1. What guidance his Department has issued to NHS organisations on co-payments. (211290)

Guidance has existed for more than 20 years. I have today asked Professor Mike Richards—the national clinical director for cancer—to review policy relating to patients who choose to pay privately for drugs not funded on the NHS. Terms of reference have been placed in the Library.

I very much welcome the Secretary of State’s announcement, as will many campaigners up and down the country and in the House. The ban on co-payments was cruel, because, as we know, it took NHS care away from patients who were dying, and it was illogical because co-payments existed in other parts of the NHS. Will the Secretary of State assure the House that the review will not have the effect, however inadvertently, of kicking the issue into the long grass, because, as the case of Linda O’Boyle proved, patients want and need the change in the policy now, not in a year’s time?

The hon. Gentleman has represented his constituent, Mrs. Linda O’Boyle, vociferously in the House and, indeed, on a non-party political basis, and many other Members on both sides of the House have raised the issue. It is time that someone with the expertise of Professor Mike Richards looked at the issue. It will hardly go into the long grass; I want Mike Richards to report in October. When the hon. Gentleman has had a chance to read the terms of reference, he will see that I am asking Mike Richards to look at very complex issues. I am not saying that he should come down one way or the other; I am saying that he needs to review the issue, given the need, which hon. Members on both sides of the House understand, to protect the principles of the NHS as a service free at the point of need and the very understandable concerns of Mrs. O’Boyle’s family and many others involved to find out whether we can ensure that we get guidance that is up to date and related to what is happening now in the NHS, that is fair to everyone and that resolves some of the problems that the hon. Gentleman and others have raised.

May I welcome the Secretary of State’s statement? Many Labour Members welcome it, as well as Opposition Members. I am grateful for his emphasising that this is not a new policy; it is one that the Government inherited. May I add that, by in a sense time-limiting the review, he will increase support in the country for the outcome of the review, whatever it is?

I thank my right hon. Friend. He, too, has raised the issue in various debates in the House. The guidance goes back at least to 1986 and probably before then. I have no need to ask Professor Mike Richards—he will do this anyway—to talk to Members, such as the hon. Member for Billericay (Mr. Baron), my right hon. Friend and others who want to raise specific issues. That can be done in the time scale that has been set—certainly, Professor Richards thinks that it can—and, as I say, that will ensure that I do not stand at the Dispatch Box merely repeating guidance that has existed for 20 or 30 years. We can determine what we need to do now in the NHS to resolve some of these very difficult and complex problems.

I also welcome the review that the Secretary of State has announced. Will he ensure that, in the deliberation, the needs of the silent voices—those who cannot afford the extra payments—are not forgotten?

The hon. Gentleman raises a very important issue. The scenario that many in the NHS feared, which has led to the guidance over the years, is that a patient in the first bed on a ward would be treated completely differently from the one in the second bed, because of their ability to pay. That is not the argument that has been raised by hon. Members in the House. I understand very clearly the fundamental points that are being made, particularly about Mrs. O’Boyle, who did not know that there was an obligation to pay for treatment until she had received it. But the hon. Gentleman, from his experience in the NHS, raises the fundamental, key issue, which I hope he will accept is very clearly set out in the terms of reference.

Will the Secretary of State give an assurance that the review will not result in a lottery system in the NHS, whereby people who can afford to pay can buy better treatment than people who cannot afford to do so? Most hon. Members on both sides of the House would be concerned if that inequality were introduced into the NHS, because it could become the thin end of the wedge for things such as top-up payments for other treatments. Will he assure us that the review will not open up that avenue?

I can give my hon. Friend that assurance. I shall quote the terms of reference, which state that the review should take into account

“the importance of enabling patients to have choice and personal control over their healthcare; and the need to uphold the founding principle of the NHS that treatment is based on clinical need not ability to pay, and to ensure that NHS services are fair to both patients and taxpayers”.

My hon. Friend should be reassured that we are reviewing how the system works in the 21st-century NHS, and that the outcome is not predetermined. Professor Mike Richards is a respected clinician: he led the development of the cancer plan and cancer strategy, and until recently he was chairman of the National Cancer Research Institute. All the cases that I have examined, including Mrs. O’Boyle’s, relate to cancer—mainly bowel cancer and kidney cancer. Professor Richards has spent his whole life in the NHS, so he is the perfect person to review the situation very quickly. The report will be published, so hon. Members will have the chance to see the results.

Desperately ill patients and their families are often vulnerable to the false hope provided by miracle drugs, which are sometimes touted in the media. What consumer advice—it is almost consumer protection—will be given to those people so that they do not waste their time and money or expend their hope on what are cul-de-sacs so far as treatment is concerned?

My hon. Friend raises another dimension to the issue. Professor Richards led on the cancer strategy, which was published in December and pointed out the need to get cancer drugs through the process much more quickly. Consumers who are considering drugs that are available on the internet should, first, take the advice of their clinician; secondly, check whether the drug is licensed; and, thirdly, if it is licensed, ensure that they know where it sits in relation to the NICE process. We can speed up the NICE process, and we will comment on that in the next-stage review, which will be published shortly. The internet contains a range of drugs, some of which are licensed and some of which are not. We must be vociferous in ensuring that consumers get the right advice, and we must do what we can to ensure the proper regulation of such drugs.

I am sure that the House is grateful to the Secretary of State for initiating the review. The Secretary of State will also appreciate that we have not had access to the terms of reference. It would be helpful if the Secretary of State, taking account of the case made by my hon. Friend the Member for Billericay (Mr. Baron) on behalf of Mrs. O’Boyle and her family, were to agree that we need to examine two principles. First, if patients access private treatment beyond the boundaries of NHS care, it should not mean that they lose their entitlement to NHS care. Secondly, NHS care itself should continue to be both comprehensive and free based on need, not ability to pay. I gather from the terms of reference that the Secretary of State has included the latter principle, but has he included the former?

I appreciate that the hon. Gentleman has not had a chance to see the review’s terms of reference, but that sounded like an attempt to pre-empt the outcome. We are clear that someone who has had private treatment can return to the NHS for treatment, and we are also clear that people who have had NHS treatment are perfectly entitled to obtain private treatment. The ambiguity occurs over the term “an episode of care” and whether someone can buy a drug that is not available on the NHS and ask the NHS to pay for its administration as part of their treatment. I want Professor Richards to examine that area, and I do not want to predetermine the review. Professor Richards is well aware of the problems experienced by Mrs. O’Boyle and others, because he deals with such issues all the time. When the hon. Gentleman sees the terms of reference—I will not take up the House’s time by reading them all out, because there are quite a few words—I hope that he will be assured that that point has been addressed. If not, the issue is not party political, and he is welcome to come and see me—indeed, I am sure that Mike Richards would be keen to talk to him.

I look forward to discussing the matter with Mike Richards. The Secretary of State will appreciate why I mention “comprehensive care”. The review particularly relates to many of the new cancer drugs. Mike Richards and the NHS also need to address how patients who rely on the NHS for their treatment can be sure that they will get comprehensive treatment. For example, I have a list of 20 European countries where Erbitux, the brand name for Cetuximab, which was privately provided for Mrs. O’Boyle, is routinely made available for patients with colorectal cancer. In the NHS, Mrs. O’Boyle was told that that drug was not available. Surely we must address that question, too.

I do not believe that that is about the terms of reference. The issue is how we deal with the NICE process. Cetuximab was a specific issue and it had not been through the NICE process. The PCT decided that the circumstances were not exceptional and, therefore, the treatment was not given. There is a whole different dimension to the issue under discussion. The fundamental problems that Professor Richards will look at are confined not to cancer drugs but to drugs per se. There may be many other issues and unintended consequences, because we have been concentrating so closely on the understandably controversial issues surrounding Mrs. O’Boyle and others. But Professor Richards’s remit will be to look right across the range. The worst thing that could happen to the review would be if he were to concentrate on one particular area and on a few particular drugs, and then miss the fact that unintended consequences apply to other illnesses and to other drugs.

3. How many newly acquired HIV infections were recorded in 2007. (211292)

Data on newly acquired HIV infections are not available, but an estimated 5,817 people were reported as newly diagnosed with HIV infection in 2007, compared with 6,769 in 2006. The figures include people with long-standing infections, including many who were infected outside England but who were subsequently diagnosed in this country.

I thank my right hon. Friend for her answer. She will know that there is a serious problem not only with the overall numbers, which, although coming down, were recently still up on the 1997 figure of, I think, 3,000. She will also know about the problem of late diagnosis—people being diagnosed six or seven years after becoming infected, by which time they have become highly infectious and less likely to respond to treatment. She will be aware that London’s strategic health authority has highlighted that big problem and is trying to address it with a target to halve the number of people who are diagnosed late. Will she seek to use her influence to spread that target and practice throughout all health authorities in the country?

My hon. Friend raises a very important point. He will know that the prevalence of HIV in England is one of the lowest in Europe—comparable to that in Sweden, the Netherlands and Denmark. Nevertheless, he is quite correct: about 31 per cent. of those who are infected are unaware of the fact. The steps that the Department has been taking have been, first, to focus on publicising the importance of early testing and on providing extra resources; secondly, to improve timely access to NHS testing, particularly in a variety of settings, not just in genito-urinary medicine clinics; thirdly, to look very specifically at where the highest risks are and to ensure that information and support are provided to those groups to encourage them to come forward for testing; and, finally, to undertake work with those in the voluntary and third sectors, as well as with local health authorities, to try to remove the stigma and the perceived discrimination that many people fear in order to encourage them to come forward.

Has the right hon. Lady had any recent discussions with her colleagues in the Department for Work and Pensions about the growing concerns regarding medical assessments of people with HIV infections, in respect of disability allowances and of fitness for work? It is a growing concern, and it would be very useful if she were to have appropriate discussions with the DWP to ensure that it applies the right tests.

I have not had any discussions recently about that point, but if the hon. Gentleman has specific issues and experience in his constituency I would be very happy if he sent them to me, because clearly we must ensure that medical assessments are conducted correctly, particularly with regard to that very vulnerable group.

I am sure that my right hon. Friend recognises the risks to public health from the greater number of new infections and from people who are undiagnosed. Given that, will she look again at including HIV in the list of infections that are exempt from NHS charges? We must have a balance between the public health risks and the financial costs, recognising that the risks outweigh the costs.

All people who are ordinarily resident in England are entitled to free national health service treatment, including for HIV. My hon. Friend will be aware that that is qualified by exempting categories of individuals from charges under the National Health Service (Charges to Overseas Visitors) Regulations 1989, as amended. He will also be aware that asylum seekers are exempt from charges for all hospital treatment, including for HIV, and will remain exempt for courses of treatment that continue if and when their applications for asylum are rejected. All the points with regard to the threat to public health that he correctly identifies are addressed in the strategies that we use.

The Minister will know even from the Government’s own data that many of the at-risk people to whom she referred are from sub-Saharan Africa. What consideration have the Government given to selected pre-screening of people who apply to move to the United Kingdom through work visas or student visas, or, indeed, as asylum seekers?

The hon. Gentleman will know that the Government have announced that they are investing an extra £2 million, in addition to the moneys already committed to prevention work, to look specifically at groups of highest risk, including gay men and people from African communities. Working through the African communities and the African HIV project, we are addressing particularly the issues that the hon. Gentleman mentions. It is important that people come forward for early testing. It is not necessary to have compulsory testing. We are seeing that testing through the various clinics and measures has increased dramatically—in some cases, by up to 85 per cent.

Does my right hon. Friend agree that there is a danger that as more and more people are living and working with HIV/AIDS, the perception of the disease as being life-threatening recedes, and that any prevention programme therefore needs to recognise that change in perception and to focus very much on the fact that being able to take drugs and in most cases live a long and productive life is not a reason to assume that one is not at risk?

My hon. Friend is absolutely right. With the development of therapies and treatments, it is particularly important that people understand that HIV is still a deadly disease. We particularly need to understand—the Department is taking this forward—which groups in the community may be less aware of the risk, or have a belief that they can live with it, and to target additional information and support to them to encourage them, first, to come forward for testing, and, secondly, to desist from activities that increase their likelihood of HIV infection.

4. What steps he is taking to tackle liver disease. (211293)

We are concerned about the increasing incidence of and mortality from liver disease. I congratulate my hon. Friend on his work in the all-party group on hepatology and on the many Adjournment debates that he has introduced on this issue. We are already taking action on a number of fronts to combat its primary causes—alcohol misuse, which is the most common, viral hepatitis and obesity. We accept that there is strong support for developing a national plan for liver disease.

Unlike deaths from other major diseases, which are going down significantly, deaths from liver disease caused by viral infections, obesity and excessive consumption of alcohol are, tragically, rising significantly. What more can my hon. Friend do to reverse that trend, and when will we see a national service framework established in the field of hepatology?

We have engaged with a wide range of stakeholders in order to build a consensus on the issues that my hon. Friend has raised and on what we might do about them. We shall decide on our next steps in the light of that and of preliminary work on the evidence. Much of the evidence is being taken by Professor Ian Gilmore and Professor Eileen Kaner of Newcastle university. Problematic drinking is a key cause of liver disease. In our national alcohol strategy, we support a comprehensive approach, across and beyond Government, to address the consequences of harm caused by alcohol. We have a range of measures in place to tackle hepatitis B and C, such as a national hepatitis C action plan and awareness campaign. Our expert committee, the Joint Committee on Vaccination and Immunisation, is reviewing the national hepatitis B immunisation programme. Tomorrow, I shall meet some officers of the all-party group, and I hope to take the process forward as soon as possible.

Does the Under-Secretary share my concern at the growth in the instance of liver disease among younger people through the misuse of alcohol? What steps is she taking in conjunction with other Departments to target that age group to prevent the problem of binge drinking?

Our national alcohol strategy has been rolled out along with, today, a Home Office initiative on the very subject that the hon. Gentleman rightly raises. Education on liver disease and its serious consequences, which sometimes do not come to light for many years to come, is difficult to get across to young people because they live for today, and serious consequences for the liver may not become apparent for 10, 15 or even 20 years. Much more can be done and I am happy to work with the hon. Gentleman on any initiative he wants to bring to me.

Has my hon. Friend considered a requirement for a Government health warning on all tins and bottles of alcoholic beverages, similar to the warnings that we have on packets of cigarettes? A number of countries throughout the world use them.

I am informed by the Minister of State, my right hon. Friend the Member for Bristol, South (Dawn Primarolo), that there is a voluntary system in place at the moment, but we can always look to do more because the consequences for young people are so serious and because the rate of deaths from liver disease in this country is rising.

What discussions has the Under-Secretary had with colleagues in the Department for Children, Schools and Families and the Ministry of Justice to ensure that there is some sort of co-ordinated action whereby the contents of the strategy can be rolled out in prisons in due course, and within young offender institutions in particular? Action is urgently needed there.

The hon. Gentleman is right. The Department for Children, Schools and Families works closely with the Department of Health. Secretaries of State from both Departments meet regularly to consider the children’s plan and the health plan. It is not only alcohol that causes liver disease and hepatitis, but obesity, too. The obesity plan for young people is currently in place.

5. What recent steps he has taken to extend the hours during which GP surgeries are open for patients. (211294)

In March, we agreed changes with the British Medical Association to reward practices that extend their opening to provide weekend or evening appointments. I am pleased to tell the House that 21 primary care trust areas have already achieved our aim that at least 50 per cent. of surgeries should offer extended hours.

But would not the creation of 152 GP-led surgeries, open from 8 am until 8 pm, seven days a week, provide greater choice and better health opportunities for patients—[Interruption.]—rather than leading to closures in Nottinghamshire, or anywhere else in the country, as the British Medical Association suggests?

I agree with my hon. Friend, who makes an important point. I heard some Opposition Members shout, “Not in rural areas.” Yet Cornwall is one of the counties that has already achieved the 50 per cent. target—indeed, it has exceeded 90 per cent. However, some GPs may not want to open in the evenings or at weekends, so we believe that it is perfectly proper that patients in those areas are not denied the ability to remain registered with their GP, if they wish, and to see a GP in the evening or at weekends. They will value that greatly and not understand the Conservatives’ promise to reverse the policy.

I strongly support the idea that GPs’ surgeries should open for longer. In the main, GPs are popular with their patients, are trusted and know the details of the conditions of those on their panel. However, I am reserved about the Government’s proposal to open polyclinics, which I believe would be an expensive duplication of GPs’ services and undermine the position of GP surgeries. Will not the Government reconsider their proposal and perhaps try to work through GPs to extend services, so that the services that people want are available in the evening and at weekends?

The hon. Gentleman is rarely known to be reserved in the House, but I welcome his support for our extended hours drive and invite him to discuss it with his Front Benchers. As I said, they promised to reverse the policy and give the BMA a veto over extended hours. The last time we had an exchange on the subject, the hon. Gentleman highlighted the success and popularity of a GP-led health centre that provides an excellent service in his constituency. We are not imposing anything on any primary care trust, but simply saying that, in every PCT area, there should be a GP-led health centre, such as the one of which the hon. Gentleman is fond in his constituency, for patients whose surgeries are not open in the evenings or at weekends to give them the choice.

In the city of Wolverhampton, some GPs have tried extended opening and found little demand, whereas another surgery is opening on Saturday mornings to trial the policy. Is there any quantitative evidence from the west midlands—or, indeed, the city of Wolverhampton—that might give us a better steer on potential demand from patients for the extended hours service?

Every survey that we conduct of what the public think is the most important improvement that we can make to build on the improvements that we have already made in the health service shows that people want to be able to see a GP at a more convenient time to the patient—at weekends or in the evenings. My hon. Friend’s local primary care trust may not yet have hit the 50 per cent. target, but neighbouring Heart of Birmingham PCT has, with 75 per cent. of GP practices already offering extended hours. It is popular, the public tell us that they like it, and the GPs, once they start doing it, also find it popular.

Does the Minister agree that it is not so much the hours that GPs are available that are important, but the services that each GP practice offers? Is he aware that the White Paper on pharmacy proposed taking away the ability of GP practices in market towns such as Thirsk to dispense? That will reduce the services that they can offer. There is no point in the Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo) shaking her head. I met representatives of GP practices and I also declare an interest as a GP’s daughter and a GP’s sister. We want to keep dispensing services in rural practices.

My right hon. Friend was shaking her head because she wrote the pharmacy White Paper and she knows that it does not do what the hon. Lady suggests. The hon. Lady also knows that we are consulting on all aspects of the White Paper, and I invite her to make a formal representation as part of the consultation.

Does the Minister know that, in areas such as Leek, which is a market town, GPs already successfully offer an out-of-hours service from 10 am until 2 pm, on Saturdays, Sundays and bank holidays? Is not it time that other GPs followed that good practice and recognised that patients want not only high quality but more accessible services to fit in with their lifestyles?

I agree with my hon. Friend, who has given a good example of what happens in an area when one or two GPs start offering the service to patients: other GPs quickly follow suit because they discover that it is popular. It is extraordinary that some hon. Members still believe that, although it is fine for people in some parts of the country to be able to see a GP in the evenings and at weekends, that service should not be available to everybody. Labour Members believe that it should be.

It seems extraordinary that the Minister is claiming credit for the Government reinstating a service that they removed three or four years ago. I want to press him further on the point that my hon. Friend the Member for Vale of York (Miss McIntosh) made. She was absolutely right to say that access to GPs and primary care is about more than just opening hours. Will the Minister acknowledge that the proposals in the pharmacy White Paper that potentially remove the right of GP practices to dispense are causing immense concern both to service providers and, more importantly, to their patients? In consultation with the Minister responsible—the right hon. Member for Bristol, South (Dawn Primarolo), who is whispering in his ear—will he confirm that there will be no changes to the control of entry regime without a full, published, comprehensive and genuine consultation that takes into account the needs of communities that use GP dispensing services and pays particular regard to the proposed changes in the White Paper to the imposed distance criteria?

The hon. Gentleman is doing the same thing as a lot of his hon. Friends—confusing out-of-hours services with extended hours. I am pleased if he is reversing the Conservatives’ policy and saying that they will not reverse the provision for extended hours, because I suspect that he will find shortly that extended hours will be very popular with the public when they begin to access to them. I suspect that the policy is not one that the Conservatives will abandon as quickly as they have most of their other policies.

On the pharmacy White Paper, I have already said in answer to the hon. Member for Vale of York (Miss McIntosh) that there will be a consultation. Our view is that the hon. Gentleman is wrong in his interpretation of the White Paper’s impact, but he is welcome to make his views felt during the consultation.

6. What progress is being made on proposals to re-use the Standish hospital site. (211295)

The national health service locally in my hon. Friend’s constituency is continuing to consider the future of the Standish hospital site and is exploring the potential to develop services that would benefit the people of Gloucestershire. We expect the decision to be made shortly.

I thank my hon. Friend for that and commend him on visiting the site. He knows what a beautiful site it is and what potential it has. It would be good to hear that progress is being made. Indeed, I gather from what is happening that this innovative scheme between the learning and disabilities trust, the primary care trust and the voluntary sector will become a reality, so anything that he can do to help it along will be gratefully welcomed in the area.

I am grateful to my hon. Friend for that and for the invitation to visit his constituency, which I recall I did on an extremely wet spring day. My understanding is that the main obstacle to progress is the listing of part of a building on the site. May I suggest to my hon. Friend that he make representations to my right hon. Friend the Minister of State, Department for Culture, Media and Sport, if he has not already done so, to ensure that she is well aware of his views on the merits or otherwise of listing that building?

7. What steps he is taking to improve access to NHS infertility services. (211296)

Two main issues are currently being addressed. First, the Government conducted a survey of in vitro fertilisation provision in all primary care trusts. A copy of that survey has been placed in the Library today. That is part of the Department’s regular monitoring of IVF provision and tracking of progress towards the National Institute for Health and Clinical Excellence’s recommendations. Secondly, the Infertility Network UK, which is funded by the Department for that activity, is identifying and establishing standard access criteria to fertility treatment.

I very much welcome that statement. As my right hon. Friend knows, next month is the 30th anniversary of the birth of the first test-tube baby. Will she consider marking that by ensuring an end to the postcode lottery that still exists in access to treatment and by increasing entitlement to three rounds of treatment on the NHS, as recommended by NICE?

As my hon. Friend is well aware—she has campaigned extensively in her constituency and in the House—the local NHS takes decisions about the treatment that it provides for its local communities and identifies priorities. In my view, we will reach the NICE recommendations when the local NHS acknowledges the fact that one in seven adults experiences difficulties with fertility, and makes the provision of fertility treatment services a higher priority. Members of Parliament have an important role in discussions with their PCTs, which do a difficult job in trying to reflect local criteria and priorities.

The Minister will know that IVF treatment was suspended in Northamptonshire because of lack of money. Northamptonshire is the worst funded primary care trust in the whole country in respect of the national capitation formula, so the suggestion that it is up to local PCTs to decide on IVF treatment is a little unfair when the problem is the lack of Government money going to Northamptonshire.

That is simply not true. I know that the hon. Gentleman has made representations and that he is very clear in making them for his constituents, but he will also know that his PCT is within the 3.5 band in terms of funding. I have to tell him, in view of the different number of cycles offered, that one of the big debates that remains to be concluded across the country is whether the provision of IVF treatment is a priority for local health services that is equal to other priorities. That matter can be settled locally when it is made clear that the provision of IVF services is important. The hon. Gentleman’s PCT provides other services that it also believes are important, so we need to ensure that equal priority is given.

8. What plans he has to establish a national cord blood programme. (211297)

There is already a national cord blood programme in place. The NHS cord blood bank, supported by NHS Blood and Transplant and funded by the Department of Health, collects cord blood from four centres. All the cord blood units stored in the NHS cord blood bank are available to NHS patients across the country.

Is the Minister aware that the Anthony Nolan Trust estimates that tens of thousands of pints of cord blood, which could be used for transplantation and research purposes, are discarded every year in the UK? Will the Minister support the charity’s proposed national cord blood bank to ensure that units donated altruistically by mothers are used to drive forward medical research rather than be discarded, thereby totally wasting this valuable resource?

I had a meeting with representatives of the Anthony Nolan Trust recently and I should say to the hon. Lady that the NHS has access through the international bone marrow registry and others to about 10 million samples, and that 72 per cent. of the matches in cord blood in the UK are provided internationally. There are two separate issues here: the first is treatment now and the second is research. The Anthony Nolan Trust is looking particularly into the issue of treatment now. The NHS cord blood bank is currently undertaking a review, which will report to me later this year about how to ensure a greater percentage of matches. We have already put in extra money, particularly for collection in respect of black, minority and ethnic communities. Over and above that, the Anthony Nolan Trust is looking into the development of its services, and I have said that it is crucial that developments at both the NHS blood bank and the Anthony Nolan Trust take place in partnership to ensure that we maximise the benefits for UK patients. That is what we intend to do.

9. When he was informed of reported increases in the occurrence of cardio-vascular incidents linked to Vioxx (rofecoxib). (211298)

The cardio-vascular safety of Vioxx was intensively monitored and investigated by the Medicines and Healthcare products Regulatory Agency with regular, independent advice from the Committee on Safety of Medicines. That happened since a possible increased cardio-vascular risk was noted in the VIGOR study in 2000, shortly after Vioxx was marketed. The first definitive evidence of increased cardio-vascular risk arose in a long-term placebo-controlled clinical trial, the APPROVe study, in September 2004, at which time the manufacturer withdrew Vioxx from the market.

May I remind the Minister that many hundreds of NHS patients, such as my constituent, Mr. Lowe, who were prescribed Vioxx have subsequently suffered serious side-effects—in Mr. Lowe’s case, a heart attack? What steps will the Minister take to get the manufacturer of Vioxx—Merck Ltd. from the United States—to face up to its liabilities to patients here in the UK in the way that it has been forced to do in the United States of America?

The hon. Gentleman raises an important point. A number of patients within the NHS feel that their lives have been adversely affected very seriously as a consequence of taking the drug. He is right to say that compensation is being paid by the manufacturer in the United States of America. We need to look at the pressure we can apply to that manufacturer in terms of its responsibilities to people in the United Kingdom who have been affected.

May I reinforce the intense sense of anger and injustice felt by the victims of Vioxx in the UK, many of whom attended a lobby of Parliament today? They are in exactly the same position as people in the United States who have benefited from a $4.8 billion settlement. Does the Minister agree that it is an outrage that this drug company is discriminating against UK victims? Will he join me in calling on it to rethink its position and meet an all-party delegation of MPs to see what further pressure, as he says, should be put on the company?

Again, I agree with the hon. Gentleman. I think that I can commit to two things. First, of course I will meet an all-party group of MPs to focus on this particular issue and consider what we might do. Secondly, I will certainly be making sure that the Department contacts the manufacturer to ensure that it fulfils its responsibilities to people who have been affected in the UK in the same way as it is now compensating people in the United States.

T1. If he will make a statement on his departmental responsibilities. (211315)

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.

My supplementary question is on mental health advocacy. What measures is my right hon. Friend putting in place to ensure that there will be adequate resources in April 2009 when measures in the Mental Health Act 2007 on independent advocacy are implemented? How will he ensure that non-statutory services will be safeguarded and improved?

Negotiations on the comprehensive spending review included the introduction of those services in April 2009. The funding is already available for that. Non-statutory funding—assistance of the voluntary sector and so on—is crucial to the success of this project. I give my hon. Friend the assurances that I believe she is seeking.

On the subject of dentistry, in February 2008, the Secretary of State said:

“Access to NHS dentistry is getting better all the time.”—[Official Report, 5 February 2008; Vol. 471, c. 772.]

I do not think my constituents, constituents around the country or dentists are quite certain what figures the Secretary of State was referring to. Recent figures since his contribution in 2008 show that nearly 1 million British members of the public no longer have access to NHS dentistry. Will he now retract his comments and scrap this ludicrous contract?

No, I will not.

“It’s getting better all the time”,

to quote a line from a track on “Sgt. Pepper”. It is getting better in dentistry because the original contract, which the hon. Gentleman seems to want us to reintroduce, was wrong in every respect.

No, we do not.

But we are being asked to withdraw the current contract. It replaced the contract that encouraged drill and fill. It meant that when dentists left the local vicinity, the money went with them. Of course, there was a period when dentists did not sign up to the new contract. Gradually, they are coming back and gradually we are getting to a situation in which dentistry is provided not just on the basis of drill and fill, but on a preventive basis, with a much simpler structure and much better access. The money that we are putting into dentistry this year, next year and the year after has gone up, and primary care trusts are commissioning more dental practices as a result.

T4. As my right hon. Friend will know, back in 1997, the construction industry was on the point of collapse. I am proud of the health service’s commitments to new hospitals and clinics, which have revitalised the industry, but I want to ensure that its significant investment leads to training opportunities for young people as part of their apprenticeship programmes. What is my right hon. Friend doing to ensure that those public sector funds are spent on delivering better skills and better-qualified young people? (211318)

My hon. Friend has been a champion of apprenticeships. I think she will accept that what the Department is doing is exemplary in Whitehall terms. Indeed, I hope she will accept that we are “Top of the Pops” in terms of the number of apprentices we are recruiting.

As for what we are doing in the country more generally, my right hon. Friend the Secretary of State for Innovation, Universities and Skills is running an integrated project to establish how we can use the huge public sector investments that we are making in, for instance, hospital-building programmes to ensure that apprenticeships are provided in the construction industry, and also in education, so that we do not waste the valuable opportunity provided by our capital investment to increase the number of apprentices again. It needs to be raised to the level suggested in the Leitch review by 2015.

T3. Would the Minister of State like to have another go at answering my earlier question about HIV/AIDS? Given the increasing number of cases of HIV/AIDS and, indeed, TB in this country, many of them brought in by people from sub-Saharan Africa, will she tell us whether she believes that selective pre-screening of those people before they enter the United Kingdom, not while they are here, is a good idea for Britain? (211317)

I believe that I have already answered the question, but I will answer it again. No, the Government do not consider pre-screening to be necessary. Our policy is to encourage the highest-risk groups to come forward voluntarily for screening. The group that the hon. Gentleman has identified is not the highest-risk group, but it is one of the groups that we are addressing.

T5. The report “Aiming high for disabled children: better support for families” led to additional resources. Can my hon. Friend the Under-Secretary of State assure me that they are being used to enable the services identified in the report to benefit disabled children and their families, and for no other purpose? (211319)

I pay tribute to my right hon. Friend for the work that he did in the House in championing the needs of disabled children and their families, as a result of which we are investing an unprecedented amount to support those families—and so we should.

The money from the Department for Children, Schools and Families is ring-fenced, and amounts to £370 million over three years. In the autumn of this year, the Department of Health will announce the overall sum that we will invest in child health over the next three years. It will include a specific figure to be put into primary care trust baselines to increase support for children with special needs and provide short breaks and support for children with palliative care needs. It is crucial, in all parts of the United Kingdom, for us to prioritise the needs of disabled children and their families, and to ensure that the money allocated for the purpose is spent on improving their quality of life.

Although the number of people admitted to hospital suffering from under-nutrition has increased by 85 per cent. since 1997, I understand that the Minister is scrapping the Nutrition Action Plan Delivery Board that he established last year. What reassurance can he give us that he takes malnutrition in the elderly seriously?

As I have only just established the board, I am hardly likely to be scrapping it. The hon. Lady’s information is completely untrue.

The nutrition action plan is overseen by the director general of Age Concern. It has independence, and is being overseen by someone who has passionately championed the importance of nutrition, particularly in relation to older people. What we have said, as the hon. Lady knows full well, is that the board will do its work for 12 months and then we will review where it goes from there. There has been absolutely no suggestion that we intend to scrap it.

T9. A constituent of mine with cystitis has received treatment for acute episodes at the nurse-led walk-in centre in Milton Keynes, but she has been unable to get an appointment with her GP in order to be referred to a consultant because she is a shift worker and because of the booking system at the surgery. Will the Minister point out to the British Medical Association and the Opposition that this is exactly the sort of problem that could be addressed by the new seven-day surgery proposed by the PCT in Milton Keynes? (211323)

We will have the perfect opportunity to do that in about five minutes’ time.

T6. If GP-led health centres are in the interests of patients, does not the Secretary of State believe that primary care trusts will procure them anyway? Why is he running the show like a command economy and requiring 121 PCTs outside London to procure them? (211320)

Because, No. 1, we believe that we ought to enhance capacity in primary care; No. 2, we do not believe that PCTs should be paying for extra facilities from money we have already allocated—we will provide that from the centre; No. 3, we think patients such as the constituent of my hon. Friend the Member for Milton Keynes, South-West (Dr. Starkey) should be able to access a GP surgery from 8 am to 8 pm, seven days a week, 365 days a year; and, No. 4, we believe that people who cannot get to their GP because, for example, they work in the centre of town or in another town should be able to access primary care. For all those reasons, it is extraordinary that Opposition Members, including the Parliamentary Private Secretary to the Leader of the Opposition, oppose this extra investment in primary care. They will live to rue the day.

T7. I met Dr. Goel at his Carshalton fields surgery a couple of weeks ago and he presented me with a petition with 570 signatures from patients who are very worried about the future of their local family GP practice. Can the Secretary of State confirm that that practice will not be forced to merge with a polytechnic—or a polyclinic, rather—at some point in the future? (211321)

It certainly will not be forced to merge with a polytechnic; I can give the hon. Gentleman that assurance very firmly. Our proposals are for additional GP-led health centres. The name should give the Opposition a bit of a clue as to who will lead these health centres. They will be GP-led, and there is no intention whatever of removing existing services.

Does my hon. Friend have a view on the Council for Healthcare Regulatory Excellence report on the Nursing and Midwifery Council?

We welcome the report and accept its recommendations. It makes some very serious criticisms of the functioning and leadership of the NMC, saying it has failed to carry out its statutory duties to the standard the public have the right to expect and it has lost the confidence of its stakeholders. It is our view and that of the CHRE, the trade unions and other stakeholders that it would be in the best interests of the NMC and the individuals involved if all three senior figures stepped down from their current positions. We welcome the leadership shown by the president and chief executive today in indicating their intentions to resign.

T8. I am sure that the Secretary of State will agree that many of our hospital accident and emergency departments are full of people whose ailments would be better treated elsewhere. On the basis that all of us are in favour of preventive health measures, will the Secretary of State discuss with the Secretary of State for Children, Schools and Families the possibility of introducing first-aid training as part of the school curriculum, in accordance with my excellent ten-minute Bill? (211322)

I will have another look at the hon. Gentleman’s excellent ten-minute Bill, and will doubtless talk about it in the many meetings I have with the Secretary of State for Children, Schools and Families. The hon. Gentleman makes an important point, and one of the fundamental reasons why the NHS in London is proposing polyclinics in London is the number of people clogging up accident and emergency departments who should really be in primary care.

T10. Is the Secretary of State aware that some hospitals have banned people from bringing in flowers for patients on health and safety grounds, and what guidance, if any, does he have for these hospitals? (211324)

I have a full briefing with me that relates to every issue under the sun, but not this one. I do not think that it is a matter for me; I think it is for the local trusts, and I would be very surprised if they took that decision on any grounds other than patient safety. I believe that health care-acquired infections may well be the reason these flowers have been banned, but I will find out, perhaps, and write to the hon. Gentleman.

Does the Secretary of State share my concern that 1 million people appear to have been treated under NHS dentistry since the new contract came in, and that there also appear to be perverse incentives within the contract so that dentists are encouraged by the financial set-up not to treat those with the greatest oral health need? Could we not have a perverse outcome whereby those with least in our society will be able to tell their social class by the state of their teeth—and under a Labour Government?

The hon. Gentleman was probably mistaken in saying that he thinks that there are 1 million more dentist appointments now, because he probably meant the reverse—I do not accept what he says either way. I believe that this is a big issue in relation to heath inequalities, which is why I announced to Parliament our intention to introduce fluoride in more areas. That is the single biggest contribution that we can make to tackling health inequalities. On the dental health of young children in this country, our 12-year-olds have the healthiest teeth in the whole of Europe. That is a great tribute to the dental profession, and I would think that it is not detrimental to the amount of investment that this Government are putting into dental care.

I welcome the fact that the Government are finally talking about reform of our system of care for the elderly. Given the urgency of the crisis—Help the Aged describes our system as being in crisis, Age Concern calls it a disgrace and the Local Government Association yesterday said that it is coming apart at the seams—will the reform, and the legislation to enable it, be brought before the House before the next general election?

May I say to my good friend that as well as the long-term review, we have, from April, been introducing a transformation programme in every local authority area, supported by £500 million of reform money over three years? We will soon be publishing the first ever national dementia strategy and end-of-life strategy; we have announced the extension of our “Dignity in Care” campaign; the Secretary of State has announced a new package of preventive health measures specifically to support older people; we are extending the Human Rights Act 1998 to publicly funded residents of private care homes; and we have announced a new 10-year strategy to support carers. I am not sure that the hon. Gentleman’s party has anything else to offer on this issue.