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Oral Answers to Questions

Volume 485: debated on Tuesday 16 December 2008


The Secretary of State was asked—


Reducing smoking is a public health priority for the Government. We will bring forward legislation to remove the display of tobacco from retail environments and tighten requirements on vending machines. Both policies primarily aim to protect young people from smoking. Protecting young people will also be a key theme in our new tobacco control strategy.

I thank my right hon. Friend for that very positive response. Does he recall the private Member’s Bill that I introduced in October 2005, entitled the Age of Sale of Tobacco Bill, in which I proposed to raise the age for smoking from 16 to 18? That proposal was later incorporated into the Health Bill, I am glad to say. Is he also aware that, in Barnsley, one third of all smokers under 18 buy their cigarettes illegally from what are known—for want of a better expression—as the local fag houses? The problem is so acute that Barnsley council has set up a tobacco task group to look at the issue. What more can the Government do to stop the illegal sale of tobacco to young people?

I pay tribute to my hon. Friend for his sterling work over a long period of time to get the age of sale increased to 18. He asks what more we can do. From April next year, the “three strikes and you’re out” rule will come in. If any retailer is caught selling cigarettes to under-age children three times, they will not be allowed to continue retailing. Other measures to tackle illicit tobacco are important, particularly in the context of the famous Barnsley fag houses that we are now learning about. Micro-chipping illicit cigarettes is an important development from Her Majesty’s Revenue and Customs, for example. There is a whole range of steps that should be taken, but that should not detract from the public health initiatives that we are taking in removing tobacco from the point of sale and ensuring that we take action to regulate vending machines.

I welcome the Secretary of State’s proposed legislation, which offers the prospect of real and lasting progressive change for the better. Will he tell the House what steps he is taking to enlist the services of some of our sporting icons—the Olympic gold medallists spring readily to mind—in trying to persuade young people of the dangers of smoking and the benefits of abstinence?

I thank the hon. Gentleman for his welcome for our proposals. He has raised an important point. We know that there is an issue about young people smoking. On average, 10 per cent. of 11 to 15-year-olds smoke, but almost one in five 15-year-old girls smoke. They take up smoking—as most of us did in our youth—because they see role models and people whom they admire smoking. The message from Olympians and others, which we will ensure is strongly put forward, will help in that regard. The research evidence clearly shows that the only place where tobacco can now be advertised is on point-of-sale displays and that that gives young people the impression that smoking is normal. That is what we are seeking to address with these proposals.

Regardless of the merits or otherwise of the proposals, does my right hon. Friend accept that carrying out the proposed work will involve costs to small shopkeepers? Does he have an assessment of those costs, and does he have any plans to compensate retailers for them?

I accept that there are issues for small retailers, and of course there will be a cost. The Save Our Shop campaign is the brainchild of the Tobacco Retailers Association, which is an offshoot of the Tobacco Manufacturers Association, which represents Imperial Tobacco, Gallahers and others in the smoking industry. The campaign is estimating the cost at something like—

This might be totally irrelevant to the question that my hon. Friend asked, but the campaign has put the cost at something like £6,000. There is no evidence whatever for that. The evidence from the countries that have introduced these measures is that there is a maximum cost of £1,000. In Canada, it was £500. The cost of putting up the displays is met by the tobacco manufacturers—by the cigarette companies themselves. We will of course offer assistance to small businesses. That is why we are saying that this measure will not be introduced for small shops until 2013. That will give us plenty of time to have a full consultation and to ensure that this will not damage those businesses.

I also welcome the steps taken by the Government further to reduce the damage done by smoking-related diseases, but will the Secretary of State reflect on his decision not to make progress with one proposition that achieved 98 per cent. support in the consultation exercise—namely, the proposition that tobacco products should be sold in plain packaging? That seems to have been parked for the time being by the Government. Will the Secretary of State confirm that he is not ruling out considering that matter and that there remains a strong possibility of introducing it at some point?

The right hon. Gentleman has welcomed—indeed, two Opposition Members have welcomed—the proposals, unlike the Conservative Front-Bench team. I heard the argument from the Conservative Front Bench in last week’s Queen’s Speech debate that there was no evidence base for the proposals. I have to say, however, that despite the fact that the right hon. Gentleman is quite right about the huge response in favour of plain packaging, there is no evidence base that it actually reduces the number of young children smoking. We want to keep that under review, and when there is an evidence base for it, it could well be another important measure to meet our goal, which is to reduce the number of young people smoking.

As the chairman of the all-party group on smoking and health, I warmly welcome the proposals. There will not be evidence on plain packaging now, as we are the first country to suggest the measure, so it needs to be piloted in some way. May I say to the Secretary of State that I was disappointed in one aspect of the announcement—the failure to abolish vending machines, which are used as the medium of sale for fewer than 1 per cent. of all cigarettes? The suggestion that we can somehow tighten up to minimise the number of young people buying from vending machines is likely to prove a dead end. The sooner we introduce the abolition, the better.

I understand my hon. Friend’s argument. We will take a power in the proposed Bill to ban vending machines. We were persuaded during the consultation, however, that there are other measures to restrict young people’s access to vending machines without banning them. I do not think that Governments should move to banning things if there is another alternative. We were persuaded of the alternatives such as carrying out an age check before giving tokens to use in vending machines and other methods that have been used successfully to restrict access by young people. It is sane and rational to try those out first, to have the power to ban in the legislation if necessary and to move towards a ban if the other measures do not work.

The Secretary of State knows that we want to proceed on the basis of evidence and he has appealed to evidence. Last Thursday, he told the House:

“The number of young smokers in Canada… was reduced by 32 per cent. among 15 and 19-year-olds as a result of the implementation of the measure.”—[Official Report, 11 December 2008; Vol. 485, c. 724.]

Well, I asked the House of Commons Library to look at the statistics from Canada and it says that the tobacco display ban was not introduced in all provinces; that it was introduced only in Manitoba and Saskatchewan; and that since the tobacco display ban was introduced, there were no statistically significant results for any reduction in the number of young people smoking in either of those provinces. Will the Secretary of State simply apologise for giving the House an inaccurate presentation of the data on Canada and will he put a note in the Library explaining his basis for the proposition that there is a proven reduction in young people smoking?

That is an extraordinary position for the Opposition Front-Bench team to take, particularly when we have produced the research from the British Heart Foundation—

Well, if that is shredding—[Interruption.] The hon. Gentleman should hang on before he talks about shredding things.

What Cancer Research UK’s extensive evidence shows—and it was all produced during the consultation period—is this: young people are more receptive than adults to tobacco advertising; being exposed to tobacco advertising and/or promotion increases the likelihood that a young person will take up smoking; and large displays of tobacco convey the notion that smoking is common. In Canada, 12 out of 13 provinces have introduced this legislation—and they have introduced it because there is absolute evidence, as there is in Iceland and other countries that have introduced it, that it reduces the number of young people smoking.

Thailand and the British Virgin Islands, if the hon. Gentleman wants an exhaustive list, but as my hon. Friend the Member for North-West Leicestershire (David Taylor) said, the point is this: someone has to be in the vanguard, which is why Australia and New Zealand are preparing to introduce such legislation. It is hugely disappointing that there is not a political consensus across the three parties, because the evidence is clear, the evidence is there.

NHS Dentistry

5. What his most recent assessment is of levels of access to NHS dental treatment; and if he will make a statement. (243635)

In the 24 months to the end of June 2008, 26.9 million people saw an NHS dentist. Improving access is a top priority and we have increased dental funding to more than £2 billion. In addition, last week we announced that we have set up a review to advise how we can ensure that everyone who wants to see an NHS dentist can do so. The review will be led by Professor Jimmy Steele of Newcastle university.

Over the past two years, my constituents have constantly approached me to say that their dentist has stopped doing NHS work and that, contrary to what the primary care trust website says, they cannot find a dentist in Chesterfield or Staveley who will take new patients. Yesterday, a Chesterfield dentist of 32 years’ experience told me that the current contract is the most bizarre arrangement ever devised by man. Will the Minister finally admit that the Government got the contract completely wrong, that 1.2 million fewer patients are seeing NHS dentists and that the contract needs scrapping and rewriting as quickly as possible?

The British Dental Association is working very positively with us on the contract. The review that we have recently announced is to ask how we can improve access, but there is no question but that access has improved throughout the country.

There is a question whether access has improved throughout the country. I have been telling Ministers for some time that the majority of my constituents, me and my family cannot find an NHS dentist in Leicestershire. That is the fact. Access is not better. The review announced last week is an admission of the failure of the contract. Instead of a review, how about the Government saying what they are going to do about this now to improve access to NHS dentistry.

I suggest that the hon. Gentleman calm down a bit, for the sake of his own health. I am happy to advise him on how to do that. Access throughout the country and the oral health of patients throughout the country have improved. The review is assisting us to improve access. There are open lists in his constituency. That has been stated by the primary care trust.

The Minister will know that there are 24,000 fewer patients registered with NHS dentists in Stockport, compared with 1997. Stockport primary care trust has been offering extra sessions to try to fill the gap, but local dentists prefer to stay private, saying that the fee structure is not sufficient for them to provide a professional service under the NHS. Does she share my concern at the state of NHS dentistry in Stockport and will her review tackle the issue, whereby my patients are denied NHS treatment and, in a recession, are forced either to pay to go private or, worse still, to go without treatment altogether?

The review will be guided by the principles of the NHS next stage review, ensuring that services are responsive to the needs of individual patients, that there is a strong focus on prevention as well as treatment, and that there are continuous improvements in the quality of care, especially in relation to the inequalities at the moment.

The whole House should also recognise the work that dentists have done with the contract and the improvements that have been made, such as the new treatments and the new dentists who are coming out of newly opened dental schools. I look forward to discussing the Health Committee report later this evening.

My good friend the Minister has read the recent Health Committee report on dentistry, so she will be aware that there are parts of the country where very few people have any problems accessing an NHS dentist. That is true in my area, where I serve constituents from south Gloucestershire and Bristol. We found that where commissioning is taken seriously by PCTs and they collaborate with the local dentistry profession, excellent results can be produced. What will she do to ensure that PCTs take this matter seriously and work with their dentists to commission good services?

I thank my hon. Friend. The Health Committee report points out how bad things were in many parts of the country before the contract changed, and how good they are where proper commissioning takes place. That is without question. More work has to be done on commissioning and I know that Professor Steele will be looking at that matter seriously. I welcome the opportunity to share the report with the House soon.

I have a slight interest in this matter, as is well known. The Minister will be aware that there are 13,000 people with oral cancer at any one time in the UK. About 50 per cent. of those people will die, and the mortality rate is getting worse, not better. The key is access—and I believe, as do dentists, that the key to access is the contract. There has been an implementation group running for some time—I do not know its name because it has changed. What suggestions has it made to the Minister to change that contract to make it more desirable for dentists to work for the national health service?

The Health Committee’s suggestions on the hon. Gentleman’s point are taken very seriously by the Department. We want to work with Professor Steele to see how access to oral health can be improved, which the hon. Gentleman rightly raises as a concern; it is a concern to all of us. We want to make the contract work. So many people and PCTs are doing so, and this House should congratulate the dentists who have been working so hard through the new contract.

Availability of NHS dentists in Enfield is not our problem. In fact, there will be an 8 per cent. increase in the coming year, but there is a shortfall in uptake. It is a small shortfall, but none the less it is there. My PCT is going to run a major advertising campaign in the new year to deal with the matter, but constituents tell me that they are not entirely clear what they are entitled to and what it might cost them. Can I suggest that the way in which we communicate with constituents on such matters should be a major part of the review?

I thank my right hon. Friend for her comments on behalf of Enfield. We have to look to PCTs, so many of whom are very imaginative in their advertising and in their use of communication skills, to encourage the best to help the rest. I believe that world-class commissioning will help in that process.

Although health is a devolved matter in Northern Ireland, what steps can the Minister take in conjunction with other Health Ministers right across the UK to ensure that newly qualified dentists take on NHS patients, and that they do so in rural areas and in less populous areas, where the difficulty is more acute?

We are increasingly looking at how we can share best practice with the devolved Parliaments, because we can learn so much from each other. Our new students coming out of dental school are showing a great willingness to work throughout areas, particularly where health inequalities exist, which tends to be more in rural areas because of issues of access.

Telephone services have an effect on access to NHS dentistry and to GPs. What is the NHS doing to cut back on the very regrettable but widespread use of 084 telephone numbers, which cost patients extra money? It is a scandal throughout Government, with thousands of 084 numbers being used, including a lot in the NHS. What are the Government going to do about that?

I thank my hon. Friend for that topical point. We have announced and launched a public consultation today on this issue, which is due to run until 31 March 2009. It will inform the Government’s decisions on the future of such numbers in the NHS. I certainly share my hon. Friend’s concern about those actions, as do the ministerial team.

The British Dental Association will be fascinated by what the Minister said earlier about working with it. This contract was imposed on dentists even though the BDA warned that it would not be any good for British dentistry. Also, a Minister was invited to this year’s BDA national conference, but no Minister turned up, even though one was on the train going to Manchester when I was travelling to speak at the event. I know that we will debate this important issue later, and we have had an excellent report from the Health Committee, but can the Minister explain why she thinks things are going so well when 4,000 patients a day are not able to see an NHS dentist?

On the point about the conference and meetings with the BDA, the chief dental officer and I have regular meetings with the BDA, and the consensus around the table is to work together, which I suppose would be alien to the hon. Gentleman. Working together in partnership with professional organisations that represent health workers right across the board comes naturally to Labour Members, and it will always continue to do so.


3. Whether he plans to meet Merck, Sharpe and Dohme to discuss compensation for those affected by Vioxx. (243633)

I have no such plans. The then Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), met representatives of the company on 10 July 2008 and conveyed to them the concerns expressed by Members.

I thank the Minister for his answer. My constituent, Mr. David Jones of Elterwater, is just one of the many hundreds of innocent UK victims who have suffered severe health problems as a result of taking the anti-arthritis drug Vioxx. Following the landmark victory of Les Thomas in last week’s court case in Cambridge and the $4.85 billion settlement already paid to American victims by Merck and Co., will the Government now put pressure on Merck to ensure that all patients whose health has been damaged by Vioxx are given the compensation they deserve?

The hon. Gentleman knows that this is a very complex issue, and I have every sympathy with those UK patients—including his constituent whom he has mentioned—who believe that they have been adversely affected by Vioxx. As the hon. Gentleman knows, I cannot comment on individual cases, but I understand that the case he mentioned is not related to the matter concerning cardiovascular disease. It would be inappropriate for Ministers or Government officials to intervene in, or comment on, any current or potential claims for compensation from the company in question in this country, as they are properly for the legal system. However, patients who believe they have a case are not prevented from taking a test case to a court of law.

I wonder where the Minister draws the line on patient responsibility when they may know the potential dangers of a drug but still wish to take it because it is effective. I should declare an interest: I took Vioxx and I found it wonderful. It probably caused an ulcer, but I still agreed with my doctor to continue to take it because of its effectiveness, despite knowing of the risks. It was then withdrawn, so I could no longer do that. Vioxx is not the only such drug; there is also co-proxamol, for example, which has been withdrawn from use, too. It is difficult for people with arthritis or joint pain to find an effective analgesic, because the ones on which they have come to rely have been withdrawn. Nevertheless, many such patients would accept the risks involved in taking those drugs and still take them.

My hon. Friend speaks with great personal experience, and her question illustrates the complexity of these matters. It must, therefore, be right for it to be up to individual patients who believe that they may have been adversely affected in any such circumstance to make their own decisions about claiming for compensation and pursuing that through the legal system. It is certainly not appropriate for the Government to try to bring pressure to bear on an individual company in the circumstances my hon. Friend describes. These must be matters for clinicians and individual drug companies to decide, and it is for the National Institute for Health and Clinical Excellence to make recommendations as appropriate.

The Minister’s predecessor took a rather different view, and four years ago The Lancet concluded that:

“The licensing of Vioxx and its continued use in the face of unambiguous evidence of harm have been public health catastrophes.”

This year, a leading US American journal claimed that Merck had drafted “dozens of research studies” on Vioxx and then got prestigious doctors to put their names to them—there was ghost-writing, in other words—and had misrepresented data. Given that most of the 400-plus victims of Vioxx in this country were NHS patients, is it not incumbent on the Government to intervene in this scandal and demand that Merck treats British victims in exactly the same way as US victims have been treated in the $4.8 billion settlement from which they have benefited?

I understand the concerns of the hon. Gentleman and other hon. Members. My predecessor met a parliamentary delegation on the matter only this July, so representations have been made. I must emphasise to the hon. Gentleman that it is not appropriate for Ministers or for Government to intervene in, or comment on, a potential claim for compensation that might be carried out in this country and that is properly a matter for the legal system to address. I repeat to him that the Government do not have any ability to bring sanctions to bear on the company that he is describing. If patients believe that they have a case, they are not prevented from taking it forward in a court of law in this country.

Prescribing Costs

Annual growth in primary care prescribing costs in the year to March 2008 was 1 per cent. That is set against a 5 per cent. increase in the number of prescription items dispensed. Unfortunately, it is not possible to attribute a specific cash sum to more efficient prescribing, because variables, such as the cost of the drugs themselves, will affect the savings that are made by primary care trusts. I think that the hon. Gentleman can see that there has been some progression in efficient prescribing over the past year or so.

The Minister may recall that in its 2007 report, the Public Accounts Committee recommended, and the Government accepted, that more than £200 million a year could be saved for the NHS by prescribing generic drugs, rather than branded ones, without any adverse effect on patients. Has that target of £200 million been achieved? Which PCTs have made the most progress and which have made the least progress? If he does not have the information to hand, he may write to me.

The PAC report was very helpful, and I am grateful to the hon. Gentleman’s Committee for the work that it has done. The health service pays an £8 billion drug bill at the moment, so I am pleased to be able to tell him that PCTs are making considerable progress. Generic prescribing has increased from 51 per cent. in 1994 to 83 per cent. in 2008—that is the highest rate in Europe. He will know that PCTs are independent bodies and that they make their own decisions about these matters, but we have issued guidance to PCTs. Although it is ultimately for them to decide, the practice-based commissioning that we have seen and other guidance that we have issued is definitely driving the NHS forward in the right direction, towards the more efficient prescribing of drugs.

Five thousand of my constituents have written to the Minister, via me, asking that their general practitioners be allowed to continue dispensing. Will he take heed of this Bassetlaw common sense?

My hon. Friend has been at the forefront of the campaign on the issue of dispensing by doctors. We are analysing the responses to the consultation on pharmaceutical provision in England, and we will be making an announcement on these wider issues as soon as possible in the new year. I am aware of the strength of the responses we received on the various options for amending the criteria for dispensing by doctors. We have taken into account the views of those attending the listening events, the meetings and so on, and as a result I am pleased to announce to him that there will be no change to the current arrangements on GPs dispensing medicines to their patients.

Building on the remarks made by my hon. Friend the Member for Gainsborough (Mr. Leigh), does the Minister accept that if his June steering group report recommendation that there should be statutory regulation were implemented for complementary medicine, herbal medicine and acupuncture, that would create further downward pressure? That is because doctors would be prepared to refer to these practitioners, who charge a lot less, and, thus, the cost to the health service would be less.

I thank the hon. Gentleman for his question; I shall certainly consider the contribution that he is making and write to him on the particular point that he raises.

Has my hon. Friend considered the wastage of drugs through inefficient prescribing, especially in relation to free prescriptions? Many people accept the drug offered on the prescription, but do not use it. Even though the drug is unused and still in its original packaging, it cannot then be used and has to be destroyed. That loses the NHS a huge amount of money.

I understand my hon. Friend’s concerns and those of other hon. Members who have written to me about wastage. We are all concerned about wastage caused by unused medicines. The difficulty is that the recycling of medicines in the way that he and others have suggested is regarded as unethical and unsafe according to the code of ethics produced by the Royal Pharmaceutical Society. Indeed, some hon. Members have suggested that we could donate unused drugs to other countries, but the World Health Organisation guidelines state that no drugs should be donated that have been issued to patients and then returned to pharmacies. I understand the concerns about wastage, but we must take clinical matters into account when making decisions.

The Government have shown themselves willing to qualify the autonomy of primary care trusts when they feel it necessary to do so. Why then are they ignoring the huge disparity between the best and worst performing primary care trusts in the drug-prescribing habits of their practitioners and the related costs?

I referred to that matter when I answered the question asked by the hon. Member for Gainsborough (Mr. Leigh). We are drawing the attention of primary care trusts to the value of more efficient prescribing commissioning, and—as I said—generic prescribing has increased from 51 to 83 per cent. We are making excellent progress and I hope that PCTs, autonomous bodies as they are, will none the less take notice of the guidelines that the Government have issued, which will ensure that we have more efficient drug prescribing in future.

Accident and Emergency

6. Whether any of those accident and emergency departments redesignated as urgent care centres have subsequently been reinstated as blue light accident and emergency departments. (243636)

Not as far as we are aware. It is up to the local national health service to ensure that urgent and emergency care meets national performance requirements as well as reflecting local needs.

That is a disappointing reply. The transfer of blue light accident and emergency from Burnley to Blackburn has been a running sore for more than a year. Given the present capacity problems at the Royal Blackburn hospital, ambulances are again taking patients back to Burnley. Why cannot we reinstate our accident and emergency at Burnley general hospital, if necessary with a published protocol indicating where patients should be taken with their various injuries and conditions, whether it be to Burnley, Blackburn, Preston or even Manchester?

I am nervous about intruding on what I understand to be the historic but friendly rivalry between Blackburn and Burnley. Seriously, however, I understand the organisation of services there to be a result of what clinicians felt would be the best way to concentrate specialist accident and emergency care in Blackburn and elective planned surgery in Burnley, which would avoid some of the cancellation problems that his local hospital was experiencing because of the need to deal also with accident and emergency cases. My hon. friend will also be aware that the democratic check on those organisations—in his case, the Lancashire overview and scrutiny committee—strongly supported the proposals. The recent problems that he mentions happen in many accident and emergency services when there are particular, localised and sudden pressures, and they are not peculiar to the reorganisation to which he refers.

Could the Minister confirm that the urgent care centres are in addition to accident and emergency provision, and not in place of it? The care centres are a better use of the expensive professional staff—doctors and consultants—instead of a way to close accident and emergency services. People who would have automatically gone to accident and emergency are being transferred to a more appropriate form of treatment.

Yes, the hon. Gentleman is absolutely right. The decision at local level is made on a case-by-case basis, but he is right to draw attention to the benefits of urgent care centres in reducing the pressure on, and unnecessary referrals to, accident and emergency departments.

I hear what my hon. Friend says. One of the most difficult aspects of the way we now treat accident and emergency departments is how they must lock in carefully with the ambulance service. One of the continuing problems in Gloucestershire is the number of times that ambulances back up in the car parks of our two main acute centres. Is it not time to look at how the ambulance service operates in relation to accident and emergency, and consider ways we can improve that operation?

Let me say loud and clear to the trusts, through my hon. Friend and any other hon. Members who experience that problem, that it is totally unacceptable for ambulances to back up either because they are being forced to do so by the accident and emergency department or because the ambulance service has decided to do so. I am sure he is aware that the clock starts ticking on the four-hour maximum wait 15 minutes after the ambulance arrives. Any accident and emergency department that thinks it can fiddle its achievement of the four-hour figure by keeping ambulances stacked up outside the hospital is wrong. That message has gone out loud and clear many times from this Department and I am happy to repeat it in the House today.

Will the Minister confirm that when making decisions about the structure of emergency care in the years ahead, it will be increasingly important to take account of not only the evidence on how to achieve the best clinical outcomes but the resource implications of the different structures of emergency care? The Government have been signalling for some time that the rate of growth of cash available to the health services is going to slow down. In the pre-Budget report, the Chancellor made it clear that spending cuts were intrinsic to the Government’s plans. Against that background, is it not important to begin to manage expectations about the structure of emergency care that is likely to be delivered by the health service in the years ahead?

“Lower increases” would, I think, be a more accurate description of future spending projections. Of course, last week we announced annual increases of 5.5 per cent. and 5.5 per cent. for PCTs in each of the next two years. There will be lower increases from the Government, but there would be cuts from the Opposition, were they to get into government.

The right hon. Gentleman is absolutely right, and I commend the thoughtful remarks that he made at the King’s Fund discussion either today or yesterday, which I read. He is right to say that high-quality care is often the most cost-effective care. There is no doubt—this is the pattern not just in this country but in other countries around the world—that when it comes to accident and emergency services it is safer, better and more effective to concentrate care in a smaller number of specialist units. It is often better for in terms of survival rates and health outcomes people to travel a little bit further to those specialist units.

In view of the confusion that still exists among patients about whether they should go to accident and emergency, urgent care centres, minor injuries units or the out-of-hours GP centre, will the Minister tell us what progress he is making in establishing a single telephone number, less than 999, that would be relevant to each area and would direct every patient down the appropriate pathway for their area?

Very good progress, I am pleased to tell the hon. Gentleman. However, he will have to be a little more patient before we make a formal announcement.

Will the Minister find time before Christmas to go to Enfield and tell the people there why they do not need an accident and emergency department at Chase Farm hospital and why it will be replaced by a non-blue light service at the urgent care centre? The most recently published report by the experts, the College of Emergency Medicine, concluded:

“There is no evidence of the clinical or financial benefits”

of the urgent care centre model, and that the Government’s proposals are

“clinically unproven and against the principle of patient choice of access to proper emergency care.”

In the light of those statements, will the Minister and the Secretary of State reverse their decision to replace accident and emergency services at Chase Farm with an urgent care centre?

The hon. Gentleman is aware—or at least he should be—that there is a potential legal challenge, if not an active legal challenge, to that case. I shall therefore not comment on his specific point. He will be aware that the proposals in north-east London have been through the democratic check of both the overview and scrutiny panel and the independent reconfiguration panel. Everybody—including the four primary care trusts, most of which cover boroughs with Conservative majorities—is agreed that the proposals are the best solution for the north-east London health economy.

North Yorkshire and York PCT

7. What recent assessment he has made of the financial position of the North Yorkshire and York primary care trust; and if he will make a statement. (243637)

My right hon. Friend the Secretary of State was pleased to announce last week that North Yorkshire and York primary care trust will receive an 11.6 per cent. increase in funding over the next two years. That places my hon. Friend’s primary care trust in the top quarter of increases in allocations.

I have been arguing for years that the North Yorkshire and York PCT did not get enough money to meet the health needs of the large number of elderly people who live in what is a largely rural area, so I congratulate the Government on changing the funding formula to put that right. I am pleased that the PCT will get larger increases than the national average in future, but will the Minister do everything he can to ensure that it clears its deficit as soon as possible? That will ensure that this large amount of extra money will be used to provide new and better health services for patients, and not to clear historical debts.

Yes, and I am delighted that my hon. Friend’s persistent and effective lobbying on behalf of his local PCT has paid off. He will be aware that the PCT has gone through some difficult personnel issues, which are now being addressed. It is working very closely with his regional strategic health authority to ensure that the challenges to which he refers are overcome as quickly as possible.

Although I welcome the additional expenditure, will the Minister tell the House for how long the extra money will be available, and does he accept that the funding formula has to change? Per patient, the PCT and the individual hospital trusts have been receiving much less than the average, so will he review the patient formula? Will he reintroduce the factors that reflect the sparsity and rurality of the population because, as the hon. Member for City of York (Hugh Bayley) suggested, our ageing population lives in deeply rural areas? [Interruption.]

Exactly, we have just done that—the new formula has been changed to take into account elderly populations, and that is why the hon. Lady’s PCT has benefited so dramatically from the increase in funding. She asks how long the funding formula will apply, and I can tell her that it is for the next two years. At the end of that period, her PCT will still be 2.4 per cent. below target, but that is a good position for it to be in as it will then have more catching up to do. However, it is far less likely to catch up under a Conservative Government, as her party is committed to cutting spending on health.

Will the Minister review the role of patient referral units? They cajole patients to take up operations at the Capio private hospital in York, even though many would otherwise choose to have their operations in Scarborough.

It is interesting to hear a Conservative Member running down the use of the private or independent sector in health care. No one is being cajoled to go into the Capio centre, but people are being offered a choice. I thought that Conservatives were in favour of choice.

Topical Questions

The responsibilities of my Department embrace the whole range of NHS social care, mental health and public health service delivery, all of which are of equal importance.

May I congratulate the Department on its foresight in supporting the local campaign to reuse the Standish hospital site in my constituency? It would appear that in January we are to get the good news that the site will be transferred back to the PCT, and we look forward to the development of a fully integrated care setting there. There have been two obstacles to the campaign’s progress: my hon. Friend the Minister will know about the security issues with the site, but I am pleased to say that the listing of block C seems to have been sorted out. Will he ensure that this wonderful proposal sees the light of day, and will he give every support to the PCT so that it can see it through?

Yes, and let me commend my hon. Friend for his active interest in this matter. He is right to point out that the two remaining blockages to progress have been removed: the Department for Culture, Media and Sport has decided not to list block C—having visited the site with my hon. Friend, I believe that that is a very sensible decision. In addition, problems to do with security and vandalism have been sorted out, and I look forward to an announcement that he will be pleased with being made in January.

I recently chaired a seminar on Lyme disease in Westminster Hall, and two things became clear—that diagnoses of people suffering from Lyme disease are on the increase, and that sufferers are beginning to encounter the same scepticism that people with other chronic fatigue syndromes such as ME have been subject to. Will the Under-Secretary of State for Health, the hon. Member for Brentford and Isleworth (Ann Keen), address that matter? What instructions can she give to GPs to ensure that they treat more seriously the symptoms of long-term sufferers from Lyme disease?

May I congratulate the hon. Gentleman on the work that he is doing on Lyme disease, and indeed other hon. Members who have shown an interest in that relatively new disease? Guidance on the diagnosis and treatment of Lyme disease is provided to general practitioners and other clinicians by the Health Protection Agency and is published on its website.

T6. My right hon. Friend the Secretary of State will be aware that more than 90 million working days are lost in Britain every year through mental health issues such as stress, anxiety and depression. Many employers do not quite know what to do about mental health problems, so may I invite him to look at the innovative work being developed by the Cheshire and Wirral Partnership NHS Foundation Trust, together with local employers across Cheshire and the Wirral, which is having significant results? In particular, I point out the partnership between the trust and Airbus; their work has resulted in a 20 per cent. reduction in staff absences at Airbus. (243661)

I am very grateful to my hon. Friend for drawing to my attention, and the attention of the House, the excellent work done by Cheshire and the Wirral, and the scheme involving Airbus, which she identified as working very well. She is quite right; there are issues to do with mental health and employment that need to be addressed. She will know that we launched a consultation on the subject earlier this year, and a report on the issue is due in the spring. Dame Carol Black is chairing a steering group that is looking into how mental health provision can be better tailored and integrated to help people to find, stay in or return to work. I will certainly draw to the steering group’s attention the excellent work that my hon. Friend describes in her constituency.

T2. Will the Secretary of State agree to take an urgent look at the perverse effects of the NHS’s so-called choose and book system, which my constituents think should be renamed confuse and book? My local primary care trust is so fed up that it now routinely explains to my constituents that the system is nothing to do with it. It is certainly nothing to do with general practitioners, who often end up making the bookings on behalf of my bemused constituents, who cannot work their way through the system. Choose and book is certainly not helping my constituents, the overwhelming majority of whom would rather go to the local district hospital, Stepping Hill, than have what often turn out to be illusory offers of treatment elsewhere. Do Ministers accept that choose and book is putting at least three extra leaps between the consultant and the patient, and that the matter needs to be tackled urgently? (243657)

Order. If the hon. Gentleman ever wishes to apply for an Adjournment debate, I guarantee that he will get one, but I need questions to be brief.

No, we do not accept what the hon. Member for Hazel Grove (Andrew Stunell) says. I am afraid that it is the responsibility of his local primary care trust and GPs to manage the system efficiently and competently, as most primary care trusts and GPs across the country do, to the great benefit of their patients.

Will my right hon. Friend the Secretary of State confirm that the introduction of GP-led health centres will improve access to GP and primary care services, 12 hours a day, seven days a week, and that such health centres do not threaten well-run, easily accessible village surgeries?

I shall be very pleased to confirm that. Indeed, Bradford—not too far from my right hon. Friend’s constituency—had the very first GP-led health centre, which I opened on 28 November. There, we found that people can drop in at any time. They are guaranteed not to wait more than half an hour, even if they have not got an appointment. The contract was given to a fabulous social enterprise formed by GPs in the area who are doing excellent work throughout Yorkshire. Such health centres are about improving access and increasing the capacity of primary care, so it remains totally mystifying why the Conservative party opposes those new services.

T3. Is the Secretary of State aware that there has been a very serious outbreak of norovirus at the Queen Elizabeth hospital in King’s Lynn? Wards have been closed and all non-urgent operations have been cancelled. Obviously, the problem comes at a bad time for the hospital, as it is trying to pay off its historical debt. The problem could well have an impact on waiting lists and affect the hospital’s finances. What advice could and does the Secretary of State give to hospitals in that position? (243658)

Hospitals should know what to do in that position. This is not a new problem—as I am sure the hon. Gentleman is aware, it happens regularly at this time of year—and our latest understanding from the Health Protection Agency is that it is less bad this year than in previous years. However, it is important that hospitals take swift and immediate action and it is important, too, that people, not least hon. Members in the House, should not spread undue alarm by, for example, comparing this to health care-associated infections, the implications of which can be fatal.

T7. Will the Secretary of State confirm that the incidence of health care-acquired infections such as MRSA and C. difficile is down in 2008? Does he agree that at this time of welcome reductions it is all the more vital that all parts of the NHS remain focused on maintaining those clinical practices, standards of cleanliness and public education to drive out those infections completely? (243662)

My hon. Friend is absolutely right. We have halved MRSA bloodstream infections across England, hitting our target, and we are making excellent progress towards the 2010-11 target to reduce C. difficile infections by 30 per cent. However, we must continue to drive that forward and drive home the message, not just with health professionals but with the public at large, and I am extremely happy that all our people are working all the time to make sure that that happens.

T4. Will the Minister explain to my constituents in Romford and the London borough of Havering why the operating framework from the Department of Health for 2009-10 does not give priority to the health and well-being of our increasing ageing population? (243659)

The operating framework that we issued this year has been well received in the NHS. We have ensured that instead of trying to prioritise everything, and thus prioritising nothing, we have focused attention on health care acquired-infections, which are a huge issue for older people, particularly the over-65s; on dementia; and on greater patient involvement. Those priorities all apply to older people. The dementia strategy, which we will shortly publish, is of particular benefit to older people, as is the debate on the reform of adult social care which, although not restricted to the over-65s, is very much the focus of that report.

T5. It would be churlish to allow 2008 to close without thanking the Secretary of State for accepting in full the recommendations of the independent reconfiguration panel regarding Horton general hospital, and a lot of work has been done to try to balance accessibility issues and safety. May I trespass on the seasonal mood of good will to point out that the Leader of the Opposition, the shadow Secretary of State for Health and at least three members of the shadow health team all visited Horton general hospital in 2008? May I invite the Secretary of State or one of his team to come to visit the Horton general hospital in Banbury at some stage in 2009, so that when he considers these issues he can visualise the balance that we are trying to strike? (243660)

Order. Once again, in topical questions, questions should be brief, not long. Short and sharp—that is the idea.

I thank the hon. Gentleman for his comments. What happened with Horton hospital was verification of the process, and the independent reconfiguration panel made those decisions on the basis of the clinical argument. I should be glad to visit the hospital, but I do not believe that I have ever received an invitation. Usually, I depend on an invitation before I pop up, so it would be nice to receive one.

T8. Can the healthy schools programme be revised, so that medicine policies and support systems for children with diabetes and other long-term conditions are taken fully into account? (243663)

We are committed to improving diabetes care for children and young people, including the way in which the condition is managed in schools. The national clinical directors for children and for diabetes are working together to look at how to support the NHS to improve the way it cares for children with diabetes and other long-term conditions.

The Secretary of State will know that the NHS Information Centre provided to 10 Downing street information from hospitals about people presenting with knife wounds—data that were unpublished, not yet validated and incomplete. That was done on the basis that the information would not be used publicly in that form. Can the Secretary of State tell the House whether he knew about 10 Downing street’s intention to use those data and, whether he did or not, what steps he personally is taking to make sure that NHS data are not used for partisan purposes in that way?

I have nothing to add to the Home Secretary’s comments yesterday, particularly her apology for what happened. The hon. Gentleman has written to the Information Centre and made a number of points, all of which will be answered in due course.

T10. Are my right hon. and hon. Friends aware of the campaign by thalidomide survivors, who make the point that that increasingly elderly population who were victims of a great tragedy many years ago are now beginning to suffer the ill-health effects of ageing? How do the Government intend to respond to their aspiration for proper recognition of their plight? (243665)

There is, of course, huge sympathy across the House for individuals and families affected by thalidomide. My hon. Friend will know that a private compensation settlement was arranged many years ago—this is the 50th year, I think, since the tragedy occurred. In addition to the annual payments to victims, those affected by thalidomide will continue to benefit from ongoing improvements to health and social care in the circumstances that he describes, particularly the developments that we are introducing to help people with disabilities to get better social care. There have been substantial increases in the level of funding provided for health and social care services in recent years, and thalidomide survivors and their families will benefit from those services over the years ahead.

T9. Figures given to me by the Minister in a written answer show that alcohol-related finished admissions to hospital in Bexley have increased by more than 70 per cent. since 2002. Does that not show that Government policies on tackling the public health problems caused by alcohol are not working, and why we need our vital accident and emergency hospital department at Queen Mary’s in Sidcup? (243664)

On the hon. Gentleman’s final point, I understand that the independent reconfiguration panel is considering the matter. On alcohol issues, the hon. Gentleman makes a serious point. The number of admissions as a result of alcohol is increasing. If one looks at the reduction in premature deaths from heart disease, cancer and cardiovascular disease against the increasing trend in diseases caused by too much alcohol, one realises there is a very real public message to get across. That is one of the reasons why, the week before last, the Home Secretary announced that she was taking measures to ban the promotions that lead to a large consumption of alcohol in a very short time such as “women drink free” and happy hours on which there will be restrictions. We need to look much more closely at how we introduce other public health messages so that people are aware that consuming too much alcohol is a real and dangerous health risk.