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Oral Answers to Questions

Volume 497: debated on Tuesday 13 October 2009


The Secretary of State was asked—

Prostate Cancer

Through our national awareness and early diagnosis initiative, we are working to improve awareness of the signs and symptoms of cancer, including prostate cancer, among the public and health care professionals in England. As part of this initiative, we are investing in a number of prostate cancer awareness campaigns.

I thank my hon. Friend for her answer. She will be aware that of the 35,000 men who get prostate cancer each year, 10,000 are unlikely to live. Men are seen as being particularly loth to go to hospital or to the doctor with problems relating to intimate parts of the body. What does my hon. Friend intend to do to allay men’s fears and get them to go to their GP or to hospital, to ensure that 10,000 more people do not die next year?

My hon. Friend raises an important point. We know that men tend to put off going to see their GP, which can result in devastating effects following later diagnosis and treatment. We are investing in schemes such as the Football Foundation’s Ahead of the Game campaign, which uses the appeal of football to raise awareness of prostate, lung and bowel cancers in men over 55. We are also working with a number of prostate cancer charities and patients to raise awareness of that cancer and to get the message out: “Don’t wait—check it out.”

Research carried out by the Prostate Cancer Charter for Action shows that, in at least 96 of England’s 529 constituencies, the death rate from prostate cancer is well above England’s average. Does the Minister accept that this reflects inequalities in NHS prostate cancer services? What is being done to remedy this?

We have done much to narrow the gap in relation to the inequality of cancer services. The introduction of the two-week maximum wait from GP referral to seeing a specialist and the recent announcement of a diagnostic result one week after being referred will also be extremely welcome. There are differences around the country, and it is difficult to give a definitive answer, but we have ensured that doctors are educated and supported to provide the right kind of understanding. As I have said, we are also working to raise awareness of the signs and symptoms, because the main thing is the need for men to present earlier.

My hon. Friend will be aware of how successful women have been in coming together to campaign on breast cancer. Indeed, I am wearing pink today to support that campaign. What does she think can be done to get more men to campaign on the important issue of prostate cancer, and to persuade them not to ignore it? She will be aware that my own father went to the doctor too late, and consequently died of the disease. Can we not get men to do more?

My hon. Friend has sad and poignant personal experience in this respect, and I thank her for sharing it with the House. Prostate cancer represents a different challenge for all of us, not least because the signs and symptoms are not always as clear as we might want. Research needs to be encouraged and supported to develop effective screening, which we do not have at the moment. We are, however, providing high-quality services tailored to the individual patient, and I am sure that men across the country will have heard my hon. Friend’s encouragement and will rally to take action, which I would certainly welcome.

Maternity Services (Rochdale)

2. What his most recent assessment is of the adequacy of maternity service provision in Rochdale constituency. (292229)

The North West strategic health authority reports that work is progressing as planned on the Making it Better reconfiguration, which aims to improve the quality of maternity services across Greater Manchester.

Does the Minister accept that in the current economic climate, closing two maternity units—at Rochdale infirmary and Bury Fairfield hospital—that are less than 10 years old and spending £15 million on a brand new unit at the Royal Oldham hospital does not represent best value for money? Does she agree that the money could be better used elsewhere?

I am sure that the hon. Gentleman is aware that the Manchester proposals are overwhelmingly supported by local clinicians and backed by a clinical and quality-based case for change. Making it Better will provide safer, higher-quality care for the residents of Greater Manchester, and the nearby Royal Oldham site will become a centre of excellence for maternity and neonatal care.

The Minister may recall that I made it clear during Health questions in May that the birth rate in Greater Manchester was rising, contrary to the predictions on which the reconfiguration proposals were based. We now know that something like 5,000 more babies were born in Greater Manchester than had been predicted. If the assumptions on which the plan was based are no longer true, will she act on the evidence and reconsider the plans to shut obstetrics services at the Fairfield hospital in Bury and at Rochdale infirmary? Otherwise, 5,000-plus mothers living north of the M62 simply will not have the choice to access obstetrics services close to home.

It is for local commissioners to keep that always under review. As the hon. Gentleman said, the birth rate has risen, but local commissioners are in touch with their clinicians. During the consultation, which was extended over four months, the matter was examined in detail and it was decided that it was safe practice to reconfigure services as has been done.

The Minister will be aware that one of the biggest challenges facing maternity services in Rochdale and elsewhere is the enormous shortage of midwives. All the signs are that the Government will miss their target of recruiting 3,400 more midwives by 2012, so will the Minister support the Lib Dem plan to scrap the health and maternity grant, which is completely untargeted, and invest the money instead in recruiting 3,000 more midwives and health visitors to give every woman the support she needs during pregnancy?

I am saddened that the hon. Gentleman raised the issue in that particular way, because we are on target. We have checked with the strategic health authorities—[Interruption.] I must contradict the hon. Gentleman. After checking with the strategic health authorities in England, we know that the target for 4,000 extra midwives by 2012 will be met. We are working closely with the Royal College of Midwives and very positively with the Royal College of Obstetricians and Gynaecologists: the target will be met. As for the comment about the grant, I am sad that the hon. Gentleman feels that way, because I believe every woman is entitled to be healthy through pregnancy, and to have a safe pregnancy.

Small Pharmacies

3. If he will take steps to protect small pharmacies from the effects of the operation of in-house pharmacies established in supermarkets. (292230)

Independent pharmacies play an enormously important part in providing pharmaceutical services to the UK. However, the NHS (Pharmaceutical Services) Regulations treat all providers equally, and we do not intend to change that to discriminate against a particular sector.

The Minister will be aware from the representations of colleagues throughout the House that small pharmacists are an invaluable part of the local community. They are often the cement that keeps a local parade of shops going, for example, in deprived communities such as mine in Nottingham, North. The giant supermarkets are usually most welcome in communities, but does the Minister accept that they also have a tendency to suck in other services, particularly pharmacies, and not to provide the sort of intimate and local service that reaches out into the community? Will he take every possible step to ensure that local pharmacies are encouraged to survive and thrive?

We certainly want local pharmacies both to survive and to thrive. Indeed, the Health Bill, which was before the House yesterday, introduces pharmaceutical needs assessments, which will encourage primary care trusts to ensure that they consider the needs in their area. We know that different parts of the community have different needs. Young mothers who live at home with their children, and older people, sometimes like small locally based pharmacies, while younger men sometimes prefer the less intimate surroundings of a supermarket. There are all sorts of diverse needs to provide for. What we want is a broad range of services and pharmacies, ranging from small traders to multinationals.

I have a number of independent pharmacies in towns and villages in my constituency where there are no supermarkets, but supermarkets are not too far away. If those supermarkets suck in some of the customers of the independent pharmacies, we shall see death by a thousand cuts. Some of the ageing population will not be able to get into the major towns, so they will lose an essential place where they can get their medicines. If we do not want to see pharmacies going the same way as the post offices have gone over the past five years, the Government will have to take action now. What action is the Minister prepared to take?

Order. I am not saying that the questions and answers are quite of “War and Peace” proportions, but in several cases they have been a bit on the long side, and we need to hasten progress.

I have just said that the Bill before the House yesterday provides action in the form of pharmaceutical needs assessments, so that primary care trusts are able to assess local needs and ensure that they respond to precisely the sort of circumstances that the hon. Gentleman raised.

First, I thank the Medicines and Healthcare products Regulatory Agency for publishing its new guidelines on the sale of codeine-containing products recently. However, will my right hon. and learned Friend admit that the person paying for codeine-containing products at the checkout would not get the same advice in a supermarket containing a pharmacy as they would in the sort of small pharmacy that my hon. Friend the Member for Nottingham, North (Mr. Allen) described?

I certainly agree that local pharmacies are enormously important. That is why we want to support them, and that is why we have introduced the Health Bill, which the House debated yesterday and which provides for pharmaceutical needs assessments for each area. We must ensure that there is diversity of supply so that precisely the sort of needs identified by my hon. Friend are met, and we must recognise that other parts of our community want that diversity as well.

Along with many others, we value the role of community pharmacists, but recognise that the most important challenge for small and single-handed pharmacies is presented by the Medicines (Pharmacies) (Responsible Pharmacist) Regulations 2008, which came into force last week. Can the Minister deal with the significant confusion and real concern among pharmacists regarding the regulations? Will he, for instance, clarify whether a small pharmacy that is open for the minimum 40 hours per week would be in breach of its NHS terms of service were a responsible pharmacist to be absent for two hours, and whether a responsible pharmacist failing to sign off and taken a rest break would be in breach both of professional requirements and of the European working time directive?

We certainly do not want a local pharmacist to be in breach of either the regulations or the working time directive. We want and intend to ensure that the regulations are applied flexibly so that we can continue to provide effective and good local services in the community.

Cancer Services

4. What is his most recent assessment of the level of provision of cancer services in England; and if he will make a statement. (292231)

The first annual report on the Cancer Reform Strategy, published in December 2008, is the most recent assessment of cancer service provision in England. The report showed that good progress is being made against the objectives of the strategy to improve cancer services further across England by 2012.

When considering that report, did the Minister examine the research conducted by Professor Karol Sikora at the university of Buckingham medical school? It shows that in NHS centres where complementary services are offered, 70 per cent. of women and 40 per cent. of men take them up, and that they are of great help with chemotherapy. However, there is a real problem. There is not enough knowledge about which therapies are working when they are used together. If I wrote to the Minister, would he please consider funding a little extra research?

I look forward to receiving the hon. Gentleman’s correspondence. I do not think that any Member has done more to champion the cause of complementary and alternative medicine across the national health service. As he will know, as a result of his efforts and those of others, the National Institute for Health and Clinical Excellence has included the role of complementary and alternative medicine in its service configuration guidance on supportive and palliative care for cancer patients—which is due to be implemented fully by December this year. Of course I would welcome a further letter from him, particularly one containing the views of such an eminent clinician as Karol Sikora.

In September, I had a breast cancer scare. Within five working days I was in the hospital and being screened—and everything was fine. I want the House to know that that was not because I am a Member of Parliament: when the staff contacted me by phone, they called me Mr. Taylor. I had to correct that quickly!

I raise the matter here today because I received excellent service from the University Hospital of North Tees; the breast cancer unit was excellent. My question to the Secretary of State is quite clear. When is it expected that all cancer services will be resourced to the same extent, so that it will be possible for everyone, within five working days, either to have their minds put at rest or to begin their treatment?

I thank my hon. Friend very much for her question, and I will relay what she has said to the NHS so that it will get her name right in future. It is important that she has shared her experience with the House, because it illustrates how far the NHS has travelled. It is a sad fact that breast cancer is the most common form of cancer in England. Some 38,000 new cases were diagnosed in 2006. I have seen the devastating effects of breast cancer in my own family, and I know only too well how quickly it can spread if it is not picked up early.

As my hon. Friend knows, we are extending the two-week guarantee to all suspected cases of breast cancer. She will have heard recently that we also want to extend GPs’ access to tests, so that although not every case may qualify for the urgent referral pathway, cases that do not can nevertheless be checked out by GPs. She is absolutely right: there can be no complacency. We will go still further to ensure that we give everyone in the country the best possible chance of surviving breast cancer.

The Secretary of State will recall that the Cancer Reform Strategy says:

“Sufficient finance will be made available to the NHS as part of their general capital allocations to fund investment in new cancer equipment.”

That was two years ago. Two weeks ago, the Prime Minister said that hospital building projects should have their resources taken away to fund new cancer equipment. Clearly that has not happened—or can the Secretary of State explain what additional diagnostic equipment is going to be paid for?

I do not think that it is possible for the shadow Secretary of State for Health to accuse the Government of not investing in cancer services. This Government made the change on day one of taking office, and we have invested in cancer services throughout our period in office. The facts are as follows. Cancer mortality among under-75s fell by almost 18 per cent. between 1996 and 2006. That is a record of which we are very proud. However, we must continue to invest in the equipment and capacity to give people as rapid access to tests as possible. As I said earlier, we want to give GPs the ability to refer people for non-obstetric ultrasound, for flexible sigmoidoscopy and other such tests, so that we can give people ready access to tests in the community, help to get early diagnosis and, in the vast majority of cases, put their minds at rest.

I regret that I did not really get an answer to my question. Since the Secretary of State wants to talk about cancer mortality, will he explain why, in the decade after Labour came to office, the gap in cancer mortality between this country and the European average widened? On the other point that he made, surely he must know that the issue in the NHS now is not primarily about the capital resources for additional diagnostics, but the staffing to support them. Diagnostic equipment could be better used if there were more radiographers and sonographers.

I can answer the hon. Gentleman on both points. As I said, cancer mortality fell over the decade in question. Cancer survival rates have been steadily improving. We accept that there is more to be done to close the gap between us and comparable countries, but that is precisely why I have taken steps on early diagnosis, which is the new frontier in taking on the battle against cancer.

The hon. Gentleman mentioned the work force. The cancer work force has increased considerably in that period. We have been investing not just in equipment, but in people. He mentioned radiographers. There were some 12,500 radiographers in 2000. In 2006 there were 14,500, and the plan is to have 17,500 by 2012. That is a genuine commitment to invest in the work force and the equipment that gives people in this country the best possible chance of surviving cancer. He cannot look me in the eye and say that his party in government did the same thing.

Order. I appeal to the Secretary of State and the other Ministers on the Treasury Bench: we must have shorter answers. We need to make progress.

Does my right hon. Friend agree that he cannot say often enough that the real reason why we have been able to reduce the problems with cancer and many other illnesses, particularly heart disease, is the money that we invested in 2001 and the 1 per cent. increase in national insurance contributions, every penny of which went straight to the NHS? That had never been done before in any Budget. Conservative Members walked into the No Lobby and voted against that money. As someone who has had cancer and open-heart surgery, I cannot thank the NHS enough. I thank my colleagues for walking through the Aye Lobby and providing the extra money to find the people to do the job.

I could not have put it better. The Conservatives had the nerve to stand up in Manchester last week and proclaim themselves the party of the NHS. But as my hon. Friend rightly says, a few years before that they walked though the No Lobby to vote against the money that Wanless said was crucial to put our NHS back on its feet. That money has paid for the figures that I have been reading out in the House this afternoon.

In 2007, the National Radiotherapy Advisory Group highlighted the 63 per cent. gap between current activity levels and optimal treatment levels. That position will worsen as cancer increases in an ageing population. The Secretary of State has mentioned the projected staff increases, but what will he do about the equipment which, although it was replaced under this Government, is coming to the end of its useful life? What plans are there to ensure that the equipment and staff are there in the future?

The hon. Lady is right to say that this is not a case of one or the other: we need both together. As well as radiographers, some 1,800 extra cancer consultants have joined the NHS since 1997. We need both, and I recognise that we have to invest in the most up-to-date equipment to give people the very best cancer care. That is our commitment, and that is what we are doing by reprioritising our spending plans to get the funding into that equipment, switching away from the hospital-building programme.

“Shaping the future of care together”

5. What discussions he has had with the devolved Administrations in relation to the implementation of the proposals in his Department’s Green Paper, “Shaping the future of care together”. (292232)

The Secretary of State wrote to Ministers in Wales, Scotland and Northern Ireland with the full text of the Green Paper before publication. Officials have been in regular contact with their counterparts in the devolved Administrations, and a further series of meetings is planned.

I am grateful to the Minister for that reply. In border constituencies such as mine, many constituents—such as those who live in Sedbury and Beachley in my constituency, whose nearest town is Chepstow in Wales—will be very concerned about how this plan would work across borders. In May 2008 Ministers said in the forerunner to this document that they were thinking very carefully about how it would work across devolved borders, so can the Minister give us any idea about any proposals he has come up with—or has the last year and half just passed with no concrete action at all?

The hon. Gentleman is right to say that the system of care and support that we want to create—it will be the first ever national care service of its kind—covers a mix of devolved and reserved policy areas, because care is devolved and the benefit system is reserved. We are therefore working closely with the devolved Administrations to ensure that any changes we make to any of the systems provide the best possible outcomes for people in the UK. I cannot pre-empt the consultation in which we are currently engaged to achieve that outcome, but I can assure the hon. Gentleman that we are working closely with the devolved Administrations to get the best possible outcome for everyone’s constituents.

Will the Minister think about how to get agreement with devolved Administrations so that the portability of benefits can extend beyond England, and can in due course, by agreement, be extended to people from England moving to Scotland or Wales, or vice versa, at some future stage?

My hon. Friend has highlighted a key feature of the new national care service that we want to develop: the idea that people’s care assessments should be portable. At present in England different people get different assessments depending on where they live. The proposals in the national care service will ensure that there is a single care assessment, so that people are not identified with different needs according to where in the country they happen to live. That is the kind of discussion about how the system would operate that we are having with counterparts in the devolved Administrations, including Scotland. If there are features of the national care service that have particular merit and benefits, and which the devolved Administrations, for whom this is a devolved matter, wish to replicate, I will be more than happy to enter into discussions with colleagues in those devolved Administrations.

As a prelude to the Green Paper, on 11 June the Minister said here that each MP had to ensure that the money from the carers strategy announced by the Prime Minister actually went to carers. The Princess Royal Trust for Carers reports that of this year’s £50 million, £40 million has gone missing, including in the Minister’s own Northamptonshire primary care trust. Where has the money gone? Does it surprise him that carers feel so let down?

I guess that carers will feel most let down when they hear that the Conservatives are opposing a national care service that will provide a fair, affordable and simple system. [Interruption.] I am talking about the question that the hon. Member for Forest of Dean (Mr. Harper) asked me earlier, about the national care service. That national care service will provide much more help for people both in their own homes and in residential care, unlike any of the proposals that have come forward from the Conservative party. In terms of the allocation of the carers money, I am delighted that the Government—again, the Conservatives voted against this—committed a sum of £150 million to be paid in to the national health service, to be provided by local primary care trusts. It is for PCTs to identify the priorities in their area. We are encouraging organisations, and we will be issuing guidance on how that carers’ support money can be provided, but it is this—

Alcohol-related Mental Health Services

6. What assessment he has made of the availability of services for patients in north Northumberland with mental health problems related to alcohol. (292233)

The North East strategic health authority has advised me that NHS North of Tyne undertook an assessment during 2007 to map the service provision against best practice guidance. Following that, the trust is now working with local partners on developing services in the local community for people with alcohol and mental health problems.

I welcome the flurry of activity since I tabled that question some time ago, but will the Minister take a personal interest in a matter that is worrying general practitioners throughout north Northumberland: the fact that there is no facility to which they can refer people with alcohol problems and alcohol-related mental health problems? Will she help and encourage all the relevant NHS trusts to fill that gap urgently?

I can indeed confirm a personal interest, as I spoke with the primary care trust this morning. It is aware of the challenge to provide better services and is in the process of completing a review of all alcohol services, including those for people who also have mental illness. I have asked the local director of public health to meet the right hon. Gentleman to discuss the review’s findings and he is happy to do so. I am also assured that the PCT is prioritising alcohol reduction services and, within that, has identified new investment for community-based alcohol services, which is particularly important for those with a lower-level mental health problem.

Order. I know that the hon. Member for Huddersfield (Mr. Sheerman) will stick to the subject of north Northumberland.

Can the Minister tell me whether the relaxation of product placement rules would help the people of north Northumberland in coping with alcohol problems?

I am happy to refer that question to colleagues in the Department for Culture, Media and Sport.

The Department of Health’s policy guideline on dual diagnosis talks of teams with specific expertise in dual diagnosis being developed and better co-ordinated. That was produced seven years ago, but anecdotal evidence from Northumberland and elsewhere suggests that little improvement has been made; indeed, people with schizophrenia have a 10 per cent. higher than average risk of having an alcohol problem. What action is the Minister taking to ensure that people with a dual diagnosis receive the right support?

We all know that providing the services for those who have both mental illness and an alcohol problem is an increasing challenge. There are many examples of good practice, but the truth is that, of course, we can do better. That is why we will publish, before the end of the year, good practice guidance on the development of integrated care pathways. That will give specific guidance for those who are working with people with co-existing alcohol and mental health problems. In other words, we seek to get the right people doing the right thing at the right time in the right way.

Better Healthcare Closer to Home

7. What his most recent assessment is of the effectiveness of the Better Healthcare Closer to Home programme in achieving its objectives. (292234)

I thank the Minister for his reply. He may be interested to know that more than 800 people wrote to Sir Richard Sykes, the chairman of NHS London, asking that there be no further undue delays in the Better Healthcare Closer to Home programme. We have received reassurances from Sir Richard that there will be no such delays from his end, so I now seek the Minister’s reassurances. Can he confirm that no block on that programme will be caused either by a south-west London review or by a pan-London review that is under way? Will he confirm when the Department—

First, I can confirm that the case in respect of St. Helier looks to be good, and we hope to be able to announce some progress on that in the near future. On the Better Healthcare Closer to Home programme, the primary care trust has already developed the Shotfield health centre—a new £13 million centre—in Wallington; the Robin Hood Lane health centre in Sutton officially opened in May 2008; and the PCT is also developing a GP-led health centre on the Wilson site in Mitcham, which will open in spring 2010. That is good progress.

Given the great importance of these services, will the Minister confirm that the working time directive has not had an adverse effect on the service provided?

It is important that we ensure that the quality of delivery of care in the NHS is not compromised by staff who are overtired and unable to make the difficult judgments that we often call on them to make. We have to ensure that the working time directive is delivered appropriately and that staff comply with it.

Social Care

We have held 28 “Big Care Debate” events in nine regions in England, which were attended by about 1,000 people. In addition, there have been more than 10,000 responses to the public consultation. I have also received 29 written parliamentary questions and 141 letters and e-mails about the care and support Green Paper.

I thank the Secretary of State for that response. A number of my constituents have contacted me about the Green Paper. Typical of their responses was one from a lady who said:

“I am deeply concerned about the proposals in the green paper to hand disability benefits over to the local authorities…It has taken me a long time to get the DLA Lifetime Award which is a tremendous help to me and has enabled me to go out and get a job and actually live my life a lot easier and I am also less dependent on people to do things for me.”

Will the Secretary of State take this opportunity to reassure my constituent that the Government will not take away awards such as the disability living allowance and the carer’s allowance, which allow people to live independently and with dignity?

We think that there is an argument for combining some disability benefits with the funding that goes towards social care to create a better system for care and support. I also want to reassure the hon. Gentleman’s constituent that no decisions have been taken on this matter. Obviously, we are consulting on it through the Green Paper. The main point that I want to put across is that whatever changes we make, we want to ensure that under a new and better care system people can still get an equivalent level of support to that which they are used to. We would want to replicate the level of control that his constituent describes under the new national care service that was described by the Minister of State, my hon. Friend the Member for Corby (Phil Hope).

If we are going to introduce a national care service, why should it not be funded in the same way as our national health service is?

I would say to the Chairman of the Select Committee on Health that we have to be careful to ensure that it is fair across the generations. To say that the cost of social care should be fully funded by the taxpayer raises a genuine question about whether that is fair to today’s working-age population, who obviously face their own pressures. The proposal at the heart of the Green Paper, in all the scenarios, is a partnership between the state and the individual. We think that that will be the fairest way to proceed, but obviously there are different ways in which that partnership could be constructed.

Allergy Services

9. What assessment he has made of the effectiveness of the specialist allergy service pilot in the north-west. (292236)

The pilot allergy network in NHS North West started in February 2009. The project team is beginning to work with the clinical evaluation unit at the university of Liverpool on “An Analysis of North West Services” to review data about current activity and measure improvements and outcomes.

I thank the Minister for that reply. The pilot for specialist allergy services is very important. I hope that she agrees that the active co-operation of primary care trusts is essential. What are her Government doing now and in the future to get PCTs to buy in to the allergy pilot?

First, may I congratulate the hon. Lady on her gallant fundraising efforts, through which she has achieved so much for the Anaphylaxis Campaign? The direct answer to her question is that it is, again, about commissioning. That is why the pilot and the evaluation of it are so important to us. We are meeting the national allergy strategy group on Thursday and we hope to discuss some of those issues, and in particular that raised by the hon. Lady. Until we have seen the evaluation of the pilot in north-west Manchester, it is more difficult to highlight best practice, which is what those involved are so keen to do.

We recognise that, but it is important that PCTs get the extra funding to provide support for specialist allergy services and for referrals, as well as for the provision of extra knowledge within the PCTs. A hospital such as that in Chorley could be a centre for specialist allergy services, too.

As always, my hon. Friend has raised his constituency and praised it—and rightly so. It is important that we get our GP training packages in place so that there is a first point of call for a patient who suffers an allergy that is not always as well known as some other conditions. We need to look at the training of GPs and of the work force in general.

Mid Essex Hospital Services NHS Trust

10. What recent assessment he has made of the financial performance of the Mid Essex Hospital Trust; and if he will make a statement. (292237)

The trust’s finances were classified as “performance under review” in September by the director general of NHS finances. The East of England strategic health authority is working with the trust to ensure that it brings its finances into balance by the end of the year.

How would the Minister respond if he were to receive a complaint from an ancillary worker or nurse at the Mid Essex Hospital Services NHS Trust that the trust’s financial performance over the past two years had been affected by the income garnered in staff car park fees? That income has risen from £90,000 to £250,000, and the effect is felt most especially by those members of staff who find it hardest to pay the charges.

The trust has to determine how to raise finance, but I do find such a large rise in car park charges a little excessive. The trust has had a number of good financial years, and it was supposed to go into surplus at the end of this financial year. The result of the Department’s intervention is that we know that the trust is working on a programme to bring itself back into surplus, but I do not expect that to be at the expense of staff.

Berkeley Hospital

NHS Gloucestershire has identified the Littlecombe south site at Dursley for the relocation of Berkeley hospital. Heads of terms for the site are to be agreed by the end of October and the project is expected to be completed in 2011-12, with services transferring to the new hospital in spring 2012. It has been suggested in initial discussions that the existing site should be used for mixed residential and retail purposes.

I thank my right hon. and learned Friend for that response, and it is good to hear that a site has been identified. Does he agree that we need to make rapid progress on this excellent project, and that it is essential to ring-fence its funding to make sure that it goes forward? Will he allow me to discuss with local people how the existing Berkeley site could be used most appropriately?

Obviously, the use of the existing site is a matter for local decision, and I have no doubt that my hon. Friend will be involved in that. As for the project’s funding, it has been allocated from the community hospitals programme already and I understand that it is secure.

NHS Work Force

The most recent NHS work force census was published in March this year, and it shows that, as at 30 September 2008, there were 1,368,186 staff employed by the NHS in England. That is equivalent to 1,124,818 staff working full time.

I acknowledge the huge increase in expenditure on the NHS, but does the Minister accept that many non-clinical staff have been needed because of the service’s top-down style of management and bureaucracy, as well as what I would call its “tick-box” culture? In these straitened economic times, will she ensure that front-line clinical services and staff will be protected—not least in maternity services, given the increasing birth rate due to immigration—

I can assure the hon. Lady that front-line clinical staff will be protected at all times, as quality and safety are this Government’s priorities. Managerial staff are of course always required to run an efficient and progressive health service, but the front-line clinical staff will be there to provide the quality service that we have grown to respect and need.

The Royal College of Surgeons conducted a large-scale survey of its members this summer, and it found that two thirds of surgeons felt that the quality of care given to patients had been reduced because of the European working time regulations. Will the Minister say whether there are enough surgeons to cope? Should we not have rather more in the NHS work force?

Our overriding priority will always be to continue to ensure that patients experience high-quality, safe and effective care in the NHS, which of course we have provided by our surgeons. Hospitals such as Homerton in London have been working a 48-hour week for more than two years, and have produced evidence that the change has decreased hospital mortality. There is no evidence of harm being caused to patients. I think we all want our surgeons to be rested and to have had a night’s sleep, to be well equipped for the job ahead.

Hospital Services (London)

Clearly, it is for the local NHS to determine the best way to reconfigure services to meet the needs of local people, but changes to existing service provision should be initiated only where there is a clear and strong clinical case for doing so in the best interests of patients.

I welcome news from the Imperial College trust that the new hyper-acute stroke unit is to be based at Charing Cross hospital in my constituency. However, hidden in the small print of the consultation document there is already a proposal to move those new facilities to St. Mary’s in Paddington. Does the Minister share my concern about the continual transfer of services from Charing Cross hospital to others, including renal, obstetrics, gynaecology and now vascular surgery, and the detrimental impact that will have on my constituents and those across west London?

That is a somewhat churlish way of welcoming the fact that the hon. Gentleman is having a new facility located in his constituency at Charing Cross. I should have thought he would welcome that. As far as Charing Cross hospital is concerned, the aim is to retain a full range of health services for the people of Hammersmith and Fulham, including 24-hour full accident and emergency and maternity services. The trust will continue to provide neurology and stroke services at Charing Cross. That is the long-term programme, but we want to have a project at St. Mary’s as well, so I do not think the hon. Gentleman needs to get overly worried—there will continue to be stroke services at his hospital.

Topical Questions

On Thursday, the Care Quality Commission will publish its NHS performance ratings for 2009. On the same day, the chief medical officer will give an update on swine flu, including further details about the vaccination programme. Following last night’s vote on the Health Bill, the Government are assessing how best to take that important policy forward and will make a further statement in due course.

The Secretary of State will be aware that the out-of-hours service is becoming increasingly dependent, particularly at night-time, on non-British doctors. As he will be aware, the UK is unique in the European Union in having a general practice provision. What precautions is he taking to ensure that non-British doctors coming from other countries are suitably qualified to perform the out-of-hours service, and are fully acquainted with the level of drugs that should be issued to patients in their care?

The hon. Lady raises a very important point. It is important that primary care trusts ensure that the providers of out-of-hours services are conducting a proper, full assessment of those who carry out those services, that they understand the way the NHS works and how drugs are allocated and prescribed in this country, and that they can speak adequate English.

T3. According to the National Autistic Society, in a report in the summer, people aged 40 to 50 are not being diagnosed with autism, and the BBC recently said that GPs feel that they do not receive the training necessary to give patients that service. Can my hon. Friend tell me what he intends to do to ensure that GPs get that training so that those 40 to 50-year-olds have the diagnosis they require? (292255)

I thank my hon. Friend for his very important question. First, autism is actually mentioned in the GP curriculum statements on mental health and on children and young people, so we already expect all GPs to have a general understanding of first principles, but I fully agree that more professional training is a key area for development. It is one of the features of our recent consultation on the first-ever national strategy for adults with autism, which focused on a range of areas, including health and training. That will have a direct impact on GPs and their training, and that national strategy will be backed in law.

T2. In the north-west only 53 per cent. of children receiving treatment for substance misuse complete the course. What are the Government doing to improve that alarming figure? (292254)

We have to look at all ways of reducing the harm caused to children by addictive substances, including drugs. Our campaign under the tag FRANK is one of the ways. We are also increasing access to services across the country, but we are tailoring them to ensure that we meet the needs of all groups.

T8. I wonder whether my right hon. Friend would like to come and visit Chorley hospital, one of the best hospitals in the country, and support a walk-in treatment centre beside the accident and emergency department, which will give new life to Chorley. (292260)

I understand that my right hon. Friend the present Home Secretary visited not long ago when he was in the post that I now hold. I am not sure whether my hon. Friend the Member for Chorley (Mr. Hoyle) got something new on the occasion of that visit, or whether he wants something new on the occasion of another visit, but as he knows, I am not far down the M6, so I will bear his kind invitation in mind.

T4. Returning to the subject of carers, do Ministers accept the figures in today’s report from the Princess Royal Trust for Carers and Crossroads Care that only one pound in five of the money allocated this year for carers has been spent? Will they publish, for each trust, the amount that has been allocated and ask each trust to publish by the end of this month how they intend to spend the money on carers this year? (292256)

I understand and fully appreciate the concern that carers organisations have about the fact that the Government have put £150 million over two years into PCT budgets to pay for respite care and other support for carers. The Government have played their part in responding to the needs that we recognise among carers. The question is how that money is spent by local PCTs. The hon. Gentleman knows that those primary care trusts make these decisions based on an assessment of their own areas. He knows, too, that the Department is producing a document to assist primary trusts and local authority commissioners to understand how the needs of carers may be effectively identified, and that we will seek to publicise that guidance as widely as possible. That, I think, will have an impact on the primary care trusts delivering the money that we provided to meet the needs of carers and those for whom they are caring.

T9. Worcestershire Acute Hospitals Trust has recently reported to me on the huge progress that it is making in reducing hospital-related infections—only seven MRSA infections so far this year, well inside the rightly tough target that has been set for them. Given that that progress saves lives and saves money, how can we ensure, first, that it continues, and secondly, that money saved in Worcestershire is reinvested in improving patient care even further in Worcestershire? (292261)

I welcome my right hon. Friend’s question because it gives me the opportunity to congratulate the health service on the achievement of the national target for MRSA, which has reduced by 50 per cent. the number of MRSA bloodstream infections, in comparison with the number in 2003-04. The latest data for April show that MRSA bloodstream infections are down 74 per cent., but we can never be complacent in relation to these infections. We are tremendously pleased with the progress that has been made. While constantly keeping our eye on those figures, we are reinvesting money in the knowledge that we already acquired because knowing how to reduce infection rates is so important. I welcome all the improvements that have been made and look forward to discussing them in my right hon. Friend’s constituency.

T5. The Secretary of State has announced recently his policy aspiration to abolish car park charges in NHS hospitals for patients. He did not mention in his speech ancillary workers and nurses and doctors. Will that policy, if he ever has the possibility of bringing it in, apply to that group, and if not, why not? (292257)

I hear the hon. Gentleman, but of course the policy has to be affordable, and I think it fair to say that when a family has somebody in hospital, particularly if that person is in for a long time, we should make it easy for the family to visit as much as possible. To go further still and provide free parking for everybody would be a difficult policy to introduce, because it would provide an incentive for everybody in the locality to park for free at the hospital. We think it right to prioritise in-patients, but, if the hon. Gentleman is making a spending bid to go further, perhaps he should direct it to his Front-Bench team.

Monitor produced early this year a damning report on the governance of Heatherwood and Wexham Park Hospitals NHS Foundation Trust in my constituency. This week, at last, the chairman of the trust resigned. What can the Department do to ensure that when there is a failure of governance, the consequences of the past poor actions by the board and by executive officers are not taken out on staff, who may face redundancy now?

As my hon. Friend knows, in the Health Bill yesterday we made some amendments that will enable de-authorisation to occur in particular circumstances, with the consent of Monitor. We need to ensure that when trusts are not foundation trusts, we are able to act quickly to ensure that people who are responsible for ineffective administration of the health service are dealt with; and that the strategic health authority bears in mind that there might be financial implications that it would have to consider as part of the overall regional budget.

T6. A memorandum of understanding has been reached between Sutton and Merton primary care trust and the London borough of Sutton over the sale of land that is needed for Stanley Park high school. May I urge the Secretary of State to intervene and ensure that, as soon as possible, the memorandum of understanding is converted into a firm contract, so that this fantastic project to build a new school can proceed as soon as possible? (292258)

I hear the hon. Gentleman, and I am very happy to have a look at the project, but, as the memorandum of understanding has already been signed, some progress is clearly being made.

My right hon. Friend the Secretary of State has announced that the Care Quality Commission will be reporting in due course. He will not be surprised to hear that in a meeting with Charnwood carers group, I found that the quality of care in the community and in care homes is high on people’s agenda. In fact, many were in tears at their own experiences, despite the tick-box reality of the commission’s work. Will Ministers ensure that there is genuine personal care in such places? That is what people really want, for the dignity of their elderly relatives.

My hon. Friend is right to highlight issues of concern about the quality of care, whether it is care of people in their own home or in residential care homes. The Care Quality Commission plays an essential role in monitoring and inspecting care homes to ensure that standards are sufficient. We need to go further and ensure that all care, whether in a care home or in a person’s own home, is personal and tailored to meet individual needs. The Prime Minister’s announcement of free personal care for everybody who is looked after in their own home and has the highest level of critical need is a major step forward and—

T7. Following the recent death from swine flu of Louise Jones from Leigh, what steps is the Secretary of State taking to increase the number of extracorporeal membrane oxygenation—ECMO—beds, especially in the north? The UK has only five, whereas there are 23 in Australia. (292259)

Of course, the case of the 24-year-old woman, who did not live directly in my constituency but in Tyldesley, which is nearby and, as the hon. Gentleman knows, not so far from his constituency, was incredibly sad. I am led to understand that, in that case, the clinicians did not think it possible for the patient to travel. However, a decision was taken recently to expand ECMO provision in Leicester. The clinical advisory group advised that it was right to concentrate provision in that area, given the huge amount of training and intensive support that the unit needs. The decision has been taken, we recognise that such technology has a very important role to play and I hope that the hon. Gentleman welcomes that decision.

Some of the big pharmacy wholesalers, such as Phoenix Healthcare and Alliance Healthcare, are also retailers and so refuse to supply wholesale to small, new and independent pharmacy retailers. Will the Minister look into that apparent restraint of trade, please?

The answer is yes, I am doing that. There are concerns about the way in which wholesalers are now using, in effect, funnels to restrict the ability of some of the pharmacy retailers to get access to drugs, thereby driving up the price. I am concerned about this, and we need to watch it very carefully.

T10. During the summer recess another NHS dentist in my constituency left the NHS and went private. The provision of NHS dentistry is getting worse year by year in Cornwall generally. When are the Government going to do something about it? (292262)

NHS dentistry provision has improved in the past few months in most areas of the country. PCTs are given the priority to secure access to such provision for all who seek it. All 10 SHAs have now set themselves the aim of achieving that by March 2011 at the very latest.

Can my right hon. Friend ensure that PCTs in areas where first-cousin marriages are the norm will provide genetic screening and counselling and ensure that the communities are aware of that provision?

My hon. Friend raises a very important point. Before giving a firm assurance on that, we need to take some advice on the clinical implications from those whom we would call upon to carry out such tests.

Many cancer patients complain of feeling isolated during their treatments, citing lack of appropriate information and support. The Department’s “Cancer Reform Strategy” promised the introduction of cancer patient experience surveys to help to monitor better-quality care that is given to cancer patients. Could the Minister explain why this measure still has not been introduced, two years after it was first promised, and what is he going to do about it?

I agree that it is very important to help people to live with cancer. In this financial year, we are providing some £1.6 million to Macmillan for precisely that purpose—to help people to get on with their lives and deal with the effects of living with cancer. On the specific issue that the hon. Gentleman raised, I will write to him.

Yesterday was world arthritis day. What is being done to ensure earlier diagnosis of rheumatoid arthritis, which is a very painful and disabling condition if it is not detected early, often leading to people being unable to work?

That is a very important point in relation to rheumatoid arthritis. As has been stated, this week is world arthritis week. We are having a discussion with Dame Carol Black on how we can enable the health work force, particularly GPs and others, to be aware of the early detection of this painful crippling, which obviously has many implications for the patient’s quality of life.