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Oral Answers to Questions

Volume 487: debated on Tuesday 10 February 2009


The Secretary of State was asked—

District General Hospitals

1. What recent assessment he has made of the contribution that district general hospitals make to improving the health of the public in their local communities. (255395)

District general hospitals provide a vital range of services for local people, and the level and range of their activities have expanded significantly in recent years. At the same time, some treatments that used to be provided in hospitals can now be provided in the community and smaller local hospitals, GP practices or even people’s homes, while some specialisms and acute treatments are best provided in specialist centres, which can offer the necessary round-the-clock professional and technical expertise and capacity.

After last year’s scare stories from some quarters about mass closures of district general hospitals, I thank the Minister for a reassuring answer. Does he agree that to be truly effective in serving their public in future, those hospitals need very strong links with their primary health care, social services, housing providers and the third sector, and that that is especially important against the background of an ageing and growing population, if they are to keep to a minimum admissions to hospitals in the first place and re-admissions after discharge into the community?

My hon. Friend is right, although a hospital’s role is, of course, mainly to help deal with people when they fail to prevent an illness for one reason or another. It is important that hospitals work closely with primary care trusts, social services and others on the public health agenda, and one of the things that the next stage review published by my noble Friend Lord Darzi made clear last year is that we now expect every primary care trust in the country to commission comprehensive well-being and prevention services based on local needs, but including delivery on a number of important issues, such as mental health, obesity, alcohol, smoking and sexual health, which I hope are being provided for in my hon. Friend’s constituency.

Can the Minister please explain to my constituents what positive contribution there can be to improving health care from the Mid-Essex Hospital Services NHS Trust receiving about £1 million a year in car park fees, which many of my constituents regard as a tax on health care?

The hon. Gentleman should be aware that the shadow spokesman on health supports the freedom of hospitals in England to levy acceptable charges to help cover the cost of hospitals; if they did not levy those amounts, they would have to take them away from patient care. I often get questions on the subject from hon. Members such as “What about Scotland?” or “What about Wales?” In Scotland and Wales, people wait much, much longer for their operation. If the hon. Gentleman has a particular problem with his local hospital’s policy, he should take that up with the hospital, which is supposed to offer concessions to people who need to visit regularly. If he is suggesting that everyone at his local hospital should be able to park freely, regardless of what they are doing there, that is a very foolish approach and it would take money away from essential medical need.

One of the issues that is affecting district general hospitals such as mine in Barnsley is their inability to attract sufficient numbers of doctors. The postgraduate dean at the Yorkshire and the Humber NHS Deanery has done some work on the issue, which shows that in certain areas of the country, including Yorkshire and Humberside, we are under-provided for in almost every discipline in health. I have written to my right hon. Friend the Secretary of State for a meeting to discuss this, but will my hon. Friend look into the matter to try to determine what we can do to redress the balance between Yorkshire and Humberside and other areas of the country, such as London and the south-east?

We have record numbers of doctors, health care professionals and health services, as my hon. Friend knows. I will certainly look into the concern that he raises about Barnsley and his local area. I would find it surprising, however, if it was even more challenging for Barnsley and the surrounding area to attract good doctors and staff than it is in London, where attracting them can be a particular challenge, for a number of reasons which most hon. Members understand. I will have a word with the strategic health authority covering Barnsley, which is responsible for ensuring that work-force planning is carried out effectively and that the needs of local hospitals, including his own, are fully appreciated.

Does the Minister acknowledge the excellence of our local district general hospital at Macclesfield? It has retained superb maternity and accident and emergency units and is applying for NHS foundation status. Does he recognise that it serves not only the towns of Macclesfield and Congleton, but a huge rural area? Patients come from Derbyshire and Staffordshire as well as Cheshire. Such district general hospitals must be retained for the future health care needs of a very large area.

I am pleased to acknowledge the very good work done by Macclesfield hospital and I wish it all the best with its application for foundation trust status.

One under-recognised aspect of the role that district hospitals can play is nutritional standards and food procurement policies. In that context, will the Minister add his own congratulations to those given to the Nottingham University Hospitals NHS Trust on the award that it is to receive from the Soil Association on 20 February in relation to the Food for Life programme? The trust has won the award because it threw out the external food contractors and sourced its food supply from local farms, generating 300 jobs in the local food supply industry. Will the Minister also inquire into how he could assist the hospitals in making the next step to developing a sustainable community kitchen that would put £6 million of investment into raising nutritional standards and supporting the local food infrastructure?

My hon. Friend raises an important point, and I congratulate Nottingham on the work that it has done. Such work is replicated in a number of other hospitals around the country, including the Royal Brompton hospital and including in Cornwall. In those hospitals, good local food procurement policies have not only saved money but—the evidence gives this impression—helped to improve recovery rates and general patient satisfaction. We are working actively in the Department and the NHS to see whether that good practice can be spread. We are also consulting on the registration requirements for NHS providers, including hospitals. It is likely that those requirements will include good performance on nutrition.

Further to the Minister’s initial answer, will he give a little more detail on what is being done to encourage primary care trusts and district general hospitals to work together to provide more services closer to where people live? He will be aware that in my very rural constituency, people live some distance from a district general hospital. What is being done to ensure that people can be treated closer to home?

Rather than reel off a long list, I shall give the hon. Gentleman a concrete example from my own area. Until recently, people in the area needing renal dialysis had to come to the Royal Devon and Exeter hospital in Exeter to have it done. The service has now been devolved out to the community hospitals, including one in Honiton. People who used to have to travel into Exeter no longer have to travel such distances. That is just one example of a range of services, including in Cornwall. People in Cornwall used to have to access such services by going to Plymouth or Torbay; now they can stay in Cornwall and get them. That is the direction of travel in the health service, and it is absolutely right that it should be. Where possible, people should be treated in their home or community, but when a specialist or acute need can best be met in the safety of a specialist and centralised environment, that is where it should happen.

Obesity (Physical Activity)

The Government strategy document “Healthy Weight, Healthy Lives” sets out the steps that we are taking to tackle obesity. In addition, tomorrow the Government will publish a new national plan for the delivery of physical activity alongside sport for the period leading up to the London 2012 Olympic and Paralympic games, and beyond. The plan is part of the wider cross-Government strategy, including the flagship Change4Life campaign, to increase participation in physical activity and to reduce obesity.

I congratulate the Secretary of State on the strategy to be launched tomorrow. It is vital that there should be a co-ordinated approach to the issue locally. As he knows, and as the National Institute for Health and Clinical Excellence clearly explains, physical activity is the best way to tackle obesity in the long term and one of the most cost-effective ways of doing so. There is a great deal of experience in county sports partnerships. Will he ensure that there is a co-ordinated approach with primary care trusts and CSPs locally, so that there is no duplication? Over time, will he ensure that there is an increase in funding from the Department of Health to cross-match what is coming through sport and other physical activity through local government as well?

My hon. Friend is an expert in this area, and he will be delighted to learn that one of the aspects of the plan to be launched tomorrow is energising the existing regional and local delivery structure. He knows about this because he is chair of Leicestershire county sports partnership. He will be pleased to hear that the plan recognises the important role that CSPs can play in local delivery, and that we are investing new money to enable them to continue the seamless co-ordination of physical activity and sport at a local level. To complete his afternoon of happiness, he will also be delighted to hear that crucially, for the first time, we are setting out the financial costs to local authorities of inactivity. That is an important driver in getting the few recalcitrant local authorities—and perhaps, in some rare cases, NHS trusts—to work together to tackle these issues.

I am sure that the Minister agrees that the main way to increase levels of physical activity is to foster and garner a love of sport in the young. Unfortunately, many teachers in my constituency tell me that owing to the number of Government-led educational targets they have to meet, the first subject to give way to allow them to do so is sport and physical activity. Should not the Minister be cross-referencing with the Department for Children, Schools and Families to guarantee that children from a very young age get the love of sport that we, at our age, had in our schools?

I do not know whether we did have it in our schools. The amount of time, money and effort going into school sports is in a different dimension from when we came into government in 1997; we are not just getting to four hours a week of sport and physical activity in every school, but moving towards getting six hours by 2010-12. Another myth that arises concerns school playing fields. Ten thousand school playing fields were sold off between 1979 and 1997. [Interruption.] “Still selling them off”, says an Opposition Member. That compares with 192 sold off since 1997. Ninety-one of those schools had closed, and every one of the rest had to invest the money in better sports and educational facilities. I am very pleased to set the record straight.

The Secretary of State will know that 58 per cent. of type 2 diabetes cases come from obesity. He took a diabetes test when he came to Leicester, and the Minister of State, Department of Health, my hon. Friend the Member for Exeter (Mr. Bradshaw), will take one at 3.30 pm today. Does my right hon. Friend agree that one way of dealing with this issue is to have preventive work, not just exercise—on Sunday, he suggested that people should start dancing more—and that people should have these tests so that they can deal with the issue of diabetes and take the necessary medication?

I pay tribute to my right hon. Friend for the work that he has done in Leicester. I did indeed have the test at the splendid centre in the middle of Leicester. I was fine, by the way; for the record, I scored five. My right hon. Friend did the work to get that centre built in his constituency and to have a mobile testing centre that goes out to workplaces; indeed, it came down to the House of Commons a few months ago, and it is here today. He is absolutely right to talk about the importance of these tests. As he knows, they are part of a concerted effort, backed by Diabetes UK, to ensure that physical activity, proper diagnosis and early treatment are regarded as essential; they should be of the quality that they are in Leicester everywhere else in the country.

With the imminent arrival of Lent and the associated resolutions to lose weight, is this not a good time to have a gentle campaign to encourage people to walk or cycle to work?

I completely agree with the right hon. Gentleman. The Change4Life campaign is encouraging people to take small steps—not necessarily to seek to be Olympic athletes or champion dancers, but to build activity into their lives. It is helping them to make those small steps, such as walking to work or, if they have to get the bus, getting off a stop earlier. He will have seen the London underground map that Change4Life has refocused to say how long it will take someone to get to their destination if they get off the tube a stop earlier. Those small ways of ensuring that people can change their lives include cycling, dancing, of course—my hon. Friend the Member for Loughborough (Mr. Reed) did ask me what steps we were taking—and all aspects of physical activity, with a recognition that according to the statistics, if more people engaged in physical activity, we could reduce the number of premature deaths by about one in 10.

Wakefield PCT has allocated more than £1 million to local and voluntary sector community groups to help them participate in the Change4Life campaign to help people to change their lives. May I press my right hon. Friend on when we can expect the announcement of a final decision on food labelling, which is essential for parents and consumers if they are to make clear decisions in making the choices that they face in supermarkets? May I also press him on the point that, as part of Change4Life, we should educate parents about the dangers of sweet, sugary drinks and the hundreds of calories that they contain, with zero vitamins or benefits for children?

My hon. Friend has done sterling work in this field. I cannot give her a date on which we will make a final statement on food labelling, because the Food Standards Agency has been asked to carry out that work for us, and until it is complete, we cannot make a statement. I will say, however, that this country is well ahead of other countries in the world because retailers have voluntarily adopted food labelling systems. We would like one system, because that would be less baffling and less complex for consumers, but we admire the work that has taken place in this country to put voluntary food labelling at the forefront of these campaigns.

I must say to the Secretary of State that after getting slapped down by Lord Mandelson the week before, it was good to see him get one up on Lord Mandelson this Sunday by having his own “Strictly Come Dancing”. No doubt he will invite the noble Lord Mandelson to be a participant in that.

I welcome the announcement of the Active England strategy, but it has taken a year to get there. I am afraid that the Secretary of State has got it wrong about school sports. The Government are not meeting their commitment to ensure that all pupils get two hours of sport a week in schools. In the school sport survey last October, the number of 11 to 16-year-olds getting two hours of exercise had gone down from 88 per cent. to 83 per cent. in a year. Will the Secretary of State, with his colleagues at the Department for Children, Schools and Families, ensure that the commitment to a minimum of two hours of exercise in schools is achieved, and will he tell us when will it be achieved?

From memory, the proportion of young children getting two hours of exercise in schools was about 24 per cent. when we came into government, so a drop—[Interruption.] Incidentally, I am not sure about the statistics that the hon. Gentleman just quoted. If there has been a slight drop, it should be seen in that context. Sport in our schools is essential to the sort of message that we seek to deliver, which is why we have pledged not just effort and time, but a huge amount of finance to meet those targets. And we will meet the target in 2010, just as I am absolutely sure we will move on to meet the extended target in 2012.

GP-led Health Centres (Battersea)

My hon. Friend’s local NHS, like those in the rest of England, is planning a new GP-led health centre, open from 8 am to 8 pm, seven days a week. I understand that the proposal is to locate it near to Clapham Junction station.

I thank my hon. Friend for recognising the health needs of Battersea in that new proposal, and in various other proposals to extend GP-led health centres. Will he assure my constituents that the range of facilities that can be offered in the new GP-led health centre will be far greater than can currently be provided in the Bolingbroke hospital, which is held in great affection, but is an old and impractical building?

I can assure my hon. Friend that the range of services provided in the new health centres will be big, and will meet the needs of the local population, which is one of the criteria we have laid down. I can also tell him that plans for the expansion of health services in his area are not restricted to this particular GP-led health centre. I understand that there are also plans to expand services at Doddington, Bridge lane and St. John’s, including primary care services.

In Battersea, the provision of primary care is vital to the health of the community, but according to the Royal College of General Practitioners, seeing a doctor who knows the patient and their medical condition personally is important to more than 75 per cent. of patients. Yet the Secretary of State recently said that he “could not care less” which GP he sees. That is totally out of touch with patient needs both in Battersea and elsewhere. Can the Minister confirm that continuity of care is important to the vast majority of patients, particularly those with long-term conditions? If so, why are he and the Secretary of State centrally imposing polyclinics, against patients’ needs and wishes?

Yes, I am happy to confirm what the hon. Gentleman asks me to confirm. However, what he says is another of the myths that were peddled by both the Opposition and the British Medical Association, at the time, in their opposition to new GP health centres. I do not know whether he has now abandoned the Conservative party’s opposition to the centres. I suspect that the Conservatives will quietly abandon that opposition, because where the new centres are opening, they are incredibly popular, not least with local Conservative councillors and Conservative MPs who want theirs to open as quickly as possible.

Of course continuity of care is important for many patients, particularly those with long-term conditions. However, many people, such as professionals who are otherwise healthy and who are juggling work and family life, find it very difficult to see their GP, because of opening times. They warmly welcome the opportunity to see a GP, and they do not particularly mind whether it is always the same GP.

Influenza (2008-09)

Information on the incidence of influenza-like illnesses is collected by the Royal College of General Practitioners. The rate of influenza-like illness started increasing in late November and peaked at 69 GP consultations per 100,000 people in mid-December. The rate of ILIs decreased to 13 consultations per 100,000 people by early February.

I thank the Minister. Winter-prevalent diseases such as influenza and bronchitis lead to increased morbidity. I am told by two local undertakers in Croydon that that has led to a call on undertakers to take as many bodies as possible from south London mortuaries. I am told also that some south London hospitals have found it necessary to hire extra equipment for the cooling of deceased bodies. Is that a normal situation in the NHS, or is it peculiar to south London hospitals? Does it mean that additional support might be appropriate?

I do not know the exact details that the hon. Gentleman mentions, and I shall certainly examine the situation in his area specifically. The peak rate this year was a quarter of the level experienced in 1999-2000, which was the last severe flu season. The connection that he suggests between flu and early death is not showing up in the statistics at the moment, but I shall certainly give his points closer consideration and write to him.

Can my right hon. Friend tell me what steps her Department takes to encourage primary care trusts to contact all older people—those in the influenza bracket, at over 60—and ensure that they are told about the availability of an influenza jab that would increase their chances of surviving the winter?

I can assure my hon. Friend that all primary care trusts have active policies with their GPs and make information available to those over 65 and others who are entitled to the free flu jab. The rate of patients being immunised with the influenza vaccine is increasing, and it is currently 74.1 per cent. That clearly needs to continue to rise to the 75 per cent. level we aim at.

Foundation Hospitals

5. What criteria are used by NHS foundation hospitals when deciding on the location of their facilities. (255399)

The criteria are the same as those used by non-foundation trust hospitals. Any changes to be made to services must be for the benefit of patients locally and led by doctors and health care professionals locally.

In Rushden, an out-patients facility is being closed. Some 6,000 constituents have written to me demanding that a replacement facility be built in Rushden. The NHS’s weighted criteria state that it should be built in Rushden, but in fact it is being built in an adjoining constituency, in a small town. That constituency already has a minor injuries unit and is getting a new hospital. What is the difference between the two constituencies? One is the Conservative marginal seat of Wellingborough, and the other is the Labour marginal seat of Corby. Are not this miserable Government making decisions about health facilities based not on need, but on political advantage?

I am advised that no such decision has been made. The hon. Gentleman has been involved in detailed discussions with health care managers on the ground, who are considering the matter. I am sure that he recalls that we had an Adjournment debate on the subject. Kettering hospital and Northamptonshire primary care trust want to expand the out-patient provision in his constituency or for his constituents because they believe that the current provision in Rushden does not cover the numbers that they want to serve. Ultimately, what they are trying to achieve will mean that tens of thousands of people who must currently travel from the hon. Gentleman’s constituency to Kettering hospital for treatment will no longer have to travel so far. I therefore urge him to continue his discussions with his local health service managers. I understand that they have not ruled out alternative locations if one can be found that provides his constituents with the health care that they deserve in the 21st century.

Will the Minister be careful when he imposes criteria and regulations on foundation trusts? Clearly, local managers and professionals need to develop local solutions to local problems. That is important.

My hon. Friend is right. People who should know better often misunderstand—I hope accidentally—how the system works. Any changes to services, whether to a foundation or a non-foundation trust, are matters for the local health service. If the proposals are sufficiently significant for local authorities’ democratically elected overview and scrutiny committees to think that they should be consulted, they must be consulted. If those committees remain unhappy, they can refer the proposals to the national independent reconfiguration panel. My right hon. Friend the Secretary of State has made it clear that he will respect and has respected all the IRP’s recommendations, which include two recent ones in Conservative areas, where the IRP recommended against the local health service’s proposals and its recommendations were upheld.

Acute Sector Staff (Assaults)

6. What progress his Department has made in reducing the number of assaults on NHS staff in the acute sector in the past 12 months. (255400)

The NHS constitution recognises that staff have the right to work in a safe environment, free from violence. Staff are saying that they will not accept violence or abuse as part of the job, and they are demonstrating that by reporting violence. In 2007-08, the number of criminal sanctions following cases of assault in the acute sector increased by 13 per cent.

I thank the Minister for her response. She referred to an increase of 13 per cent. What are the exact figures for the number of prosecutions made in the past five years? If she has not got those figures, will she supply them to me?

The NHS security management service has signed a memorandum of understanding with the Association of Chief Police Officers. It encourages trusts to agree a protocol with their local police on how they can work together. The SMS has also signed a memorandum of understanding with the Crown Prosecution Service to ensure the effective prosecution of cases that involve violence and abuse against NHS staff. This is a matter for local management, but the hon. Lady shows great concern about the issue which I believe is felt across the House. I am happy to supply her with as much information as I can.

Does my hon. Friend have figures to show how many assaults on NHS staff are fuelled by alcohol? What are the costs of such assaults to the NHS as opposed to law enforcement agencies?

We are aware of the concern that alcohol causes staff, especially in accident and emergency units, and of how it infringes on their management of other patients as well as of the patient who has the alcohol problem at the time. Continual work is being done on the matter with the SMS, which continues to consider figures on that troubling subject.

The number of violent attacks on Shropshire ambulance crews continues to increase, as does the number across the west midlands, so much so that Shropshire crews have had to resort to buying their own stab-proof vests. I have written to the chief executive of West Midlands Ambulance Service NHS Trust asking for the vests to be provided by the service. The reply is that the service is currently reviewing the situation. That review has been going on for some months. Is it not time that the Government spoke to West Midlands Ambulance Service NHS Trust and ensured that stab-proof vests are made available, in order that ambulance crews can do their duties and feel safe and their families know that they are safe?

The hon. Gentleman raises a serious issue. It is up to the service to look at that, but I believe that the local and national standards that we, the police and all the agencies concerned are applying in respect of the worrying vulnerability of all our public sector workers will result in the correct policy, which will be managed locally, because that is how all such matters must be looked at in local decision making.

As my hon. Friend knows, the Scottish Parliament introduced the Emergency Workers (Scotland) Act 2005, which offers legal protection to front-line health service staff such as doctors, ambulance personnel and A and E nurses. Do we have any thoughts about introducing similar legislation in this Parliament?

A Ministry of Justice Bill addressed that issue last year, but I would be happy to discuss with my hon. Friend any areas that he has concerns about in relation to the serious issue of violence against staff.

I am sorry to say that the Minister was very selective in her comments about how many assaults on NHS staff there were in 2007-08. The truth is that 12,500 staff who had gone to work to care for the community in this country were assaulted by cowards, and that criminal sanctions—I stress that they were not prosecutions, but sanctions, including some that were just cautions—were applied in fewer than 700 cases. Where is the zero tolerance that this Government promised to protect our emergency services?

The hon. Gentleman raises an issue that concerns the entire House. When increases in violence against our front-line staff continue, it is a matter for us all to address, in order to get the prosecutions, which is why we work with the Crown Prosecution Service and, in particular, with the Association of Chief Police Officers. That is an area for the Crown Prosecution Service, but it is not an area that we dismiss in any shape or form, and it would be wrong to give that impression. We are talking about serious measures for serious times, for our hard-working front-line staff.

Undergraduate Courses

7. What assessment he has made of the adequacy of provision for teaching of therapeutics and prescribing in medical undergraduate courses. (255401)

The General Medical Council has the statutory responsibility to determine the extent of the knowledge and skill required for the granting of primary medical qualifications in the United Kingdom. The GMC’s document “Tomorrow’s doctors” sets the standards and outcomes for undergraduate medical education. The GMC is currently consulting on the draft of a third edition, which would include a strengthening of the requirements in this area and, consequently, provide the opportunity to address any areas of concern.

Professor Webb of Edinburgh university recently told the Select Committee on Health inquiry into patient safety that the teaching of therapeutics and prescribing had all but disappeared from the undergraduate curriculum. A recent survey of medical students showed that 80 per cent. felt that they were either poorly or very poorly prepared for prescribing by the time they qualified. With drugs becoming more powerful and treatment regimes becoming ever more complex, surely it is important to ensure that medical students are properly equipped. Is there more that the Government can do to ensure that this valuable part of the curriculum is given the priority that it deserves?

I thank my hon. Friend for that. The GMC is currently consulting on the draft of a third edition of “Tomorrow’s doctors”, which, as was noted on 22 January by the Health Committee, of which my hon. Friend is a hard-working member, enshrines the competences drawn up by the safe prescribing working group. Those competences are included in the draft. The consultation concludes on 27 March. The GMC will then consider all the representations received, before publishing the next edition in the summer of 2009. It will be the duty of us all to ensure that all our doctors’ education is safe in its practice.

Does the Minister agree that doctors should look not only at the efficacy of the drugs that they prescribe, but at their cost-effectiveness? Should they perhaps be trained in how to resist the beguiling attentions of the pharmaceutical salesmen who so often visit our GPs’ surgeries?

A strict code of practice governs this issue, as I am sure the hon. Gentleman is aware, and it is still a matter for the General Medical Council to look at all aspects of the training and practice of our medical practitioners.

May I draw my hon. Friend’s attention to the all-party group on drugs misuse’s report on physical dependence on, and addiction to, over-the-counter and prescription medicines? Does she agree with three of the report’s recommendations—that medical staff should be properly trained to recognise these problems; that they should follow the prescribing guidelines laid down by the Department of Health; and that they should be aware of the withdrawal protocols in cases where people have become physically addicted or dependent?

My hon. Friend raises issues of concern, and I fully accept that we should study them carefully.

Lightning Process

8. What guidance his Department has issued to NHS trusts on the use of the lightning process in the treatment of people diagnosed with chronic fatigue syndrome. (255402)

The Department has issued no guidance on this process, because we expect decisions on clinical interventions, whether they involve complementary or alternative treatments, to be made by front-line clinicians. In making such decisions, clinicians will take into account evidence for the safety and clinical and cost-effectiveness of the treatment concerned.

I thank my hon. Friend for his reply. Sussex ME and Chronic Fatigue Society works tirelessly to assist the 6,000 adults and children across the county who suffer from the disease, and several of those people have been contacted about the success of the lightning treatment. Will he assess that treatment, in conjunction with the bodies that he has mentioned, and monitor how successful it is?

It is not for the Department to undertake that activity. The National Institute for Health and Clinical Excellence, the independent body, issues guidance on the use of such treatments, and that guidance is the subject of a judicial review this week. It is to that independent body that those patients and organisations should make their representations, so that it can make the appropriate recommendations on the use of such treatments.

I agree with the Minister that treatments such as these should not be performed on the NHS until independent medical evidence has been obtained to show their efficacy. Will he tell the House how much is spent by the NHS on chronic fatigue syndrome?

I am grateful for the hon. Gentleman’s support for a way of working in the national health service that has widespread support on both sides of the House and throughout the country. I do not have the figures that he requests to hand, but I will write to him in due course.

Is the Minister aware that herbal medicines—[Hon. Members: “Hear, hear!”] I have written to him about the fact that, if he does not introduce statutory regulation of herbal medicine practitioners by the time the herbal medicinal products directive is implemented in 2011, there will be no proper regulation whatever. What is he going to do about that?

I thank the hon. Gentleman for his question. This is a serious issue that many people are concerned about. We will be undertaking a consultation on the future regulation of herbal medicines in the near future.

Child/Adolescent Psychiatric Services (North-West)

9. How long the average waiting time for accessing child and adolescent psychiatric services in the north-west is. (255403)

Information from the annual children and adolescent mental health services—CAMHS—mapping exercise, conducted by Durham university for the Department of Health and the Department for Children, Schools and Families, indicates that NHS trusts in the North West Strategic Health Authority have waiting times for CAMHS that are better than average. During 2007-08, 91.6 per cent. of new referrals for CAMHS were seen within 13 weeks in the North West SHA area, compared with 87.4 per cent. in all strategic health authorities.

I have a letter from a whistleblower who alleges a serious scandal in the north-west, citing CAMHS waiting lists of one year for serious and complex tier 3 needs, a lack of resources, a shortage of in-patient beds, and looked-after children being dumped in private homes. May I ask the Minister seriously to look further into the information that he has and to check its accuracy?

I will certainly take away the information that the hon. Gentleman has presented this afternoon and respond to him in due course. I am aware that one of his constituents had to wait 12 months for referral to the children and family services. I understand that Sefton primary care trust is now working with Alder Hey Children’s NHS Foundation Trust to introduce waiting time initiatives to ensure that the PCT in the hon. Gentleman’s constituency meets the waiting-time targets across the borough. That includes extra temporary staff and introducing “choice and partnership”—a new system for the management and referral of patients. The hon. Gentleman has raised a serious point on the Floor of the House; I will take it away and write to him in due course.

The early intervention of child and adolescent mental health services is as serious an issue in the north-west as it is for the rest of the UK, as failure to access child and adolescent mental health services can lead to long-term mental health problems for youngsters. We know that between 10 and 20 per cent. of young people will have such long-term difficulties, which can lead to suicide, long-term mental health problems and self-medication with drugs and alcohol, so will my hon. Friend agree to look seriously at how we can bring about improvements to child and adolescent mental health services across the UK?

Order. The hon. Lady linked her question to the north-west, and she was entitled to raise it. It was a wee bit long for a supplementary; perhaps we could cut the supplementaries down a little.

My hon. Friend the Member for Bridgend (Mrs. Moon) has raised the concerns in her constituency on many occasions both inside and outside the House. I am grateful and pleased that, so far as I am aware, all of them are not replicated in the north-west. I agree that gaining earlier access to services for children and adolescents with mental health problems is a serious matter. We have undertaken a review of this country’s child and adolescent mental health services; funding went up from £322 million in 2003-04 to £523 million in 2006-07, and there has been a significant fall in the number of people waiting, along with shorter waiting times for CAMHS. However, there is more to be done and the Department will make sure that we press forward on these issues because our children and young people deserve the best mental health service that we can provide.

How can the Minister justify the fact that someone with a physical health condition will have an operation within 18 weeks of referral from a GP, whereas someone suffering from a mental health condition can find themselves waiting—as my hon. Friend the Member for Southport (Dr. Pugh) said, in the north-west and in many other parts of the country—sometimes more than a year for cognitive behaviour therapy and other NICE-approved therapies, particularly when we know that early intervention is very important in aiding recovery? Is it not about time that we ended this discrimination in the health service—for that is what it is—and ensured that people with mental health problems had an entitlement to access treatment?

The hon. Gentleman will know that over the next 12 months we are launching the “new horizons” project, which is our strategy to take mental health services forward. He and I have appeared on many platforms together, celebrating the significant improvements in mental health services, as major investment means that we have many more psychiatrists and psychiatric nurses than we have ever had before. The real challenge in front of us, however, is not only to ensure that we maintain that improvement in mental health services, but to challenge the wider stigma and discrimination attached to people who have mental health problems. That means bringing about a cultural shift so that we not only continue to improve mental health services by putting in investment, as we have over the last 10 years, but move forward towards genuinely healthy communities, which means mentally healthy communities. We need to take away and end the stigma currently attached to people who suffer from mental health problems.

The figures for the north-west are, like those for the rest of the country, truly shocking, with one in 10 five to 16-year-olds having a clinically significant mental health problem, including anorexia, anxiety and depression—one in 10: the numbers are huge. Furthermore the use of anti-depressants on children has increased 38 per cent. over the past 10 years. These shocking figures clearly demonstrate the failure of our child and adolescent mental health services. Although I welcome the Government’s attempts to do something about it, the Minister should, to be fair, admit that children and adolescents have been failed over the past 11 years and that we are now seeing the results in the increase in the mental health problems of young adults.

No, I do not accept that the Government have failed. What I do accept is that there has been a significant increase in funding for children’s and adolescents’ mental health services, from £322 million in 2003-04 to £523 million—half a billion pounds—in 2006-07. That has produced a fall in the number of children and young people waiting to be seen, and it has reduced waiting times. Nevertheless, there is clearly more to be done. That is why we instigated the review, that is why are setting up a new national advisory council, that is why we are setting up a national support programme, and that is why we are driving forward changes up and down the country to ensure that children and adolescents with mental health problems—[Interruption.] The hon. Lady says, from a sedentary position, “Eleven years”. I can remember the 18 years of a Conservative Government who failed to invest a single penny in children’s and adolescents’ health services.

Topical Questions

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

I welcome the Government’s campaign to alert people to the symptoms of stroke and to encourage them urgently to seek medical treatment, but what reassurance can the Secretary of State offer that every hospital in the country will be given adequate resources with which to deal with the increase in demand, especially in scanning departments? What guarantees can he give those who may present at hospitals with stroke symptoms that they will be given the timely treatment that they need to ensure that their future health is not impaired?

I can reassure the hon. Lady that the 20-year stroke strategy that we set out in December 2007 will be completed. However, there comes a point when there must be a drive to increase awareness along the way, and a debate has been held with the Stroke Association and others about when that should happen.

As the hon. Lady implies, we are not at the end of the stroke strategy yet, and not every treatment centre has the best facilities that we want to see throughout the country; but the view expressed in the debate was that now was the time to raise awareness and, in particular, to make people aware of FAST—the face, arm, speech test, which paramedics have used for some time. Strokes, probably more than any other illness or attack, require early treatment and a scan within the first three hours: that is essential. One of the main problems is a lag at the beginning because either the person having the stroke or those around him or her do not realise that it is a stroke.

This is the right time for a public awareness campaign. Meanwhile, we recognise that there is more to be done to ensure that services around the country are uniformly excellent.

T5. Does the Secretary of State—or the Minister of State—welcome a publication on teenage pregnancy produced by the Nottingham teenage pregnancy taskforce, and will he or she underline the fact that this is everybody’s problem? It is not just a health service problem about contraception; it is as much about ensuring that young people have the life skills and the social and emotional capability to enable them to make the right choices when they become sexually active. (255424)

I congratulate my hon. Friend on the leadership that he is showing in his city in relation to young people’s opportunities and life chances, and, in particular, on the publication about preventing unplanned teenage pregnancy in Nottingham, of which he gave me a copy last week. In all areas, the important factors are leadership, shared objectives and a clear focus on ensuring that young people are given the sexual health education that crucially influences the choices that they make for the rest of their lives.

T2. Southend hospital has banned visitors from bringing in flowers on health and safety grounds. Does the Minister believe that flowers present a real risk to patients? (255421)

The hon. Gentleman raised the issue with me last summer, and I wrote to him about it on 27 June. It is a matter for the local trust. At that time the trust was beginning a consultation, to which I hope the hon. Gentleman contributed, and I understand that it established that there was 75 per cent. public support. The Department does not recommend the banning of flowers other than where they cause particular problems to patients, but we consider that this is an issue for local trusts, and that we should not dictate to them from the centre.

T6. Recently, more than a quarter of care homes in Calderdale, which includes my Halifax constituency, were given the lowest two ratings by the Commission for Social Care Inspection. Does the Minister agree that many care homes are more intent on making a profit than on looking after the elderly, and will he tell me what improvements will be made to the standard of care, and what sanctions will be imposed on those who do not comply? (255425)

It is essential that we continue to improve the quality of residential care for older people, and I appreciate my hon. Friend’s concerns, but I am pleased to be able to say that the most recent annual report on the state of social care by CSCI inspectors shows the sixth successive year of improvement against the national minimum standards for care homes that we established in 2003. The commission is also taking action to drive up the quality of residential care further. The performance ratings it awards to councils will be affected if those councils only purchase services from care homes rated as poor or adequate. I hope that, together, we will drive up the performance of care homes, so that older people can expect to be looked after with dignity in their retirement.

T3. The campaigning social issues journalist in Croydon, Aline Nassif, has revealed two very worrying cases regarding my constituents. The Mayday hospital accident and emergency department turned away a young mother many times, saying she had depression; she subsequently died from swelling of the brain. There is a very similar story of a young teenager who was also misdiagnosed. While I should, perhaps, have performed the courtesy of advising Ministers before raising this matter in the House, and although Mayday is clearly unable to comment at present as these matters are now under investigation following media coverage, might consideration be given to supporting Mayday, in terms of proper co-ordination and diagnosis at its neurological and accident and emergency departments, while such investigations are ongoing? (255422)

As often happens in topical questions, we are hearing about things for the first time. I will be very pleased to look into this matter and see whether there is, indeed, a case for Mayday improving its neurological services, and I will also be very pleased to meet the hon. Gentleman to discuss it.

T7. May I draw the Minister’s attention to a scrutiny review that is taking place in Staffordshire of the contracts that the primary care trusts have with the independent sector treatment centre in Burton? People in Stoke-on-Trent by and large do not want to go to Burton for treatment, and they do not want to be cross-subsidising health care at their expense. Can my hon. Friend confirm that the letting of the new contracts will be determined locally by the primary care trusts? (255426)

T4. Since 1997, almost 800 organs from British donors have gone to people resident outside the United Kingdom. Over the same period, the list of British people waiting for organs has increased by more than 2,400, while only 140 organs have been brought into this country from abroad. Do not the Government need to take some action as this situation is rather shambolic, and does not the Secretary of State need to get a grip on it? (255423)

We might need to take some action. As I understand it, this matter involves a few hospitals, and NHS Blood and Transplant has not been happy with the situation—its correspondence was leaked to the press over the weekend. The organ donation taskforce has been looking at a number of very important elements of organ donation, but we did not ask it to look at this issue because at the time it was not highlighted as a problem. We might need to do so, however, because the hon. Gentleman raises a serious point: we want to increase the number of people on the register, and if people think they are going on the register for their body organs to be part of some export system, that will not do us any favours in achieving that end, so we need to tackle this, and to tackle it quickly.

T8. Will the Secretary of State reassure me that it would not be acceptable for a Labour Government to endorse surplus taxpayers’ money from an NHS hospital trust being used to create a private hospital to be run by that trust? Would that not fly in the face of the ethos of the NHS, create a conflict of interests when services are being delegated, and involve taxpayers in the risk if that private venture were to fail? (255427)

I would like to know the details of what the hon. Lady is describing. My local acute trust at Castle Hill has purchased the private Nuffield hospital and brought it into the NHS—it says that it had to spend lots of money to bring that hospital up to NHS standards, although that may or may not be true. I shall look at the point she raises, because it sounds like it involves a deeper story.

T10. Merseyside and Cheshire Cancer Network proposes to move cancer services from Clatterbridge to Liverpool, not on the basis of an objective, transparent and rigorous process or a proper business plan, but because the money is available. Will the Minister meet me and my colleagues, so that we can discuss our objections to both the form and substance of this? (255429)

Is the Secretary of State aware that when I was first elected to this House, almost every GP practice in my constituency offered an out-of-hours service? Despite the dramatic advance in medical treatments and drugs, my constituents receive a much less personal service from their GPs than they did 30 to 35 years ago. Does he agree that that is not progress?

No, I do not, and I shall tell the hon. Gentleman why. At the turn of the century, there was a very serious problem with getting medical students to go into general practice. The forecast, given the demography of general practices then, was that the shortage was bad and would become much worse, so something had to be done. Since the new contract, we have given GPs the option to opt out of 24-hour cover, and the vast majority of them—all bar 10 per cent.—have done so, despite the fact that it has meant a reduction in their pay. We have moved from a system where GPs would look at someone at 9 am having only struggled into bed at about 6.30 am because they had been called out through the night—the situation was similar to the long hours that junior doctors worked, which seemed to be some kind of badge of courage. Tired doctors are not good for our health service, and I am very pleased that we have moved beyond that archaic system.

My local newspaper, The Bolton News, recently reported that a 29-year-old woman in the Royal Bolton hospital was so terrified in a mixed-sex ward with three men that she was forced to sleep in the examination room overnight. Is it not bad enough being ill in hospital without having to deal with the added stress that mixed-sex wards cause men and women? When can we expect to see the end of these wards in Bolton? [Interruption.]

Conservative Members say “After the election”, but, of course, before we came into government nobody kept any statistics on mixed-sex accommodation—the most recent statistics showed that the level of mixed-sex accommodation was about 50 per cent. The Healthcare Commission now reports that nine out of 10 patients have elective care in single-sex accommodation. This is not an easy issue to resolve. We have to be sure that there are good medical grounds—for instance, in intensive care units and emergency accommodation—for not being able to operate single-sex accommodation. Beyond that, what happened to my hon. Friend’s constituent should not have happened—it is unacceptable. It breaches the dignity and respect of the patient, the emphasis on quality—quality relates to more than just quality of care; it relates to the patient’s experience—and our new NHS constitution, which is why I have introduced a £100 million capital fund and I have said that from 2010-11 no acute trust will receive any payment if it gives care unnecessarily in mixed-sex accommodation. I think that will mean the final eradication—I agree that it is taking too long—of mixed-sex accommodation in Bolton and across the country.

Last April, the Secretary of State told the Royal College of Nursing that he was within “touching distance” of abolishing mixed-sex accommodation—nothing happened for nine months. The Conservatives then published the data from hospitals showing the number of people affected by the lack of compliance with the mixed-sex accommodation rules and exposed the Government’s failure—nine days later, the Secretary of State announced a £100 million dignity and respect fund. Will he explain why the Government do nothing unless and until we expose the extent of their failure?

It is not right to say that nothing happened after the Royal College of Nursing conference. In fact, the week after that conference I wrote to every strategic health authority and made it clear that by the time the RCN next meets I want to see progress in this area. It is true that the operating framework that we planned to get out in July did not, in the end, go out until December, and our announcement about what we would do was made on the back of the operating framework.

This issue is too important for party political point scoring, because the care and respect agenda is crucial to Members on both sides of the House. All I would say is that the plans that the hon. Member for South Cambridgeshire (Mr. Lansley) has put forward for an increase in single rooms are hopelessly under-costed. He says that they would cost £1 billion, but they would actually cost about £9.5 billion, and he will not be able to afford it.

T9. The Secretary of State recently visited the Vale of York and I am sure that he will have been told that spending per capita in the Vale of York, North Yorkshire and the Humber region is less than in any other region. What is he personally going to do about that? (255428)

As the hon. Lady will know, because I have already told her, North Yorkshire and York PCT recently received one of the biggest increases—[Interruption.] Yes, but the funding comes from the PCT. It received one of the biggest increases for the next two years of any PCT in the country—in the top 30 per cent. of increases.