1. What progress has been made on the deployment of patient administration systems in hospitals. (232530)

There have been 141 patient administration systems deployments in total, including 43 in acute hospitals, 23 in mental health trusts and 75 in primary care trusts.

I thank the Minister for that ingenious reply, but the Financial Times last week said of the new systems that in the north, planned implementation has not happened and in the south, the contractor has been fired, and that hospital bosses generally believe that the project is near to death. Which bit of “not working” does the Minister not understand? Is it not time for a review?

No; the hon. Gentleman is getting confused between full implementation and connection with the national spine in acute trusts, and the implementation of patient administration systems in general, in many cases, which has been very successful. We acknowledge that there are problems; there are always problems with computer systems on such a massive scale—the biggest IT programme in the world. There have been problems with its introduction in acute trusts, which have between 40 and 60 systems of their own, but we are working very hard, including with his local acute trust, with the provider and with Connecting for Health, to try to resolve the problems as soon as possible.

How necessary does my hon. Friend believe it to be, particularly in acute trusts, for the patient administration systems to be capable of passing on electronically patient discharge notes, so that we do not wait days and days when patients are back in the community, but wait seconds?

My right hon. Friend makes a very important point in highlighting one of the real benefits of a computerised health care system, not only regarding discharge notes, but so that clinicians can exchange in real-time information about patients. Any hon. Member who has visited any systems that are already up and running successfully will have heard not just from patients but from doctors and other health professionals about the benefits that they bring to patient care.

Can the Minister confirm that one of the risks that the Royal Free hospital has identified is that some of its patients may be exposed to a double dose in the radiology department because of flaws in the Cerner Millennium system?

That is one of the reasons why the implementation at the Royal Free hospital has been stopped for the time being. Active discussions have been going on between the strategic health authority in London, Connecting for Health and the Royal Free to ensure that exactly what the hon. Gentleman fears could happen, could not do so. That is why the system has not been carried forward at this time.

The patient administration system is not the only one going wrong in the health service at the moment. Has the Minister had any opportunity to review the progress being made with choose and book? Does he understand the very significant difficulties that it causes for the very many people who do not find the system at all customer friendly?

On the contrary, in many parts of the country, choose and book is operating extremely successfully. It is one of the great success stories of the national programme for IT. However, the hon. Gentleman is absolutely right that in some primary care trust areas, performance is quite unacceptable. We are working very closely with those primary care trust laggards who are not performing very well on choose and book to ensure that they come up to the performance standards of others.

With £12 billion at risk, choose and book, and electronic prescriptions, still 50 per cent. and 75 per cent. behind the Government’s target for completion last year, and fewer than 0.5 per cent. of electronic records uploaded against their target of 100 per cent. by next month, will the Minister say how many lives have been lost, delays suffered and mistakes made—affecting patients and their loved ones—that would have been avoided but for his Government’s ongoing failure to design and implement a health care IT system on time and that works?

The hon. Gentleman knows quite well that the £14 billion is not at risk, because he knows that one very important part of the contract—

It is £12 billion.

Or the £12 billion. The hon. Gentleman knows that one very important part of the contract is that the costs of any delay are incurred by the supplier not by the taxpayer. That is a result of the excellent contract that the Government drew up. He knows also that the independent National Audit Office confirmed in its report earlier this year that progress was being made in all parts of the programme, and that that was bringing real benefits in terms of in-patient care, saving lives and saving taxpayers’ money.

Will the Minister investigate the London teaching hospitals, some of which are abusing choose and book, and even ignoring it in some cases? The Healthcare Commission is aware of the issue. It is a scandal; it is the fiddling of figures, and it is now time that the Minister, or the Secretary of State for Health himself, undertook a search and scratched the surface on the matter. London teaching hospitals are abusing the system.

I shall certainly look into the points that my hon. Friend raises, but he is right to raise the concerns that were expressed on the publication a couple of weeks ago of the Healthcare Commission’s annual health check, which highlighted, as I said in response to a question from the Liberal Democrat Benches, the very big variability in the performance of PCTs and trusts on the use of choose and book. That is completely unacceptable, and I shall look into the matters that my hon. Friend raises.

3. How many people have been sectioned under the Mental Health Act 1983 in the past 12 months. (232532)

In England in 2007-08, the most recent year for which information is available, there were 28,100 compulsory admissions to hospital under the 1983 Act and about a further 19,500 detentions subsequent to informal admission.

In November 2006, the Minister’s predecessor gave an undertaking that within two years no child under 16 would be detained in adult psychiatric wards, and undertakings to that effect were given during discussion of the Mental Health Bill last year. Will the Minister guarantee that that pledge has now been fulfilled, two years on, and that improvements have been made so that children in appropriate child psychiatric wards can access education so that they do not fall behind with their studies during their illness?

In fact, two commitments were made at that time. The first was that within two years no one under 16 would be treated in an adult psychiatric ward and the second was that nobody under 18 would be in an age-inappropriate setting. The latest available figures, for April to June this year, show that there were only 16 bed days for under-16s on adult psychiatric wards—the lowest level since such data collection started in 2005. I shall certainly take away the hon. Gentleman’s comments about the education of young people in those settings.

Under the Government’s 10-year plan, mental health is meant to be a priority, along with cancer services and heart services. However, there is still growing evidence locally that money is being channelled into hospitals to meet the requirements of their plans, rather than into mental health services. What reassurance can my hon. Friend give me that that is being taken into account and that priority is being given to mental health services, as was stated in the 10-year plan?

I am pleased to be able to tell my hon. Friend that no less a body than the World Health Organisation praised the Government’s record on investing in mental health. We have one of the highest spends on mental health in Europe, and our spending on adult mental health services has increased by £1.7 billion in the past six years—a 44 per cent. real-terms increase for mental health services.

My hon. Friend is absolutely right. We are now looking to the future and talking to key stakeholders about our New Horizons project for mental health services. We expect to publish proposals for that future direction for mental health services next spring.

Less money is spent on the mental health needs of East Riding of Yorkshire residents than on those of the residents of any other area in the country. Their primary care trust receives hundreds of pounds less per head for general health needs than do the constituents of the Secretary of State for Health, who live not very far away. The primary care trust in East Riding directs just 7 per cent. of its expenditure to mental health. That is about half the national average, so there is a double whammy for my constituents. What message can the Minister send to the managers of the PCT to ensure that my constituents get a decent and proper mental health service?

The obvious response is to advise the hon. Gentleman’s constituents to support Labour at a future general election. Since 1997, spending on the health service has increased up to £100 billion. We are very proud of that record, and I might say to him that it is a serious issue—

You should be ashamed of yourself.

The hon. Gentleman talks about being ashamed, but he should be ashamed of the fact that his party consistently voted in every Budget against our extra spending on the national health service.

My hon. Friend will be aware that people being sectioned are among the most vulnerable. I have always supported independent advocacy in such situations. I know that there has been an improvement, but I would like someone who is sectioned, as of right, to have access to an independent advocate. Does the Minister also aspire to that?

I am grateful for that thoughtful question. As my hon. Friend may know, from April 2009 we will give such people for the first time a statutory right to an independent mental health advocate. That builds on the excellent practice in some parts of the country of engaging non-statutory mental health advocates. In a few months’ time, from 1 April, people who are sectioned will have a statutory right to such an advocate to help them through the system.

I warmly welcome the Minister to his new position, although we have already met across the Floor in Committee.

Despite the drop in total psychiatric admissions, the number of involuntary admissions since 1996 has increased by 20 per cent.—it is up by a fifth. Does the Minister share my concern that with bed occupancy in psychiatric hospitals now at 86 per cent., and with a drop in bed numbers of 17 per cent. since 2001, decisions on treatment for people with psychiatric illness are being made not with the clinical needs of the patient in mind, but because of a lack of, and declining, in-patient facilities?

I thank the hon. Lady for welcoming me to the Dispatch Box, but she is completely wrong: all decisions are made on the basis of clinical need. She is also wrong about the number of detentions, which has remained roughly stable since 1998, at some 47,900 in 1998-99 and some 47,600 in the last financial year. We now have 64 per cent. more consultant psychiatrists, 71 per cent. more clinical psychologists and 21 per cent. more mental health nurses than in 1997. That suggests that our investment in mental health is a record that we can be proud of. Nevertheless, we will take measures to publish a new strategy for mental health services next year.

4. What research his Department has undertaken into the reasons for health inequalities; and if he will make a statement. (232533)

The Government’s programme for addressing health inequalities is informed by a wide evidence base on the complex underlying factors, as highlighted in the Acheson Report and, more recently, the World Health Organisation report “Closing the Gap in a Generation”, which was published in August and which the Government welcome and support.

I thank my right hon. Friend for his answer. I know that he agrees that the postcode lottery in health has to be stopped and we have to move forward. For example, in Scotland we have twice the waiting lists that people have in England. Can he assure me that such inequalities, and the problems that we have in the regions in general, can be looked into to ensure that best practice is taken forward and that the money that is supplied will go to where the needs are greatest?

My hon. Friend is right to draw attention to this crucial issue, which we regard as a huge priority. The Department of Health alone cannot tackle these issues of health inequality: we need concerted action across government involving education, planning, local government and housing. We are therefore working with colleagues in government. I suggest that the introduction of 113 new GP practices in under-doctored areas—the 25 per cent. with the least provision of GP services—goes a huge way towards making our contribution to tackling this crucial problem.

What would be the impact on health inequalities of permitting people to buy their own medicines where they were not available while keeping their NHS treatment?

I shall make a statement on precisely that point later on. The right hon. Gentleman reminds me—he is interested in health inequalities—that between the ’70s and the ’90s the situation on health inequalities got worse. For men of working age, comparison of the mortality rate of the unskilled with that of professionals shows that it was twice as high in the 1970s, and it ended up three times as high in the 1990s. Whatever we do, we will do much more to tackle health inequalities than the Government of whom he was a member.

Halton has the worst rate of early deaths from cancer in England, and life expectancy is three years less than the national average. A lot of work is being done locally to improve things, but I am particularly concerned about teenage health. The chief medical officer has said that poor health in teenagers can last a lifetime. Can my right hon. Friend tell me what the Government are doing to address that concern, which relates to a group that is particularly difficult to reach?

My hon. Friend is right about the need to focus on people in this group, who sometimes miss out because we are focusing on children’s and adults’ services. That transition period is very important. The biggest contribution is made by public health. This is about smoking—there are still far too many youngsters starting to smoke at age 16 and even younger. The Minister of State, my right hon. Friend the Member for Bristol, South (Dawn Primarolo), proposes to tackle that through a number of measures, including not allowing cigarettes to be sold in packs of 10. That will make a big contribution. We must also do more to tackle the problems of excessive alcohol consumption among children in their teenage years. That will be the subject of a report in the near future.

What do I say to those of my constituents who truly believe in a national health service, but who have relations in Scotland who get treatments and drugs that they cannot get in England?

The hon. Gentleman should say that that is not true. There are no drugs available in Scotland that are not available in England. It is true that the Scottish system, via the Scottish Medicines Consortium, works more quickly than the one in England, but that is because it takes its lead from the National Institute for Health and Clinical Excellence, by and large, and it does not have a consultation process. It does not consult the public on its decisions. The hon. Gentleman, as a Member for an English constituency, can take heart from the fact that the accusations he hears in his local Dog and Duck are quite unfounded.

I am delighted that Fiona and Julian Keen in my constituency have opened a brand-new NHS dental surgery that is well supported by the local PCT, but does the Secretary of State recognise that two years on from the new dental contract, access to NHS dental services is still inadequate? What will he and the Government do to ensure that dental health inequalities are dealt with urgently?

My hon. Friend may know that a very important report on dental care has recently been published by the Health Committee, whose Chairman is in his place—[Interruption.] And of which my hon. Friend is a member—I was about to say that. A number of points in it are really important, not least the recitation of the history of the problem, which points out how bad dentistry was in the 1990s, and the need to introduce a new contract. The report raises issues that we need to look at. I believe that fluoridation is a major force in tackling dentistry inequalities, and a dentist said to me recently, “It gives poor kids rich kids’ teeth.” That is why the consultation that is going on in the south-west and will soon take place in the north-west is so important.

In tackling health inequalities, particularly regarding access to new drugs and treatment, does the Secretary of State agree that we should have a system that is far more transparent about NICE decisions, so that it is more accountable, and that the models used in appraisal decisions should be published?

We need greater transparency in all aspects of the process. The greatest transparency—I shall say more about this later—comes in the decisions of PCTs’ exceptional circumstances committees where NICE has not ruled on a drug, and where there is a lack of transparency and consistency. That is the major problem, and we shall consider some of the issues relating to NICE that arose from a recent case. In a sense, the matter the hon. Gentleman raises is second on the agenda.

May I urge my right hon. Friend to press the Treasury to release the moneys that have been allocated to the NHS in the current comprehensive spending review round? Will he work to ensure that the ACRA—Advisory Committee on Resource Allocation—recommendations that will be released shortly are implemented as quickly as possible so that all PCTs will have the resources necessary to eradicate health inequalities in our country?

The situation on allocations is that we are waiting for the pre-Budget report. We can then issue the operating framework along with the ramifications of the Darzi review, and that is when the ACRA report that my hon. Friend mentioned, which is crucial in tackling health inequalities, will become part of the process. He will not have to wait long; it will certainly happen well in advance of the beginning of the next financial year.

While my party of course agrees that reducing health inequalities must be a key priority, the Government’s record has not been good, despite what the Secretary of State has said. The gap in life expectancy and infant mortality has increased during the past decade, and we have the highest health inequalities in Europe. Does he agree that there can be no reduction in health inequalities without improvement in public health driven by local control of public health budgets, accurately reflecting communities’ needs and tackling social and environmental issues, overseen by locally appointed directors of public health?

I do not blame the hon. Gentleman personally, but I wonder where we would have been on health inequalities if the Black report, which was commissioned in the late 1970s but reported in the early 1980s, had been implemented. Three hundred copies were published on a bank holiday Monday, with a foreword by the then Conservative Secretary of State, Patrick Jenkin, stating that everything in the report was basically rubbish. [Interruption.] They are chuntering on the Conservative Front Bench, but they know that health inequalities worsened between 1979 and 1997. The hon. Gentleman might like to know that, since then, in eight years, the health of the poorest and most deprived in our nation has now reached the level that the rest of the population attained eight years ago. Infant mortality is down and life expectancy is up in spearhead areas. That shows what one can do with a Government who genuinely set tackling health inequalities as a priority. The Conservative party did nothing—indeed, we went backwards during their 18 years in government.

5. What recent assessment he has made of the adequacy of NHS occupational therapy services; and if he will make a statement. (232535)

No assessment has been carried out centrally because it is for primary care trusts, in consultation with local stakeholders, to determine how best to use their funds for improving health and to commission occupational therapy services accordingly. However, today gives me the opportunity during national occupational therapy week to thank the profession for its huge contribution to helping improve the health and well-being of service users throughout the country.

Let us deal now with 2008 issues, for which the Government are responsible. Earlier this year, my mother broke her hip while in hospital and I observed at close hand the wonderful work of occupational therapists. However, the Minister knows that, in adult social services, occupational therapists form 2 per cent. of the work force, yet deal with 35 per cent. of referrals. With health and social services becoming integrated, how will the Minister and the Government tackle the increasing number of referrals with such a small work force?

First, may I wish the hon. Gentleman’s mother well? I hope that her treatment proceeds successfully.

I am happy to say that the number of occupational therapists working in the NHS has increased to 17,024—an increase of some 48 per cent. since 1997. There has therefore been a huge increase in the number of NHS occupational therapists. In addition, local authority occupational therapists provide social care and help. The integration of the two services is important, and I would like more of that to happen. We have good examples, such as the Torbay care trust, which is not in the hon. Gentleman’s constituency, of local authorities working closely with PCTs to create a single referral pathway for those who wish to use occupational therapists. Self-referral is also popular. Those who self-refer get much benefit from going straight to an occupational therapist and gaining the treatment that they need to give them successful lives and improve their well-being.

An occupational therapist assessment is the first stage in accessing a disabled facilities grant. What is the point in having enough occupational therapists if there is then, as in my constituency, sometimes a two-year wait for people to get a disabled facilities grant? Work was done for one disabled child in my constituency only because the NHS intervened and paid for the adaptations that the council should have funded. Otherwise, he would have waited two years for an essential stairlift. What is the Minister doing to ensure that that is put right?

Order. Other Back Benchers have got to be considered.

I understand my hon. Friend’s concern for her constituents, and she is right to express concern about waiting times that vary from one local authority to another. I hope that local authorities throughout the country, including the one to which she referred, will pay attention to the importance of speedier access when somebody has had a diagnosis and is clearly in need of some form of facility to help them with their condition.

6. What assessment he has made of likely changes in demand for health services in the west midlands resulting from new housing developments in the region; and if he will make a statement. (232536)

The local NHS, in conjunction with other stakeholders, plans, develops and improves services to local people. In addition, the Department provides guidance and support to encourage local NHS services to promote well-planned, healthy and sustainable communities.

The Minister knows about the genuine concern in south Worcestershire about the demand on our local infrastructure posed by the significant increase in housing numbers, planned under the regional spatial strategy—numbers that the Government want to increase still further. What reassurance can she give that the necessary increase in the area’s health service infrastructure will be in place before the houses are built to ensure that existing residents and newcomers have full and proper access to the NHS?

As the hon. Gentleman knows, the local health service will constantly be looking to ensure that it is planning for the population that it has and for expected population growth. However, there are further requirements on both local authorities and the NHS to work together through their local area agreement to ensure that any planned housing development includes the plans for any necessary health or social care. He will know that Worcestershire PCT has formally set up a committee to look into exactly what the future growth in housing in the area may be and, therefore, what any future demands may be, including the development or expansion of Evesham community hospital.

The Minister will know that the Government have overridden many of the housing targets set by local authorities for their areas. Therefore, there is a growing disparity between the increased number of houses being put into areas and the health provision that those areas are given. An example in my constituency is that we are expected to have 30,000 new houses in a single borough in the county of Shropshire, and yet the paediatric service is about to be downgraded. Is that joined-up government?

I say to the hon. Gentleman that the development of housing is intended to satisfy demands in the area. The gap between the current and future population is not always that great, but he is quite right; the work has been done on the local authority side, through the requirement both to plan for the health and well-being of their populations, acting in partnership with the local NHS to look at sustainable communities and take that forward. Of course, within that will be the development of new services for the current population as well. I assure the hon. Gentleman that there is no question of extra housing being put in place without consideration being given to the future demands for health and social care.

7. What objectives he has set for reducing health inequalities in (a) England and (b) Greater London. (232537)

For England, the health inequalities national public service agreement target is to reduce inequalities in health by at least 10 per cent. by 2010, as measured by infant mortality and life expectancy at birth. There are additional health inequalities public service agreements to narrow the gaps in cancer and cardiovascular disease mortality and to reduce the prevalence of smoking in routine and manual groups.

Is mental health and mental illness taken into account in the assessment of health inequality? The Minister will know that south London, for example, has the highest rate of psychosis in the United Kingdom, which clearly has a huge knock-on effect in any family affected. Can she tell us that mental illness is taken into account and that it is in the Government’s sights as a major issue that we need to tackle in order to reduce people’s chances of experiencing mental health problems and increase their chances of being well?

I can assure the hon. Gentleman of that, yes. The issue is crucial to the investments that we are making in mental health and to improve the health of the nation as well. He will know that huge strides have been made in his area of Southwark in increasing life expectancy and reducing the low levels of infant mortality. In fact, progress is so good in Southwark that women now live on average for 82 years, which is higher than the English average—only just, but definitely higher.

One of the ways of reducing health inequalities is to ensure that resources follow need. When will the Minister and her colleagues be in a position to increase funding to primary care trusts that are currently below target?

As my right hon. Friend the Secretary of State said earlier, the announcements regarding PCTs’ funding and the operational framework are expected to be made later this year. That will include the allocations arising from the working party considerations.

As poor access to GPs perpetuates health inequalities, will the Minister agree to do nothing to undermine the excellent work of dispensing surgeries in rural parts of England? As she well knows, some of the proposals set out in the pharmacy White Paper threaten the very existence of some of those surgeries.

There are no proposals to curtail or reduce the provision of services in rural areas, and the Government have made no proposals to abolish dispensing GPs. I have said that repeatedly at the Dispatch Box in this House.

In Slough, we have seen two quite contrasting attitudes to health inequalities, as our local primary care trust was merged with those serving the much more prosperous areas of Windsor, Maidenhead and Bracknell, where people live longer. We have narrowed the age gap between Slough and elsewhere by targeting public health in Slough but, in the consultation about the new PCT, the residents of Windsor, Maidenhead and Bracknell said, “Will Slough take all the money?” Will the Minister ensure that areas of extreme need in PCTs get the resources that they need?

My hon. Friend raises a good question. I can assure her that, where there are small pockets of deprivation in an otherwise reasonably affluent area, resources will be directed to those areas of high health inequality within PCTs. Regardless of comments made by other residents, the Government are determined to continue to keep health inequalities at the top of the agenda so that we can narrow the gap.

Londoners will have heard the complacent comments of the Minister today, but a more frank assessment comes from her ministerial colleague, Lord Darzi. In his report, he states that:

“healthcare in London is not equitable, either in terms of mental or physical health outcomes, or in terms of the funding and quality of services offered.”

Is that something that the Minister is proud of, after 11 years of a Labour Government?

I am proud that all the spearhead groups in London in the areas of highest inequality are narrowing the gap. I am also proud of Lord Darzi’s report, particularly in relation to London and to identifying polyclinics as the way forward to ensure that services are made available on an equitable basis to the population. That is a policy that the Conservatives have opposed.

8. What proposals he has to improve NHS services available to people with diabetes. (232538)

We are working with key stakeholders, including the national diabetes support team, on a range of initiatives to support the NHS in improving diabetes care. We particularly recognise the valuable role that diabetes specialist nurses play in supporting people with diabetes. In March 2008, the national diabetes support team published “Improving emergency and inpatient care for people with diabetes”, which highlights the importance of the diabetes specialist team, including the specialist nurses.

I am grateful to my hon. Friend for that response. Is she aware that Friday 14 November is world diabetes day? Will she mark that day by taking up the concerns expressed by Diabetes UK about the patchwork of provision that exists across the country for this illness, which costs the NHS £1 million an hour?

Yes, of course. World diabetes day is on 14 November, and this year its theme is diabetes in children and adolescents. I am pleased to say that I shall speak at the Diabetes UK parliamentary reception on Tuesday 18 November.

By 2025, there will be an estimated 4 million people with diabetes, yet Diabetes UK has already received reports of cuts in services. What plans does the Minister have to ensure that people with diabetes have the support that they need in order to prevent the serious complications that can result from poor diabetes management?

We are in constant touch with Diabetes UK and, in particular, with its support teams working on the “Silent Assassin” campaign, which was launched on 6 October. The campaign highlights the fact that diabetes is a very serious condition that causes heart disease, stroke, amputations, kidney failure and blindness. The advertising campaign includes a series of outdoor posters as well as newspaper and consumer magazine advertising. The Department will continue to work with Diabetes UK and to encourage all primary care trusts, and the NHS in general, to continue to work on this very important issue.

Is my hon. Friend aware of the Apnee Sehat programme that has been introduced in Warwickshire by Dr. Shirine Boardman? It particularly addresses the concerns of the Asian community, whose traditional cooking methods and dietary habits contribute to the very high incidence of diabetes in that community. Will she encourage other PCTs to consider such schemes as well?

I welcome my hon. Friend’s contribution. We are aware that the prevalence of diabetes can be up to five times higher among those from a black or minority ethnic background—for example, those from a south Asian background in the UK. That increased prevalence may be due to different underlying behavioural, environmental and lifestyle mechanisms—and, of course, the wonderful food that is produced. On a recent trip to India, I realised the seriousness of the escalation of diabetes in that country, with 40 million diagnosed with the disease and another 30 million undiagnosed. It is a serious issue, and I know that many innovative PCTs are looking into cooking methods. I would be pleased to hear more about the scheme that my hon. Friend mentioned.

NICE guidance recommends that newly diagnosed diabetics should have structured patient education made available to them. Given the rising number of people, particularly children, suffering from diabetes, is the Minister confident that PCTs have the necessary resources and diabetic nurses available to provide that service?

The hon. Member raises an important point about education. We are working continually with the support team that published “Improving emergency and inpatient care for people with diabetes”, particularly in respect of children and young adolescents. It is an extremely important programme and the diabetes specialist nurse, of course, plays a pinnacle role in the team.

In declaring my interest as a sufferer from type 2 diabetes, I welcome the Health Secretary’s proposed visit to the Silver Star centre in Leicester, whose aim is to raise awareness so that people can be tested for diabetes. Will the Minister pledge to increase the resources that the Government give to voluntary projects to help the centre to do that assessment, which is so vital to people finding out whether they have diabetes?

Great work has been done on diabetes in my right hon. Friend’s area. Since 2006-07, the quality and outcomes framework has rewarded practices for recording the ethnicity of 100 per cent. of new patient registrations. There is, of course, much more work to do, but I believe that we have made great progress.

9. What recent assessment he has made of the security of data held within the NHS IT programme. (232539)

Data held electronically can be secured using encryption and other measures that are not applicable to old paper-based systems. The NHS national programme for IT has particularly high levels of security because of the sensitive nature of the data held.

Does the Minister accept that, with hardly a week going by without some Government Department having a serious breach of data security, patients are very worried about these sensitive matters. What real assurance can the Minister give that we will not pick up a newspaper tomorrow or next week and find out about a breach in his Department?

There is no such thing as a 100 per cent. guarantee of the type that the right hon. Gentleman seeks. I hope to reassure him on his question about the national programme for IT, however, because none of the data losses over the last few months has involved that programme. It has almost entirely been the old paper-based systems of record holding that have caused the problems, which reinforces the point in my initial reply—that computer-based systems, particularly those involving the national programme, are much more secure because of encryption and other measures. Data protection is a very serious matter and we take it very seriously. We welcome the Information Commissioner’s proposals to strengthen sanctions against people who breach the Data Protection Act 1998. We require all hospitals to provide information about what action they take when such breaches occur.

Did the Minister see the recent article in Computer Weekly, which revealed that the national health service has released 300 million confidential medical records—including dates of birth, postcodes, details of A and E visits and in-patient treatment—to an academic organisation outside the NHS? A further 250 million records of a similar level of detail of out-patient treatments were released. How satisfied is the Minister that the academic world will treat such sensitive information with the necessary confidentiality? Will the framework be as tough as the one he described in respect of the NHS?

I could not possibly be such an avid reader of Computer Weekly as my hon. Friend, who takes a close interest in all matters to do with computers. However, I want to reassure him that the sort of release he refers to—I think I am right in saying this, but I shall check and write to him—is anonymised data used not only to help compile statistics on health care and outcomes, but for research purposes, which is an important function of the use of data.

To follow up the question asked by the hon. Member for North-West Leicestershire (David Taylor), does the Minister accept that, if individuals’ medical records get into the public domain by whatever means, it can be very damaging to the life and perhaps even the employment prospects of a particular individual? Will he assure me that the Government will do everything possible to ensure that medical records remain private? Are there grounds for saying that there might be compensation to an individual who feels that his or her life has been adversely affected by their records becoming public knowledge?

The last part of the question would be better answered by anyone who feels that they have been affected by that taking advice from their lawyer. However, I reassure the hon. Gentleman that the Department certainly places hard strictures on the NHS, including work done by GPs at local level, for that massive organisation to comply with data protection rules. There are clear responsibilities on individual health service managers at local level. They know their legal obligations, and there have been dismissals in the past 12 months as a result of data breaches. We take the issue seriously, but we are always looking to see how we can improve things.

10. What discussions he has had with ministerial colleagues on the contribution of local health services to the operation of children’s trusts. (232540)

My right hon. Friend the Secretary of State for Health has regular meetings with the Secretary of State for Children, Schools and Families about a range of policy and operational issues affecting the health and well-being of children. This of course includes issues relating to the operation of children’s trusts. Children, families and stakeholders have been engaged in developing the strategy over the summer. We therefore expect to be in a position to publish the child health strategy later this year.

The Audit Commission published a report last week that concluded that there is little evidence that children’s trusts have improved outcomes for children. My concern is whether local primary care trusts and other health services right across the country are fully playing their role in children’s trusts. The Audit Commission makes six recommendations for central Government. What action can the Minister promise to ensure that all services contribute to the improvements that we need so badly for children?

The hon. Lady mentioned the Audit Commission’s criticism. We are very disappointed that it chose to take such a negative approach. The headline message that has been quoted from the commission’s press release is a misrepresentation of what its report as a whole says and draws on fieldwork that is now almost a year old. Since then, the children’s plan sets out clearly our high ambitions for children and the role of children’s trusts in delivering them. That will become more apparent with the launch of the children’s strategy later this year. I believe that more information for PCTs will be announced by the Secretary of State for Children, Schools and Families on 19 November.

T1. If he will make a statement on his departmental responsibilities. (232555)

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.

I am grateful to the Secretary of State for that answer. After a decade or more of the NHS in my constituency, covering Sutton, Cheam and Worcester Park, going in ever-decreasing circles—consulting, drawing up plans, devising strategies and holding stakeholder events—at last it has come forward with an outline business case for much-needed investment in patient facilities at St. Helier hospital. Will the Secretary of State tell my constituents just how much longer they will have to wait for the Department and the Treasury to give the go-ahead, and will he meet me and other Members of Parliament with an interest in the matter to discuss it further?

I am glad that, despite the long period of consultation, plans are now coming forward. I cannot give the hon. Gentleman any idea of how long the process will take, because I am not aware of the situation, but I will be after we have met, and I very much welcome a meeting with him and his colleagues.

T4. My right hon. Friend received a nice invitation to visit Chorley and Preston hospitals. I believe that there is a great success story there. My right hon. Friend ought to come and see how the access treatment service centre is working under the NHS. He could learn from that, and I believe that it would be a good visit. Will he reconsider his position, and visit those hospitals sooner rather than later? (232558)

I was not aware that I had taken a position, but I would very much like to go to Chorley and see Hoyleism in practice.

The Secretary of State will be aware that the number of care home residents who have died as a result of clostridium difficile trebled between 2005 and 2007. I believe that the number is now 438, which is a horrifying death toll. Given that the Government have focused largely on tackling the problem in hospitals, what steps is he taking to address the problem in the wider community and does he agree that there must be zero tolerance for low hygiene standards in any health or care setting, wherever it is?

I agree that this is a crucial issue. We have not been concentrating on reducing the number of cases of clostridium difficile in hospitals to the exclusion of social care. Indeed, we have insisted on proper records being kept, and by next year we shall have in place a registration system for care homes that will be an important factor in raising standards. Our campaigns to increase awareness of the dangers of over-prescription of antibiotics, the need for people to clean their hands, and all the other issues that apply to hospitals have been conducted in care homes as well.

We do need to ensure that there is no continuing increase in clostridium difficile cases in care homes. I believe that the registration scheme will be the biggest single factor in helping us, but we must take all the other measures as well to ensure that we do not see any further increase in cases in adult social care.

T8. Will my right hon. Friend allay my fears about the problems with clostridium difficile, which is on the increase in Scotland, by ensuring—through his cross-border discussions with the Scottish Executive and, for that matter, with the Welsh Assembly and the Northern Ireland Assembly—that best practice is shared so that everyone receives the same deal in the NHS? (232563)

My hon. Friend will know that, according to the latest statistics relating to the period between April and June, there has been a 38 per cent. decrease in cases of clostridium difficile among those over 65. That builds on decreases of 32 per cent. in the preceding quarter and 22 per cent. in the quarter before that. All those figures are in comparison with the same quarter in the previous year.

This is a national health service, and we are constantly in touch with the devolved Administrations to discuss how we can learn from each other about tackling these issues. As I said in my reply to the hon. Member for North Norfolk (Norman Lamb), there are three basic messages: the need for clean hands, responsible prescription of antibiotics, and the provision of cohort nursing and isolation facilities when outbreaks occur. Those three simple messages must be repeated over and over again.

T2. In Oxfordshire, we all want to see the Oxford Radcliffe Hospitals NHS Trust succeed. Will the Minister confirm, however, that when the trust draws up its business plan for foundation trust status, it cannot expect year-on-year funding increases greater than the predicted funding increases for Oxfordshire primary care trust? Will he also confirm that when members of the independent reconfiguration panel speak of the need for county-wide health proposals, they, and the Secretary of State, expect exactly that—county-wide health proposals for Oxfordshire, not just Oxford-focused proposals? (232556)

When the independent reconfiguration panel reported, my right hon. Friend the Secretary of State made it absolutely clear that he accepted its recommendations in full, so the answer to the second part of the hon. Gentleman’s question is yes. As for the first part, I have been reassured by the Radcliffe that it is entirely aware that its financial planning must reflect the commissioning planning of the primary care trusts, and that it must continue to work closely with Oxfordshire PCT to ensure that it delivers what the hon. Gentleman wishes to see.

Will my right hon. Friend consider delaying his statement on co-payments until he has accepted that the exceptional cases and disparities across the country should be handled first? Does he agree that if they were handled first, there might be no need for co-payments?

My hon. Friend really ought to listen to the statement, because the issue that he has raised will feature in it.

T3. Given that UK-trained radiographers demonstrate best practice, why is no funding available to provide courses for the statutory 30 days’ academic study, so that those who wish to return to practice after a five-year break, for example to have a family, can do so? Does it not make good economic sense to support motivated returners so that they can enhance the UK’s radiography skill base, rather than relying on attracting foreign nationals? (232557)

The hon. Lady’s point sounds eminently sensible. Perhaps she will allow me to look into it and come back to her.

The medical director of my local NHS hospital trust has reported great difficulty in recruiting doctors to essential positions in the hospital below consultant level as a direct consequence of the restrictions placed on the number of international graduates coming into the country last year. Does my right hon. Friend have any proposals to review that system, as it would appear that there are too few doctors for the posts that are now available?

I am perfectly willing to speak to my hon. Friend about the problems in his patch, but the issue here is that we cannot have both a policy of self-sufficiency and an open-door policy. We now have the medical schools in place to produce our own graduates for jobs. The contribution made by international medical graduates has been enormous, but we ran into problems a couple of years ago because there were sometimes as many as 20 or 25 applicants for every position, and that does not make sense if the British taxpayer is putting more money into training our own graduates. We took measures this year to ensure that that situation did not arise, but I am perfectly willing to talk about any problems occurring in any part of the country, and particularly in my hon. Friend’s constituency.

T6. Did the Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo), really mean her answer to my hon. Friend the Member for South-West Devon (Mr. Streeter) that the Government have no plans that will adversely impact on GP dispensing? I have received literally hundreds of letters from constituents who all share my view, and the view of GPs, that three of the four proposals in the current consultation document would seriously adversely impact on GP dispensing and, therefore, the rural areas they serve, and only one—option 1, which recommends the status quo—is acceptable. (232561)

Yes, I did seriously mean that answer, and if the hon. Gentleman refers back to the consultation document, he will see that it sets down four possible ways of looking at an issue that has not been reviewed for more than 60 years, but there are no specific proposals to do anything. [Hon. Members: “Oh!”] There are no specific proposals to do anything, as that is not the purpose of the consultation. So if the hon. Gentleman is saying the Government intend to abolish GP dispensing, that is not true.

T7. Can the Secretary of State reassure me that, when the child health strategy is eventually published, I shall have cause to dance around the mulberry bush in joyous appreciation of its explicit commitment to take forward the speech and language agenda, or will the Treasury have spoiled my fun? (232562)

The hon. Gentleman did a first-class piece of work on behalf of myself and the Department for Children, Schools and Families. He will be ecstatic when he sees the results of the child health strategy review, and I will dance around the mulberry bush with him.

Speaking at the men’s health forum event in Manchester last week, I was struck by some of the innovative projects around the country to tackle the inequalities in men’s health, but there was a common theme for all those projects: they were innovative and they worked, but their level of funding was unsustainable. When the physical activity strategy is launched, will my right hon. Friend ensure that we try to find out which projects work, and then fund them and deliver them right across the country, rather than think of new pilot projects?

Yes, I can give that assurance to my hon. Friend. Where such projects are clearly working, it is important that that experience is shared with other areas and its benefits taken forward. We must focus on that.

Can the Secretary of State explain why he believes it is wrong for a cancer patient to pay £7.10 for a prescription in the community, while at the same time they can be made to pay more than £11,000 for a bowel cancer drug, despite its being recommended by their hospital doctors?

We are straying into the territory that will shortly be the subject of my statement. The issue of charging for drugs that are not available on the national health service is important, and I believe that I picked the right person to look into it. When I make my statement in a few minutes, I believe that hon. Members on both sides will agree that he has done an excellent job of the task that we gave him.

Does the Secretary of State agree with the findings of the Rarer Cancers Forum’s survey of English primary care trusts, which concluded that the wide variety of processes used to determine exceptional cases causes confusion among patients, that things are often dominated by administrators rather than by clinicians, and that results are sometimes not produced in a timely fashion?

I do agree with my hon. Friend. As I mentioned, we need to address that issue about transparency, consistency and a lack of clarity. If he remains in his place, he will hear that some very important proposals in that area are contained in the report from Professor Mike Richards.

I am still concerned that there are no proper guidelines for practice-based commissioning or polyclinics in relation to integrated health care and that at a time when Lord Darzi is recommending innovation and choice for patients, there is no proper thinking in the Department about what to do in respect of herbalists, acupuncturists and homeopaths, who want to make their contribution. What does the Secretary of State have to say about that?

I hope the hon. Gentleman will accept that we have announced that we will run some pilots on how to have more integrated primary care and that we have had huge interest from PCTs all over the country. He should welcome this step forward, given his long history of supporting alternative and complementary medicines.

I welcome the new Care Services Minister to his post and wish him the very best in this important role. I acknowledge the advances on hospice funding in the end-of-life strategy, but I am sure he will acknowledge that hospices still face a huge struggle to raise the funds that they need to survive. This year is the 30th anniversary of Wheatfields hospice in Headingley in my constituency—a happy event—so I invite him to join me, if he has the time, to visit that wonderful institution to see the work that it does.

I thank the hon. Gentleman for that kind invitation. He is right to say that end-of-life care is a matter that the whole House should take very seriously, because palliative care services are essential. The Government are pushing the dignity and respect campaign right across the country, with 3,000 or 4,000 people asking how we can treat older people with dignity and respect when they need social care. Dignity and respect at the end of life is a particularly important part of that. He invited me to visit his constituency to see a particular hospice, and I am happy to check my diary to see whether I can accommodate that request.