announced that the updated strategy will be with us within weeks, and that he has also announced emergency respite care provisions, and given that he originally announced the new deal for carers more than two and a half years ago—and re-announced it five times—where is the £2.8 million for the carers information service that was promised? Where is the £4.7 million expert carers programme that we were promised? Those matters really do concern my constituents in Eddisbury, and indeed those in the neighbouring constituency of Crewe and Nantwich. It is important to recognise that if the Minister cannot give us an answer to those questions, perhaps the Prime Minister is out of touch, as the Minister said on an earlier occasion.

Desperate, Mr. Speaker. There was no annual carers grant, nor even any distinct recognition of the fact that carers had their own needs, under the previous Government. [Interruption.] I will answer the hon. Gentleman directly: in the summer, the first expert carers programme training courses will begin. Later this year, the website for carers, offering them the kind of information that they tell us they need, will be up and running. Early next year, we will launch the carers telephone helpline, so that carers can ring one number and get high-quality information and advice. That builds on the unprecedented levels of resources that have gone to local authorities, year on year, to expand services and support to carers.

Carers in my constituency say that what they need most is better quality respite care; that would give them more frequent chances to get a break from caring, which many of them really need if they are to avoid stress and health problems. What specific plans are there to improve the quality of respite care?

My hon. Friend has done a tremendous job of championing the needs of carers since she became a Member of the House, and she continues to do so. She makes an important point. People who care for an ageing parent, a husband or a wife who has—[Interruption.] That is how important Opposition Members think the subject is. People who care for an ageing parent, a husband or a wife who has dementia, for example, have to feel confident that if they allow that person to go somewhere for a week or more, the quality of care and their safety will be guaranteed. We must therefore not only expand the range of respite care places available, but do more to improve quality, through regulation and inspection, and through the decisions that local authorities make about where they purchase respite care from. At the heart of that will be a greater use of individual or personal budgets, which will mean that we can give people much greater control over where they get the respite care from.

Finally, we should not forget the unprecedented level of investment that the Government are making over the next three years specifically to expand respite care for parents of disabled children; that is entirely separate to the extra commitment that we will make for those caring for adult relatives.

Hospital Beds

I am very grateful for the Minister’s response. To reduce the rate of the superbug clostridium difficile, there must be a hospital bed occupancy rate of 85 per cent. or less. Kettering general hospital had the worst C. difficile rate in the whole country. It has a hospital bed occupancy rate of 92 per cent. Would not the Minister agree that the way to solve the problem is to build a new hospital in my constituency in order to reduce the bed occupancy ratio in Kettering?

I am afraid that I have to correct the hon. Gentleman’s figures. My information from the local trust is that the bed occupancy rate in Kettering general hospital in the latest year for which figures are available was 81 per cent., whereas at Northampton general hospital it was 85.6 per cent. It is interesting that, according to the figures, although the occupancy rate in Northampton was higher, it has been even more successful than Kettering in reducing C. diff rates. In Northampton’s case, they went down by 61.3 per cent. between 2006 and 2007; in Kettering, they went down by 64.1 per cent. in the same period—a great achievement by his local hospital.

Without getting drawn into the relative merits of various claims for new hospital building, will the Minister look carefully at the arguments in favour of reducing occupancy rates? As I understand it, in France there is a presumption that a 70 per cent. occupancy rate is the tipping point beyond which the gains begin to be overtaken by hospital infections, re-admissions and staff turnover. May we have a similar independent study in the UK that would identify the tipping point at which we move from efficiency to absurdity?

We had such a report a few years ago, which stated that the optimal bed occupancy rate was 82 to 85 per cent. The latest figures available suggest that the rate has come down to below 85 per cent. on average, which we welcome. It is coming down slightly all the time, although we do not think it is our job to dictate to local hospitals how to run their affairs. If one examines the latest bed occupancy rates and superbug rates, there is no correlation between them. Other issues are much more important in the way in which hospitals manage disease outbreaks.

The Minister will be aware that Professor Barry Cookson of the Health Protection Agency has advocated an occupancy rate of about 85 per cent., yet about 50 per cent. of hospitals are running at above that level. He also highlighted the potential risk to patient safety if that level is exceeded. Despite a promise in the NHS plan that there would be 7,000 extra beds, there has been a reduction in beds of about 13 per cent. since 1997. With so many hospitals often in a state of crisis because they are completely full, is it not time for an urgent review of the number of beds in the system and the way in which those beds are used, to ensure that we do not put patient safety at risk?

Again, I must correct the hon. Gentleman. In the past there was a stronger correlation between bed occupancy rates and infection rates, but as infection rates and bed occupancy rates have come down, we have looked into the matter in great detail in the past two or three years and we cannot find the correlation that the hon. Gentleman points to. There are hospitals with a higher bed occupancy rate than 85 per cent. that have very good records on infection and other matters. What is much more important is how well the hospital is managed and what its overall anti-disease measures are, rather than the bed occupancy rates. Although we have said and I repeat that we think the optimal level is between 82 and 85 per cent., we do not think it is sensible to dictate to well performing hospitals that may have bed occupancy rates over 85 per cent. that they should bring those rates down. That is for them to manage, and it is for them to be answerable to their local communities.

A bid has been made by Stockport primary care trust for a community hospital in Shaw Heath, in one of the most deprived wards in my area. It is an exciting and innovative project. Does my hon. Friend agree that a community hospital on the site would enable better use of NHS beds at Stepping Hill, and at the same time would tackle health inequalities in the area?

I certainly would, and I was going on to say in response to the hon. Member for North Norfolk (Norman Lamb), who speaks for the Liberal Democrats, that one of the reasons for the decline in beds in acute hospitals is that more and more people are staying in community hospitals and then being cared for in their own homes, which I think is welcomed by Members in all parts of the House. My hon. Friend will be pleased to know that I am informed that the board of the North West strategic health authority is meeting tomorrow to make a final decision on the community hospital for which she has been a long and doughty campaigner. We think the scheme is a visionary and innovative one that meets national and local health objectives and will enhance community health services. I congratulate my hon. Friend on her successful campaign.

The Minister may well argue that other measures are important, but there is no doubt that an internal policy review from the Department of Health showed that reducing bed occupancy to a maximum of 85 per cent. could save about 1,000 cases of methicillin-resistant Staphylococcus aureus—MRSA—a year. The aim should undoubtedly be nearer 82 per cent. Does the Minister agree that while bed occupancy rates remain unacceptably high, consequences on the scale that we saw at Maidstone and Tunbridge Wells remain a real threat?

What was wrong in Maidstone and Tunbridge Wells was a totally incompetent management. As I have pointed out, there has been no correlation in the past two or three years between bed occupancy rates and infection rates. I would have expected that, rather than making the same old points time and again, the hon. Lady might have welcomed the fact that the latest national figures show a 30 per cent. reduction in MRSA rates and a 23 per cent. reduction in C. difficile rates in the past year. She should congratulate the Government on our action, rather than constantly criticise us.

Care Standards

In recognition of the challenges presented by an ageing society, the Government are committed to fundamental reform of the adult social care and support system. We intend to hold a national consultation, which will lead to the publication of a Green Paper, to identify options for a new system that will be fair to all and sustainable for the long term.

I understand that the first consultation meeting on the Green Paper will take place next week. Will the Secretary of State ensure that one of the key considerations will be the interface between the national health service and social services, particularly when assessments are required for conditions such as incontinence or for the care package? Will the Secretary of State make a point of asking Members of the House for their experience around that interface? Perhaps he could publish a list of Labour and Opposition Members interested enough to respond to that consultation.

My hon. Friend is right; the interface will be a crucial element of the exercise. We need to knit adult social care, local authorities and the NHS much more closely together. That is happening in many parts of the world, and my hon. Friend should take credit for what he has done in Nottingham. In the meantime, £510 million is available for the adult social care grant and it is specifically to encourage much greater integration in the next three years. The review is more long term, but we have immediate action and resources to back it up.

One of the issues in respect of standards of care relates to people with dementia. Is the Secretary of State aware of the butterfly scheme, which is being trialled in Leeds? It was the brainchild of my constituent Mrs. Barbara Hodkinson, and it has been extremely successful in allowing patients to be identified without stigmatisation and allowing their care needs to be addressed. Does he agree that we should roll the scheme out nationally? Will he or the Minister with responsibility for care come to Leeds to speak to Mrs. Hodkinson and Sister Christine Tall, who implemented the scheme, to see whether it could improve standards for dementia sufferers nationally?

I am aware of the important butterfly scheme in Leeds, and I would be pleased to nip over from Hull to Leeds to see it. It is an important part of how we can make progress, deal with the issue and use best practice to develop our strategy on that debilitating disease.

There tends to be a lack of uniformity in the care provided by child and adolescent mental health services and in the standardisation of and access to services across the UK. Is it not time that we had a more standard service so that young people who are at the difficult transition into adulthood and face mental health problems, and their parents, could access a service that catered for people aged up to 25, rather than 16, 17 or 18?

My hon. Friend is absolutely right; a review on that specific issue is under way at the moment. The Green Paper and the public debate cannot be only about adult social care for older people, which was the subject of the 2006 Wanless review; they have to embrace the entire adult population. That is not least because, as I know from my own constituency casebook, many people are alive today who would previously probably not have survived childhood. Such people need far greater care. That must be integrated into the social care system and it is a very important part of the review.

In seconding the proposition made by the hon. Member for Bridgend (Mrs. Moon), may I put it to the Secretary of State that the requirement for joined-up and continuing care is marked among those on the autistic spectrum? The right hon. Gentleman will know that I and others are looking at provision for children and young people from birth to age 19. However, there is also a significant issue for the Government in respect of assisting people well beyond age 19—sometimes throughout life—as they negotiate the difficulties that they encounter. Such people have the opportunity, if helped, to contribute to the country through employment. However, they do need some help.

The hon. Gentleman has taken a huge interest in these issues and is doing some very good work on speech and language therapy. I completely agree with him. This whole area would probably not have been very high up the political agenda as recently as 10 years ago, but it is now much more of a crucial issue. That is why announcements on it will be made very shortly, not least for the reason that he touched on—that there is such a huge waste of talent out there because we consign these young people to being the passive recipients of benefits for the rest of their lives instead of using the opportunity to make them active citizens in our society.

Children’s Health

Improving outcomes for children is a priority across the range of responsibilities of the Government. The recently published children’s plan set out how the work is focused towards achieving a long-term vision of England as the best place in the world for children to grow up.

Ten years ago there were no children’s centres in Brent; now we have 12. That has vastly improved the well-being of children and young mums. By 2010, there will be a children’s centre in every constituency. In the meantime, however, does my hon. Friend agree that baby and toddler centres like the one that my constituent, Sarah Green, is fighting for should be kept open by primary care trusts and local authorities?

My hon. Friend is right. The importance of these centres in the early years is paramount, not only for children but for parents. We are very proud of our Government’s initiative in introducing them and increasing support in the community. This morning, I saw on Beavers Lane estate in Hounslow a hub where all the integrated services are working closely together. That makes a huge difference to the future lives of children, who will be our young people, and their parents. All health professionals are to be congratulated. I urge people in my hon. Friend’s local area to take note of this.

Does the hon. Lady agree that children’s health starts with a happy and successful birth, and that it therefore makes no sense at all for the Government to press primary care trusts all over country, including those in West Sussex, to close and diminish the number of maternity services, particularly at Princess Royal hospital in Haywards Heath—an area of exceptional growth with an enormous new population expected? It makes no sense whatever to downgrade valued and cherished maternity services at an excellent hospital.

The hon. Gentleman has raised this issue with me before in Adjournment debates in Westminster Hall, and he has campaigned strongly for his area. However, what is happening is not to downgrade but to improve. The Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists would agree that we want children to have the best possible start in life, and the first few minutes are critical, for obvious reasons. As we know, this is happening with the consent of clinicians and the local community. I am sure that the hon. Gentleman will continue to engage with his constituents on this important issue.

Does the Minister agree that under-age binge drinking is a growing and alarming health problem for children? Police, ambulance workers and accident and emergency workers would certainly agree with that. Why has so little progress been made in the past eight years in cutting the amount of alcohol that school-age children drink, and what confidence can we have in the Government having more success in that area in the future?

The evidence shows that we are making improvements as regards this very difficult issue, which the hon. Lady rightly raises. It is a serious issue for all of us in this House to address because, as was said in questions and answers earlier, the consequences are so severe. In particular, our hard-pressed health professionals do not wish to have to spend their professional time and resources dealing with it. All of us, across Government and across this House, should take it very seriously.

Patient Data

Data held electronically can be secured using encryption and other measures not applicable to old paper-based systems. The health service’s national programme for IT has particularly high levels of security because of the sensitivity of data held, and individual health organisations are responsible for complying with data protection rules.

Three hundred thousand patient prescription forms have been lost, junior doctor job applications have been found on the internet, a laptop with thousands of patients’ details has been stolen, and child benefit information affecting millions has gone missing. Does the Minister accept that patients do not have faith in the Government’s plans to put their personal details on an NHS database?

No. As I have already explained to the hon. Gentleman, the level of security on the national NHS IT system is second to none in the world. In fact, we get regular complaints from people saying that it is too secure, because it does not enable them to exchange the information that they need to make sure that patients are cared for properly. I also have to tell him that child benefit is not the responsibility of our Department. None the less, we do take data losses extremely seriously.

Since the problems experienced by Her Majesty’s Revenue and Customs, the chief executive of the national health service has reminded the managers of every trust in the country of their legal responsibility to comply with data protection rules. They are now obliged to publish quarterly reports on any serious data losses and to say what action they have taken to ensure that such losses do not happen again. The vast majority of the data losses that have happened, including the ones the hon. Gentleman referred to in his question, would not have happened under the level of security used by the national NHS system for IT.

Does my hon. Friend agree that the major problem we have with the NHS database is not the database itself, which is secure—probably more secure than the local bank—but the people who misuse it by downloading information and then carelessly leaving it in the backs of cars? Millions of our constituents have had their records stored electronically for decades, and it is about time we moved away from this negative debate about it, took the issue out of party politics, and recognised the work that it can do to help people, particularly those with chronic illnesses.

My right hon. Friend, who has done a number of reports on this issue and knows a great deal about it, is absolutely right. I regret that all too often in the debates we have about the subject, we lose sight of the enormous benefits of the good exchange of data on patient care. Patients get quicker, more reliable and much safer care, while the NHS saves a lot of money through not using the old, expensive and cumbersome paper-based systems.

My right hon. Friend is right. In an organisation that employs 1.3 million people—the biggest organisation in the world, I think, after the Indian railways and the Chinese red army—it is impossible to conceive of a situation in which some human failure could not lead to data loss. That is why it is important that every NHS employee is aware of their responsibilities. It is also important that those in hospital management are aware of their responsibilities, and make those clear to staff.

Psychological Services

10. What the average waiting time was for access to primary care psychological services in the most recent period for which figures are available. (203368)

Information about average waiting times for access to primary care psychological services is not collected centrally, but we are investing significantly in improving access to psychological therapy over the next three years, with funding rising to £173 million in 2010-11, to train 3,600 therapists and to treat up to 900,000 people.

In June last year, when I raised this question with the previous Secretary of State, she was good enough to agree that waiting times were far too long. For many of my constituents, the waiting time for such vital services is still 16 months or longer. Does the Minister agree that such a wait can allow conditions that would otherwise have been treated to get worse, and will he take urgent steps to deal with the issue?

The history of this country’s approach to access to mental health services in primary care is not a happy one, but I am proud of the fact that we are the first Government since the national health service was created to say that people in every community should have universal access to psychological therapy according to clinical need. The health service must concern itself as much with mental well-being as with physical well-being. Over the next three years, we will be investing an unprecedented amount in access to psychological services, which is every bit as important as the extension of GP hours and conventional primary care. We can be proud of the fact that we are the first Government since the creation of the health service to ensure that people have access to universal psychological services, recognising that mental well-being is every bit as important as people’s physical health.

Community Hospitals

11. What assessment he has made of the contribution of community hospitals in (a) England and (b) Leicestershire. Community hospitals can provide care closer to where people live. The local health service makes decisions about how services are organised, but the Government are providing £750 million over five years for new community hospitals and new community services throughout the country. (203369)

The Minister states that the Government want people to be treated closer to home, which I applaud. However, in Leicestershire as elsewhere, the primary care trust is considering closing down or reducing services in community hospitals, especially in Lutterworth in my constituency, and possibly in Ashby. Will the Minister explain to me and to my constituents in the Lutterworth area—and, indeed, to Leicestershire PCT—how treatment closer to home is deemed desirable, yet services in Lutterworth are being reduced, which will mean people having to travel to Leicester or Rugby for treatment?

It is not the job of Ministers in Whitehall to second-guess the decisions of local primary care trusts, but I am sure that the hon. Gentleman’s PCT has listened carefully to his comments. However, my information from the PCT is that there are currently no proposals such as he describes for Lutterworth, and it has decided not to go ahead with any consultation about Lutterworth in the first round of consultation on community hospitals in Leicestershire. Contrary to his suggestion, the PCT is trying to do exactly what I described earlier: moving more services out of the big acute hospitals in Leicester and elsewhere into community hospitals, and from community hospitals into people’s homes, because that is what people want. It may be decided locally that some services are best provided by one community hospital, or by district nurses or others who go into people’s homes. That is a matter for the local PCT. If the hon. Gentleman does not like its proposals, he should speak to its representatives. If the local elected councillors do not like them, they have a democratic forum in the overview and scrutiny committee to refer them to the national independent review panel, which examines any objections to the sort of reorganisation that he describes.

GP Surgeries

The Government are working to make it easier for people to see their GP in the evening and at weekends. We are also investing £250 million in new GP-led health centres in every health care area of England, open 12 hours a day, seven days a week, and in extra GP surgeries in poorly served areas.

My constituency has benefited from a great deal of investment, especially at Priory Road health centre in Parks. Does my hon. Friend share the concern of my constituents at the Queen’s Road medical centre, who are unsure whether they will have a GP surgery in future, as it is considering moving to north Swindon? What hope can he give my constituents that they can see a doctor without having to make a complicated bus journey?

I understand that the problem to which my hon. Friend refers concerns two branches of a practice, which it does not believe are adequate to provide the sort of care that their patients expect. However, it is the duty of all primary care trusts to ensure that GPs and primary care services are adequate for an area and that there are no big gaps, especially in areas such as those that my hon. Friend mentioned, which I know quite well. I hope that when the local primary care trust considers the proposals, it will work closely with my hon. Friend, and also with my hon. Friend the Member for North Swindon (Mr. Wills), to ensure that all patients in the city of Swindon are well served by expanding GP services.

The Opposition believe that the most accessible health care services are those tailored to local needs and priorities, not those that are centrally imposed. In the debate on 23 April about GP services and access, the Secretary of State said that primary care trusts that did not want GP-led health centres would be able to use the resources to provide primary care services more appropriate to their local patients’ needs. Does the Minister stand by his boss’s statement that primary care trusts can say no to GP-led health centres?

No, my right hon. Friend did not say that. There is good flexibility in the proposals that we put to primary care trusts. Labour Members are interested in making it easier for people to see their GP. It is astonishing that the Conservative party’s policy now is to hand over policy to the doctors’ union, the BMA, and allow it to decide—[Interruption.] Yes, I am sorry, but the Leader of the Opposition said in a speech 10 days ago that the BMA should be able to decide when surgeries could open and where they were located. The Conservatives even launched a website so that doctors could sign their petition.

Topical Questions

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.

May I ask my right hon. Friend why, in connection with the consultation on the framework for the registration of health and adult social care providers, which is due to end shortly, he has decided to exclude non-urgent patient transport services from the services that will come under the remit of the Care Quality Commission? Those services—including taking people who need dialysis to hospital, for example—are a seamless part of the health and social services that we provide, so it seems perverse that they should not be included. Would the Secretary of State consider, at this late stage, including those services within the remit of the proper standards of care regulation?

This matter is out to consultation, and the consultation finishes on 7 June. Our view is that it is in the interests of good regulation that we should split away the high-dependency patient transport service from the non-urgent, as my hon. Friend the Member for Stoke-on-Trent, North (Joan Walley) rightly says. There is an issue about the balance of regulation, and we thought that that was the best idea. The issue is out to consultation. My hon. Friend will obviously make her views known, as will others, and we will consider them at the end of the consultation period.

T3. I declare an interest as honorary vice-president of the Royal College of Midwives. What steps have the Government taken to ensure that there are sufficient places for student midwives and midwifery educators in England to meet the Department’s target of 4,000 more NHS midwives by 2012? It is a simple question; I hope that I can get a good, positive answer. (203421)

The hon. Gentleman is a hero of the Royal College of Midwives, let alone a patron. He raises an important point. We wish to recruit 4,000 new midwives. Some of them will return to practice, but a large group will require extra training places. We are working on that, and I believe that there might be an announcement around the time of the annual conference of the Royal College of Midwives.

T6. Will the Secretary of State tell us what impact health can have on reducing crime and on ensuring that youngsters get good qualifications and do not spend a lifetime on benefits? Does he agree that early intervention by the health service, particularly through the nurse-family partnership, sets young people on the way forward, and—to ensure the topicality of this question—may I also ask him whether he welcomes those initiatives being applied to Nottingham? (203424)

The nurse-family partnership is undergoing a £30 million expansion, which includes Nottingham. The most important point in what my hon. Friend said about the link between crime and health relates to mental health. I believe that the recruitment of 3,600 psychological therapists, based on the pilot in east London and Doncaster, will have a startling effect on the mental health problems that have previously consigned many youngsters to less fulfilling lives than those of those fortunate enough not to suffer from such problems.

Just weeks ago, the Secretary of State’s Department received a report from an expert group on clostridium difficile infection that said:

“We consider that, more than any other factor, it is the failure to implement the existing guidelines described in the 1994 report that has contributed to the recent rise.”

Can the Secretary of State explain why, 11 years into a Labour Government, existing guidelines from before 1997 have not been implemented?

No, of course I cannot cover the course of 11 years in this answer. What I would say is that there was a period at the end of the 1990s when, if the problem had been tackled, we could have seen the elimination of MRSA before it took root, as happened in many other European countries. However, there has been a 30 per cent. reduction in MRSA since this time last year and a 23 per cent. reduction in clostridium difficile. The important elements are hand washing, isolation with cohort nursing, and the responsible prescription of antibiotics. We are acting on all three.

The complacency of the Secretary of State’s answer explains exactly why there is a wreckage of the Labour party across the country following last Thursday’s election results. Perhaps he can explain why, 11 years into a Labour Government, the report says that half the hospitals in England have C. difficile infection rates 10 times those reported in other countries. People know that the experience of Labour government has been of a top-down, target-led, bureaucracy-obsessed culture that is preventing the NHS from delivering high-quality care, and which has led directly to an inability to focus on patient safety. Will the Secretary of State explain that?

The hon. Gentleman’s problem is that people have long memories. They remember waiting lists such that people waiting for fairly routine operations wrote to ask whether their place in the queue could be bequeathed in their will to their children or their nephews, because the queues sometimes lasted four or five years. They remember the lack of capital investment in hospitals and equipment, they remember that there were too few doctors and nurses, and they remember that the health service was on its knees when we came to power in 1997.

May I commend my right hon. Friend’s decision to move services into the local community? I want to draw his attention to a consultation that I held about my local primary care trust’s proposal to open a cottage hospital in Eltham, to which the response rate was more than 10 per cent. More than 1,400 people responded, virtually 100 per cent. of whom were in favour of having a cottage hospital in the middle of our community, bringing services into the heart of Eltham. I commend the Secretary of State’s approach, and I commend my PCT’s proposal to him.

I am happy to be commended on that proposal. I believe that the consultation taking place in London about what kind of health service people want is revealing that the majority of people see the sense in the review conducted by NHS London. They see cottage hospitals and polyclinics—I see, today, that the public in London have overwhelmingly said that polyclinics are a good thing—as a sign that we are going in the right direction.

T4. Will the Secretary of State tackle more vigorously the waste of medicines in the NHS, which is enormous and scandalous? Will he look specifically into the issue of repeat prescriptions going uncollected by patients in pharmacies? That problem needs ministerial intervention, and could be tackled by better liaison between prescribing doctors and pharmacists. The current situation is completely unacceptable and an enormous waste of public money, and it needs his attention urgently. (203422)

I will look into this issue personally. There is evidence that there is a great deal of waste involving medicines and prescription, but I would not say that it is as bad as in some other European Union countries: France is one example. Nevertheless, any waste needs to be addressed. We have a target, over this comprehensive spending review period, of making 3 per cent. year-on-year efficiency savings. One part of achieving that should be tackling the waste of medicines.

The hepatitis C action plan for England was published four years ago, but a report that has just been published by the all-party group on hepatology shows that there are still big gaps between the diagnosis and treatment of hepatitis C. Will my right hon. Friend look at the report and do what he can to improve, in particular, the treatment of carriers who have been diagnosed with hepatitis C?

I will, but it says here—in my brief—that the results of the audit are encouraging and show marked improvement since 2006. The results indicate that progress made in implementing the action plan has been sustained. Nevertheless, I accept my hon. Friend’s point, and we will look to see how much we can improve the situation.

T5. With abortion at near industrial levels—there were nearly 200,000 in England and Wales last year—does the Secretary of State accept that although the original Act, as amended by the Human Fertilisation and Embryology Act 1990, set out a range of medical reasons for abortion, it is increasingly, and in far too many cases, being used for social reasons? Does he agree that that has to stop? (203423)

I struggle to understand the definition of “industrial” in this context. This is a matter for all Members of Parliament to address individually. I personally, as an individual, believe that that legislation has stood the test of time, and I would not want to see any change to it.

Can my right hon. Friend tell us when he is likely to publish the outcome of the review of prescription charges that he announced in July last year?

We are likely to publish in the summer—a period that I accept can, in political terms, stretch from April to December. However, I expect publication to take place in what could be called the summer by most reasonable people’s definition.

T7. Having had the worst hospital-acquired infection rates in the whole country in 2006, Kettering general hospital has now halved its rates of infection for C. difficile and MRSA, and met all its major NHS targets this year. In congratulating all those who work at the hospital on this tremendous achievement, will the Secretary of State encourage the strategic health authority to look favourably on Kettering general hospital’s application for foundation trust status, which is due to be submitted shortly? (203425)

I think that the hon. Members for Kettering (Mr. Hollobone) and for Wellingborough (Mr. Bone) should go and have a cup of tea together and compare notes, because we are getting a different picture of what is happening in the health service in their area from each of them. The hon. Member for Kettering has raised an important point, and we should congratulate all the health service workers in his hospital on such a fantastic result. The issues are clear: they involve good hand-washing policy, good isolation facilities with cohort nursing, and the responsible prescription of antibiotics. There are a lot of other things that I could talk about, but those are the three most important messages, and they have obviously been hammered home in the hospital in the hon. Gentleman’s constituency.

Can the Secretary of State explain why existing GP practices are being excluded from the new GP posts being established in areas that are under-doctored? Is this another attempt to privatise the NHS?

After a battle to get to the Dispatch Box, may I say to the hon. Gentleman that existing practices are not being excluded? He is absolutely wrong on that point. I did have a representation from a social enterprise to say that it was being excluded. The first contract went to a social enterprise, and I have no doubt that the majority of the contracts will go to existing GP practices. Those practices are not being excluded. They are, however, being asked to go through a rigorous process, because if we are spending £250 million of taxpayers’ money in under-doctored areas—some of the poorest areas in the country—we want to ensure that patients and the public in those areas get the service to which they are entitled.

T8. Given that there were more than 4,000 stillbirths in England and Wales last year, why is there still no national stillbirth strategy? (203426)

The hon. Gentleman has raised a point that I have raised myself in response to questions that I have been asked while going around the country. We should be looking at the situation across the country, because I hear that some places deal with such issues brilliantly, while other places could learn from those centres of excellence. Whether we turn that into a national strategy, with all that that entails, or whether we simply seek to spread the best practice, the hon. Gentleman is right to raise this issue; indeed, I have raised it myself.

Audiologists have expressed concern about the potential hearing impairment brought about by young people wearing personal music centres plugged into their ears. Does the Secretary of State agree that there is a serious likelihood of hearing impairment affecting those young people at a much earlier stage of their lives, and that there should be an inquiry into what action can be taken to prevent the danger of hearing impairment being brought about by those items of social fashion?

The hon. Gentleman has an interest in this subject. I believe that he was the chair of the all-party group on noise—[Interruption]of which he has made quite a bit in this Chamber over the years. I do not think that this issue can be near the top of our agenda, but it does need to be looked at. I increasingly find that people, not just young people, have developed problems—sometimes mental health problems—because they live in an environment of constant noise. In the workplace, for example, noise levels can be huge. Some people think that playing a radio station featuring the inane chatter of a disc jockey all day is good for calming the nerves, whereas actually it does the opposite—[Interruption.] The hon. Gentleman has started me off—but yes, I do think that we should look into that issue.