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Oral Answers to Questions

Volume 501: debated on Tuesday 24 November 2009


The Secretary of State was asked—

NHS Constitution

1. What recent assessment he has made of the effectiveness of the NHS constitution; and if he will make a statement. (300139)

The NHS constitution was based on extensive consultation and has widespread support. It gives real power to patients by describing their rights. The Health Act 2009 gives the constitution its legal underpinning and requires a report on its effectiveness to be published every three years.

Last month Milton Keynes hospital acquiesced to the demands of a pregnant woman by providing an all-white staff for the delivery of her baby. Does the Secretary of State think that this was the correct decision by the hospital, or can we sometimes put patients’ wishes too much to the fore in thinking of hospitals’ actions?

I cannot be alone in finding uncomfortable the situation that the hon. Gentleman describes. I should have thought that it was so for the NHS staff who were on the receiving end of such a request. I know that the trust concerned is conducting an investigation into the request and its handling. I shall be happy to update him when further information is available.

Does my right hon. Friend expect that when the patient consultation on the new constitution has been completed, the wait of 18 weeks or less for a referral from a GP to a consultant or the two-week wait for GP referral for somebody suspected of having cancer will be one of the most popular things that has happened in the national health service in our lifetime? Will he make sure that that is reinforced so that people will expect it for many years to come?

My right hon. Friend the Chairman of the Select Committee is right to say that the outstanding progress the NHS has made on waiting times in the past decade should never be lost. We should lock in that progress and the NHS should not slip back below those standards. The patients charter published on 3 March 1995 gave an 18-month guaranteed waiting time for in-patient treatment. That is the measure of how far the national health service has come in recent times. I expect patients to endorse the proposal on that new right, but the NHS constitution will need to be updated in line with public expectations about the national health service.

The draft NHS constitution includes a right to drugs approved by the National Institute for Health and Clinical Excellence, yet we are witnessing a growing crisis with patients unable to get hold of vital drugs for breast cancer, epilepsy and many other conditions. There is a long list of drugs that are currently unavailable because people are exporting them and profiting from the exchange rate. Is this not a despicable trade? What are the Government doing to stop it?

I understand the concerns that the hon. Gentleman expresses about parallel exports. The medicine supply chain is crucial and we are taking steps in the Department to guarantee the security of crucial medicines. He mentions the right in the constitution to

“treatments . . . recommended by NICE . . . if your doctor says they are clinically appropriate for you.”

We believe that that is an important right for patients. Obviously NICE has a difficult job to do in judging the cost-effectiveness of treatments, but we think it is the right guarantee to make so that, just as we will not see waiting times slip back, there will never be a return, under this Government at least, to the postcode prescribing that we saw in the 1990s.

The right hon. Gentleman is right that there should be an entitlement, yet every day drug companies are reporting 300 to 500 calls from people who cannot get hold of vital medicines. I have a letter that has been circulating to community pharmacists; it includes a price list, with very attractive offers to pharmacists to buy their drugs for export, thereby denying patients in this country vital drugs. What are the Government doing to stop this unethical practice?

On Friday, the Minister of State, my right hon. and learned Friend the Member for North Warwickshire (Mr. O'Brien), published clear guidance to primary care trusts. The issues that the hon. Gentleman raises are crucial. It is vital that patients have access to the medicines that they need. We are taking a range of steps to secure the medicines supply chain, but I understand the points that he is raising. We have taken action and I will continue to work with him to ensure that there is no problem in the supply of medicines.

I declare an interest as someone who suffers from type-2 diabetes. Will my right hon. Friend assure the House that the NHS constitution will properly protect those who have diabetes by giving them an assessment to determine whether they have the illness? It is better to prevent than to treat once somebody has an illness.

I agree entirely that the challenge for the national health service is to become truly preventive—to become a national health service, with the word “health” underlined. My right hon. Friend will know that as well as consulting on the proposed maximum waiting times, we are asking the public whether people aged between 40 and 74 should have a right to an NHS health check every five years. That would take the NHS into new territory. It would take it squarely into preventive territory, and I look forward to hearing whether he and his constituents think that is the right step to take.

The NHS constitution says that patients should have access to NICE-approved drugs. What does it offer a patient with primary liver cancer, for example, who has only one drug as an option for treatment and is told that the NHS will not provide it?

I described the right very clearly in my answer to the hon. Member for North Norfolk (Norman Lamb): it is a right to drugs as approved by NICE. The hon. Member for South Cambridgeshire (Mr. Lansley) should accept—indeed, I think I have heard him say before—that NICE has a very difficult job to do in judging the cost-effectiveness of new treatments. I do not want to return to a situation in which people have different access to drugs and treatments according to where they live. NICE brought order to the system, and has an international reputation for rigour in the assessment of new medicines. I am proud of the difficult job that it does, and when it has made its deliberations, that right carries its recommendations to patients throughout the country.

The Secretary of State did not answer my question, but the answer that he should have given, according to his view, is that the constitution offers patients in those circumstances nothing—they will not have access to that drug. Why will he not follow the policy, which we pressed on him and his predecessors, of a value-based pricing system for new medicines, so that patients are provided with treatments that are clinically best for them, so that the reimbursement price through the NHS then reflects the value of the drug, and so that the Government, the national health service and the drug companies get together to ensure that patients have access to treatments that are clinically effective and best for them? Why will the Government not accept that they should have a policy that puts patients first?

Let me answer the direct point about NICE’s provisional decision on treatments for liver cancer and Nexavar. It is a provisional decision, so every patient in the country has the opportunity to comment on it and the breadth and range of views can be heard. That is everybody’s right—to make their views known. I do not think that the hon. Gentleman could sit in my position and basically say that every new treatment that comes along can be afforded. We have to have some rigour in the system, and in the way that decisions are made. Experts—I stress that word—should advise Ministers on how best to take forward those decisions, and that is what we have in NICE. It does an extremely important job for the Government and, I might add, for the taxpayer, and I should expect the hon. Gentleman to show it a little more support.

About 10 or 12 years ago, I regularly had complaints from constituents who were waiting 18 months, two years and, in some cases, three years for an operation. On the patient guarantee, it is absolutely right that we reaffirm our commitment to waiting list times, and we should laud what we have done to reduce them, but will my right hon. Friend similarly guarantee that we will continue to press as hard as we can to get waiting lists down?

I agree entirely with my hon. Friend, and the whole thrust of the constitution is to translate those targets into permanent rights so that there is no slipping back. My father has just had a heart bypass operation, and he was treated within a matter of weeks. I looked at the patients charter that the Conservative party introduced in 1995, and there was a 12-month standard for an artery bypass graft. How many unlucky people died on those waiting lists for heart bypass operations? That is a world away, and I assure my hon. Friend that under this Labour Government we will never go back to such a situation in the national health service, with people dying waiting for hospital treatment.

NHS Dentistry

2. What recent assessment he has made of the adequacy of NHS dental provision; and if he will make a statement. (300140)

More than 27.6 million people saw an NHS dentist in the 24 months ending June 2009. That is almost 750,000 more than in the same period ending June 2008.

I thank the Minister for her answer. Paul Bason, a constituent of mine and a dentist, came to see me and told me that he has a major problem, because when someone needs a root canal operation on their teeth the current dental contract incentivises him to remove the tooth rather than to perform an operation. Does the Minister think that the contract is conducive to good dental practice?

No, I do not. We have discussed that issue and root canal work many times in the House, and I suggest that the primary care trust in the hon. Gentleman’s constituency speaks to the dentist concerned. Some root canal work is extremely complicated, so if the dentist cannot carry out the required clinical procedure, he can refer the patient to an NHS hospital, where a consultant will see them.

May I wish the Secretary of State’s father a speedy recovery?

In 1999, Tony Blair promised access for all to an NHS dentist by 2001. Since the contract was rejigged, more than 1 million people now do not have access to an NHS dentist—an increase of half a million. When will Tony Blair’s promise be fulfilled?

I believe that the hon. Gentleman will be aware of the increase in dentistry and dental practice over the past two to three years, particularly in his own area. Oxfordshire has a contract with an existing practice to provide short-term provision, initially for 500 additional patients. In Oxfordshire, the number of dentists increased from 262 in March 2007 to 309 in March 2009. I hope that I am known in the House for my caring attitude to staff and to Members. Later this afternoon, I am opening a dental practice in Horseferry road in Westminster, which I am sure that residents and people who work in this area will be able to use.

Will my hon. Friend agree to meet me to discuss the plight of lab technicians who make crowns and dentures for dentists? With dentists using cheaper foreign options, our domestic industry is dying on its feet.

I am sure that the whole House would agree that when our armed forces come home on leave they need the best possible treatment from the NHS. Does the Minister therefore agree that it is abhorrent that when a serviceman comes home on leave and needs dental treatment he is turned away by the PCT because there is no funding stream for that treatment and sent back to barracks for treatment? Is that not wrong in the NHS in the 21st century?

If the hon. Gentleman would like to give me evidence of that, I would be very interested to look at it.

Human Trafficking

3. If he will issue guidance to health care practitioners on the likely health care problems experienced by trafficked persons which might not present immediately. (300141)

Multi-agency guidance for all front-line practitioners on meeting the needs of trafficked people was issued last month. It includes a specific section on how front-line health practitioners should respond to the needs of trafficking victims, including those who might not present themselves immediately.

As many trafficked people have suffered from the most appalling mental and physical abuse requiring ongoing medical support and counselling, could I mention to the Minister the in-depth counselling service of the Helen Bamber Foundation in London, which gives wonderful ongoing counselling support to trafficked victims as well as to those who are found to have suffered torture? Will she consider extending that kind of in-depth counselling service to other parts of the country where more and more trafficked people are coming forward?

May I pay tribute to the hon. Gentleman, who is a passionate advocate for people who rarely have a voice themselves? I, too, congratulate the Helen Bamber Foundation, whose work does indeed help to rebuild the lives of those who have suffered the worst of violations. Provision of services is of course a matter for local health services. However, I will gladly draw the hon. Gentleman’s comments to the attention of the taskforce that the Government have set up, whose work includes looking at the role and the response of health services in respect of trafficked people.

Talking therapies are very important for people who have been through the trauma and post-traumatic stress disorder that are too commonly the fate of those who have been trafficked. In our constituencies, many of us find that there is insufficient access to talking therapies for anyone. Will my hon. Friend talk to PCTs and mental health trusts around the country about ensuring that there is better access to counselling and talking therapies for people with such conditions?

I certainly share the views of my hon. Friend, who makes an absolutely valid point. That is exactly why we have set up the taskforce. It is chaired by Sir George Alberti, who will look specifically at where there are gaps and what role the NHS and health service workers can play in supporting those who have been traumatised in the way that has been described. I hope that will do a lot to plug any gaps such as those that my hon. Friend mentions.

Most of the people who are trafficked into this country are young men and women who are exposed to terrible abuses. Will my hon. Friend have discussions with her counterpart in the Home Office to ensure that any criminal money that is recovered from the people responsible for this trafficking is confiscated and, better still, redirected to the NHS to pay for the health care of these young people?

Again, my hon. Friend makes a very important point. Indeed, the taskforce that I referred to was set up by the Home Secretary and the Health Secretary, and we want particularly to consider how we can support victims of trafficking, work better together across Government and help to bring to justice those who perpetrate this crime. We want to make the advances that my hon. Friend refers to.

Parking Charges (Offsetting)

4. What guidance he has given to NHS trusts on the offsetting of receipts from parking charges against their deficits; and if he will make a statement. (300142)

NHS trusts manage finances locally, including how they eliminate deficits. Parking subsidies need to be approached with care, especially where the trust has a deficit.

The Minister will remember that at the last Health questions, he told me that he did not expect trusts to make a profit out of car parking to pay off deficits. What is he going to do with the letter from the chief executive of Mid Essex Hospital Services NHS Trust that I sent him a month ago, which states that the trust increased car park charges from 1 February 2007 for staff at Broomfield hospital from £40 a year to £200 a year as part of the turnaround scheme to reduce the deficit? That seems directly contrary to what the Minister said last month that trusts should do.

The hon. Gentleman did raise that with me, so I have looked into it. The increase in 2007 for staff was from 77p a week to £3.85 a week. At the moment, the trust apparently charges staff half the annual cost of operating the space. In other words, I am told that the trust subsidises those car parking spaces.

Today the shadow Chancellor has said how tough he wants to be on climate change and how he wants to discourage people from unnecessarily using vehicles and so on. Now, the hon. Member for West Chelmsford (Mr. Burns) wants to ensure that instead of money being put into patient care, it is put into greater subsidies for car parking—

I believe my right hon. and learned Friend’s guidelines suggest to acute trusts that they should provide some free parking to disabled badge holders. In cases where they do not do that, such as at my hospital at Sandwell, what recourse do we have to press them to change?

We have said that we want people with disabilities who are regular visitors to hospital to have access to permits that will enable them to have car parking spaces at a reduced charge. On what can be done, my hon. Friend must of course first approach the hospital, and if that is unsuccessful he should approach the primary care trust.

Smoking Cessation

5. If his Department will take steps to promote the health benefits of low-toxicant smokeless tobacco products as aids for smoking cessation. (300143)

There is no evidence that smokeless tobacco can help people to quit smoking. Such products are tobacco, and they release harmful toxins when used. The Department therefore has no plans to promote that form of tobacco, but we will continue to support smokers in quitting using safer means, including licensed nicotine replacement medicines.

What an arrogant and irresponsible reply that is. Does the Minister not realise that based on the Swedish experience, if snus were legalised in the United Kingdom it would save up to 30,000 lives a year? Does she not realise that even the World Health Organisation recognises snus as a useful harm reduction product?

I am sorry to disappoint the hon. Gentleman, but there are very good reasons for my comments. The Scientific Committee on Emerging and Newly Identified Health Risks, which is both official and independent and provides the European Commission with scientific advice, considered in detail the health effects of smokeless tobacco products and concluded that such products were addictive. I have myself looked at the packaging of such items and seen that even the tobacco industry acknowledges that they are not a safe alternative to cigarettes.

May I associate myself with my hon. Friend the Minister’s remarks? Does she agree that the most effective way to reduce the incidence of smoking is to reduce peer group pressure on young people to take up smoking? What assessment has she made of the role of the ban on smoking in public bars and restaurants in achieving that?

My hon. Friend will know that just this year we celebrated the 10th anniversary of the NHS stop smoking services, which have saved more than 70,000 lives. We know that people are four times as likely to quit with support than without it. The important point that he makes is that two thirds of smokers start before they are 18, and that is why smoke-free legislation and other measures in recent health legislation will contribute to reducing the numbers of new recruits to the tobacco industry.

Social Care Reform

7. When he plans to publish the Government’s response to their consultation on the reform of social care. (300145)

The consultation closed on 13 November. More than 28,000 responses have been received and 37 events held in all parts of the country. The Government’s response to the consultation will be published in the new year.

I am grateful for that reply. The Secretary of State will know that all the options being consulted on, except for the one whereby everyone would pay for themselves, assume that the Government would take attendance allowance and disability living allowance from the over-65s and put them into a social care system, which would take away individual control. That move is opposed by every single organisation representing disabled people. When he publishes those consultation responses, will he listen to them and cancel that aspect of his social care plan?

The hon. Gentleman either has not read the Green Paper or has misunderstood it. The Minister of State, Department of Health, my hon. Friend the Member for Corby (Phil Hope), who has responsibility for care services, has said that the principle of individual budgets, introduced by this Government, would be the cornerstone of any national care service. That control over purchasing care would be replicated in and be at the heart of any new system.

This is an important debate which is at the forefront of many older and disabled people’s minds. The unpleasant campaign that the Conservative party launched last week will frighten vulnerable people about their benefits with misleading claims about what will happen to them. I find it despicable.

Does my right hon. Friend agree that when we are talking about people who are disadvantaged and vulnerable, and who have great fears about their future, playing party politics is disgraceful?

I entirely agree with my hon. Friend. It is utterly disgraceful. There were claims made last week that benefits would be taken away from elderly and disabled people and that some could lose “up to £60” a week. I do not know how the shadow Health Secretary can justify those claims when he knows them to be untrue. We have said clearly that in any new system people would be offered an equivalent level of support. The whole aim of this reform is to provide more support to vulnerable people, not less. It is because the Conservatives have such a threadbare response to these serious issues that they resort to scaremongering and frankly despicable tactics.

Responding to the Green Paper, Age Concern said:

“We oppose funding the National Care Service from Attendance Allowance”.

I agree with Age Concern. The Secretary of State seems to have been thrown into a panic by this subject. Why does he not simply get up now and say that the Government will reject any of the options in the Green Paper that depend on scrapping attendance allowance or disability living allowance for the over-65s?

I will get up and say what I have just said—that every person will get an equivalent level of support, and I have made that clear. The hon. Gentleman went to a press conference last week at which he suggested that money would be taken from those people. That destabilises, upsets and causes anxiety in some of the most vulnerable people in society, and for whose purposes? It is for the purposes of the Conservative party’s election campaign. I find it beneath contempt, and we would do those people a greater service by having a proper debate on the issues.

NHS Governance

8. If he will bring forward proposals to involve more elected representatives in NHS governance structures at local and regional level. (300146)

There are many ways in which elected representatives can be involved in the NHS locally. These include opportunities for elected representatives to seek membership of primary care trusts and strategic health authority boards as non-voting members or non-executive directors. There is joint working by elected representatives, local authorities and primary care trusts in local strategic partnerships and, of course, there is the use of overview and scrutiny powers by local government.

When I want to discuss health matters with a directly elected person in this country, I cannot do it at either the local or regional level. The first person I come across who is directly elected is my hon. Friend, along with his capable colleagues on the Front Bench. Does he not think that that is going a bit too high up the pay grade? Can we not have people who are directly elected and capable at the local council and regional levels?

I know that my hon. Friend plays a huge role in chairing his local strategic partnership, where he has locally elected representatives and members of the primary care trust sitting round the table talking about local needs and issues. However, I might also draw his attention to the new Regional Select Committees, which can hold regional health authorities to account for specific aspects of their performance. [Interruption.] And as you can hear from the noise, Mr. Speaker, the Opposition voted against those regional forms of accountability.

The hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) and I have worked as locally elected representatives on his energetic campaign to prevent the movement of the accident and emergency unit from Shrewsbury hospital. We have now received assurances from the authorities at the hospital that the service will not be moved, but I do not understand what formal mechanism we would have under the current arrangements to object, especially bearing in mind that this is a cross-party issue. How would the Minister advise us to ensure that our constituents’ concerns about any such move are formally registered, given the system that he has been outlining?

I am not familiar with the hon. Gentleman’s specific concern, but in general terms, decisions about reconfiguration, which is what I suspect he is talking about, are clinically led decisions, made by leading local clinicians determining what is in the best interests of patients and services in his constituency and those of his neighbours. I would hope that he, his constituents and other local bodies would make their representations in the normal way, but be guided by the clinicians, who I think probably know what is best for patients in their area.

But are patients’ voices being heard in the NHS, and what about these local involvement networks? What assessment has the Minister made of their effectiveness?

The creation of LINks is an important additional form of accountability in the NHS locally, not only to local Members of Parliament and locally elected councillors but directly to service users and patients, who will have an opportunity through LINks to influence the pattern of service, including procurement, provision and quality.

Capital Funding (Hospital Trusts)

Wellingborough is a fast-expanding constituency, with thousands of new homes being built. It has no hospital, and now this discredited Government are closing the hospital out-patient facility. In the neighbouring, highly marginal Labour constituency of Corby, a new hospital and a new out-patient facility are being built. Are this Labour Government buying votes?

I thought the hon. Gentleman’s party was fully in favour of foundation trusts. Kettering general hospital foundation trust wants to build a new unit at Irthlingborough, which is 2.7 miles from the current Rushden clinic that he is talking about. Through its overview and scrutiny committee, Conservative-controlled Northamptonshire county council decided that the move did not need consultation, because it was not a substantial change.

Given the terrific importance of abolishing car parking charges, about which the Secretary of State made such important announcements a couple of years ago, will my right hon. and learned Friend look into the possibility of appropriating those car parks into the capital structure and capital allowances of hospitals, thereby not imposing that revenue drain on them?

I shall of course look into the point that my hon. Friend makes, but I have to say this. We want to ensure, as far as finances allow, that patients and those who visit them can get a permit for free car parking in due course. I will look into the point he makes, but our policy is to move towards patients getting that free car parking in due course.

Alternative Medicine (Regulation)

10. What progress has been made on the regulation of herbal medicine, acupuncture and traditional Chinese medicine; and if he will make a statement. (300148)

The consultation on whether—and if so, how—to regulate practitioners of acupuncture, herbal medicine and traditional Chinese medicine closed on 16 November 2009. We are considering our response to the consultation, and it will be published next year.

Is the Minister aware that the qualified practitioners at the Hydes Herbal Clinic on London road in Leicester—the oldest and largest such clinic operating in this country—want statutory regulation to interface with European legislation as quickly as possible? Will she guarantee that the clinic will still be able to treat, and to prescribe and prepare its own herbs?

I thank the hon. Gentleman for making that point. We have had some 5,000 responses to the consultation, which I welcome. We will move as quickly as possible, and, when taking our decision, we will balance public safety with the risks involved, and look at the principles of better regulation in deciding whether any action would be transparent, accountable, proportionate, consistent and targeted only where action was needed.

Mental Health Services

11. What steps his Department is taking to improve the level of access to mental health services. (300149)

As a result of nine consecutive years of increased spending, access to mental health services has never been higher. Many more staff, more community mental health services and increased access to psychological therapies have transformed services since 1997. Our vision for the future of mental health services and wider public mental well-being, which we are calling New Horizons, will be published shortly and will build on these remarkable achievements.

Lord Layard’s report recently revealed that there are more mentally ill people on incapacity benefit than there are unemployed people on all benefits put together. One in four people will have a mental illness at some stage during their life. However, the 18-week waiting time target applies only to physical ailments, not to mental illness. Why do the Government treat mental health problems as a Cinderella subject, especially when the new NHS constitution states:

“You have the right not to be unlawfully discriminated against in the provision of NHS services including on grounds of…mental health”?

I am pleased to be able to tell the hon. Gentleman that Cinderella has come to the ball. We have increased investment in mental health services by 50 per cent.—£2 billion—since 2001. We have more consultant psychiatrists, more clinical psychologists and more mental health nurses. That investment in the extra services means that individuals will be able to access the mental health services that they need, not least the psychological therapies that we are rolling out across the country, investment in which will rise to a total of £173 million by 2010-11.

During the passage of the Mental Health Act 2007, there were many discussions about providing places of safety, other than police stations, to which seriously mentally ill people could be taken. Has any progress been made on that, please?

Providing such places of safety for people outside police custody has been an important part of developing mental health services for the future, and we continue to drive forward progress in that area. If my hon. Friend has a particular issue in his constituency, I ask him please to write to me and I will be happy to take the matter forward with him.

The Government predicted that the number of community treatment orders needed in the first year of the Mental Health Act 2007 would be 600 to 800, yet in the past year there have been 4,000. That was therefore a gross under-prediction. Will the Minister investigate the impact of this massive under-prediction on the thousands of vulnerable people without sufficient safeguards in place and without sufficient support in the community?

I do not recognise the hon. Lady’s description of those services. It is true to say that there has been use of community treatment orders, but those orders can be made only when a clinician has made a decision that that is the safe and right thing to do, that there is support in the community, and that the individual can be recalled if necessary. That has happened on a number of occasions. I believe that the Mental Health Act has been a success, and that these new orders have provided new opportunities to treat people safely in the community and to keep the community safe.

Independent Sector Treatment Centres

12. What assessment he has made of the use made by the NHS of services commissioned from independent sector treatment centres. (300150)

Independent sector treatment centres have treated more than 2 million NHS patients and helped to reduce waiting times and improve patient choice.

The Care Quality Commission carried out a report on the Eccleshill treatment centre in Bradford at the request of the coroner after the death of my constituent, John Hubley, in 2007. A freedom of information request has shown that in January this year, the centre still did not have adequate risk-management procedures or responses to emergency surgical situations. When can we finally have a debate about NHS use of such facilities? Is it right to send patients there when safety procedures are not adequate?

Debates are a matter for the usual channels. We of course extend our condolences to the family of Dr. John Hubley. The coroner stated that he was satisfied that there was no ongoing system failure at the Eccleshill treatment centre. The Care Quality Commission has looked into this and will continue to monitor it to ensure that quality standards are met, but 96 per cent. of patients who use ISTCs have recorded either excellent or very good quality services.

Working Time Directive

13. What recent assessment he has made of the effect of the European working time directive on NHS staff. (300151)

All NHS staff, with the exception of doctors in training, have been compliant since 1998. In 2004, working time provisions were extended to doctors in training whose maximum hours were reduced to 56 hours by August 2007 and 48 hours by August 2009.

The Royal College of Surgeons said in January this year that we simply do not have the surgeons in the UK to fill the gaps created by the working time directive. Does the Minister agree that it is wrong to put at risk the work of local trusts, including the Norfolk and Norwich University Hospitals NHS Foundation Trust, the safety of patients and the career aspirations of those who wish to become surgeons by her Department’s lack of proper planning for the implementation of the working time directive?

I am sorry to disagree with the hon. Lady. The working time directive is health and safety legislation, and there is strong evidence that tired doctors make mistakes, so reducing working hours to 48 will of course improve patient safety. I know that the Norfolk and Norwich university hospital is looking at its anaesthetic rota and coming to an agreement on it. There has always been a tradition in surgical training that needed to be addressed. The most recent survey of medical education for those in training has shown that this training is now better and safer.

Given that at the last count, only two thirds of junior doctors were compliant with the European working time directive and 77 trusts have had to request a derogation from the directive, and in the light of the fact that the Secretary of State himself does not have to comply with the directive that his own party has forced on our doctors, what action are the Minister and the Secretary of State taking to bring forward the long-delayed review of junior doctors’ training to ensure that doctors’ skills and training—and, ultimately, patient care—do not suffer as a result of the Government’s failure to negotiate an opt-out?

I can certainly tell the hon. Gentleman one thing—this Labour Government and this Minister have no intention ever of returning to the long and dangerous hours that all our doctors and surgeons used to have to work, because I actually worked with those doctors at the time. Any one of them would tell the hon. Gentleman how serious that practice was, as mistakes were made. Along with the medical education authorities, the British Medical Association and all the Royal Colleges, we take patient safety very seriously. The report that the hon. Gentleman mentioned will be looked at and we will report back on it, I believe, early next year.

Health Visitors (Greater London)

14. How many health visitors were employed in Greater London in (a) 1997 and (b) 2009; and if he will make a statement. (300152)

In the last decade, child health services have developed based on research and the healthy child programme. In the London strategic health authority region, 1,876 health visitors were employed in 1997. Following the change and the extensive child health programmes, we now deliver child health by a range of practitioners. The latest figures show that at 30 September 2008 there were 1,577 health visitors.

Does the Minister accept that after 12 and a half years in office, we are losing nationally one health visitor on average every 30 hours, that the professions reckon that we need another 8,000 to plug the gaps and that there are some places where there are two and a half as many people on a health visitor’s case load as was recommended as safe by the inquiry into baby Peter’s death?

We recognise that there is a shortage of health visitors, but, as I said in my earlier answer, we are delivering the child health strategy in a different way. Health visitors now lead teams. The 21 Sure Start centres in Southwark, part of the hon. Gentleman’s constituency, serve as a focal point for local families, and have excellent links with health visitors, nurseries and infant schools.

Unite/CPHVA and the national health service have launched an action on health visiting programme. They are working closely together, especially in London, evaluating return to practice schemes. We value our health visitors greatly. As for their case load, the Secretary of State recently announced that such issues were to be reviewed.

Working Time Directive

15. What recent assessment he has made of the effect on hospital trust budgets of the implementation of the European working time directive. (300153)

This is a matter for local organisations. They make budgetary decisions based on the needs and priorities of the local populations to deliver effective local services.

Three consultants used to provide 24/7 consultant-led paediatrics at Horton general hospital, but it is estimated that it will take between nine and 13 to deliver the service in future. That has implications not only for the trust’s budget, but for the future recruitment of consultants. What plans are the Government making in relation to recruitment as a consequence of the working time directive?

We are in constant discussion with Medical Education England, along with the strategic health authorities, which have strategic responsibility for the planning of their consultants. Money has been made available to assist them in that process.

Topical Questions

Tomorrow the Government will publish the personal care at home Bill, which will benefit about 400,000 of the most vulnerable people in our society. On the same day, I will address a conference at the London School of Hygiene and Tropical Medicine to raise awareness of the human health costs of inaction on climate change in the lead-up to the Copenhagen summit.

The people of Cumbria have been in all our thoughts over recent days. Today my hon. Friend the Under-Secretary of State for Health spoke to Sue Page, chief executive of NHS Cumbria, and passed our thanks—the thanks of the whole House, I am sure—to the NHS staff and health professionals who have done so much to help local people to pull through during some very dark hours.

I am assured that emergency measures are in operation, including the use of Cockermouth community hospital as a general practice. In Workington, emergency measures are providing the full range of primary care services for people in the north of the town. My hon. Friend the Under-Secretary will visit the affected areas on Friday, and any further steps that are necessary will be taken.

Following concerns raised about the generic substitution of epilepsy medicine, what decisions has the Secretary of State made on whether such medicines should be excluded from the pharmaceutical price regulation scheme?

We intend to launch a 12-week consultation, which I hope will begin before Christmas. We therefore do not expect to be in a position to implement generic substitution until next year. However, we will wish to examine those issues as part of our wider consultation.

T5. Cans of super-strength lager carry the message “Enjoy responsibly” or “Please drink responsibly”, yet they contain four and a half units, which is more than the maximum recommended daily intake. Given that super-strength drinks are a major killer of vulnerable homeless people, would it not be more responsible for the Department to ban half-litre cans and to introduce a super-strength tax on beers and ciders containing more than, say, 6 per cent. of alcohol per volume, as recommended by the Thames Reach charity in my constituency? (300168)

I note the clear recommendation from that organisation in my hon. Friend’s constituency. Whatever the strength of the lager or other alcohol that people drink, they should understand how strong the drink is, how much they are drinking and the health risks involved. As my hon. Friend knows, tax is a matter for the Chancellor, but I will ensure that his comments are drawn to the Chancellor’s attention.

T2. According to the Jeanette Crizzle trust, of which I have the honour to be a trustee, fewer than 7 per cent. of secondary schools have taken part in the Department’s Give and Let Live organ donor education programme. What is the Secretary of State going to do to improve participation rates? (300165)

This is obviously a very important issue. There were reports in the news again today that not enough good organs were available for donation. I think that we can reach across the House and agree that the matter is crucially important. There is more that we can do to encourage people voluntarily to join the organ donation register. Progress has been made recently, but there can be no let-up. I hope that the hon. Gentleman will work with us, and will support all our efforts to boost awareness and the number of people joining the register.

Will my right hon. Friend take a personal interest in the two capital building projects, part of the £1.2 billion committed to Liverpool hospitals by the Government, the Liverpool university hospital and the Royal Liverpool children’s hospital, both of which are critical to the future delivery of hospital services to Liverpool?

I visited Liverpool yesterday and spoke to the chief executive and chair of the Royal Liverpool and Broadgreen University Hospitals NHS Trust. The scheme has important health benefits for the city and region, but also has wider economic benefits. I can assure my right hon. Friend that I am paying close attention to both of the schemes that she mentions. Obviously there is pressure on capital budgets in the current climate but I recognise that these are important schemes.

T3. Is the Secretary of State aware that the future of the nation’s community dental practices has been put at serious risk because of guidance HTM 01-05? Will he agree to meet me and some dentists from my constituency so that they can explain what are clearly the unintended consequences of this guidance note? (300166)

There is a new village near Chorley called Buckshaw, and thousands of new homes are being developed in Chorley. My concern is that there is a drag factor between the population and the funding given to primary care trusts. What can we do to ensure that Chorley gets the right amount of funding for its primary care trust?

The NHS is constantly looking to ensure that we keep up to date with the way in which populations change in particular areas. PCTs must ensure that those data go to the Department so that the appropriate decisions on finances can be made.

T4. At a recent surgery, a constituent raised the problem of having an above-inflation increase at a private care home for his mother. It can be difficult to move people from those homes, so there is no competition with other businesses. What tools are at the Government’s disposal to deal with this and to regulate private care homes so that they cannot simply charge anything willy-nilly, knowing that people cannot access another care home? (300167)

The quality of care provided by private care homes is subject to regulatory control by the Care Quality Commission. They are independent and fee levels negotiated with local authorities are a matter for local authorities. If the hon. Gentleman has a particular issue on that, he should first discuss it with the local authority, but recent legislation means that an individual may be able to complain to the local authority ombudsman.

Further to the incident at Milton Keynes general hospital when a maternity patient demanded all-white staff, may I clarify to the Minister that I spoke directly to the chair of the hospital trust, who assured me that the patient’s request had not been acceded to and that she was treated by the duty team—a mixed team—for her caesarean? It would appear that the hospital did follow the NHS code in dealing with what was clearly a difficult and sensitive incident. I would be grateful if the Minister made sure that the accurate account of what happened is accentuated and that the hospital is congratulated.

I am grateful to my hon. Friend for that important clarification. We would want to ensure that no unfair suggestion is made about NHS staff who do their best for all of her constituents at all times. There is of course no place for racism in the NHS, nor for any discriminatory behaviour towards NHS staff. On that there can never be a compromise, but we have heard the clarification given by my hon. Friend today.

T6. A Bethlem Royal hospital in-patient who had previously been convicted of murder absconded while on a shopping trip to West Wickham. As we would expect of one of the best trusts in the country, Bethlem reacted very professionally in giving reassurance to the public about its procedures for such circumstances, but would it be worth checking whether there are sufficient resources to support such activities for in-patients outside hospital? (300169)

I am grateful to the hon. Gentleman for bringing this case to my attention. Whether a patient who has been detained under the Mental Health Acts can leave a hospital or unit under escort on a visit is always a clinical decision. The hon. Gentleman described the mental health trust involved in this case as one of the best in the country, and it is the responsibility of individual trusts to ensure that patients in their care do not abscond from secure services.

The hon. Gentleman referred to resources. As I said earlier, investment in mental health services has increased for nine consecutive years, and by some 50 per cent. or £2 billion in real terms. I understand that the South London and Maudsley NHS Foundation Trust will be carefully reviewing the incident the hon. Gentleman raised and that it will change policies and procedures for escorting patients if that is found to be necessary.

May I mention how proud my constituents are of the new Haywood hospital alongside the University Hospital of North Staffordshire NHS Trust’s new hospital? Will my hon. Friend the Minister take a very close look at investment and capital funding, however, and will he in particular look at the pace of change, as our area is still distant from the target, and at the importance of the market forces factor, so that we can make sure we get our full allocation of capital funding across north Staffordshire?

My hon. Friend is a doughty fighter for Staffordshire and for ensuring that funding goes in the direction of her constituents. I will, of course, look at the issues she raises and see if I can be helpful.

T7. Paul Bason, a Lichfield-Staffordshire dentist who came to see me, raised, among other issues, the question of training. He says that after graduating in dentistry people have to have a year in vocational training, which is a good thing, but he asks whether there will be enough vocational trainers for the next batch of graduate dentists, and he thinks that perhaps there will not be. (300170)

We have to accept that there is competition for training places in some areas and that it is necessary for some new graduates to move out of their home area. Over the country as a whole, however, we make sufficient training places available for training new graduates.

The roll-out programme for ultrasound screening against aneurysms of the aortic artery is inadequate. How and when will this treatment, which will save up to 6,000 lives a year among men aged over 60, be available? It is desperately needed, especially in working-class areas where the greatest indices of health poverty exist, such as my area.

When rolling out any new technique within the national health service, we have to prepare the work force. This screening has been in progress. It has taken off better in some areas than in others, but we are looking at this and we are particularly concerned that we get it right because of the number of lives that will be saved.

T8. Constituents are being told that GP surgeries have to use up their initial allocation of 500 flu vaccines before they can order further supplies, even if the surgery knows there are a further 1,500 or so patients still to be vaccinated. What is the Secretary of State doing to ensure that surgeries have adequate and timely supplies of vaccines so that all vulnerable people can be vaccinated as soon as possible? (300171)

It is very important that surgeries have a ready supply of vaccines so they continue with the programme of vaccinating priority groups. We were aware that some surgeries may be coming to the end of the vaccination of priority groups at around this time, which is why we took the decision to extend the vaccination campaign to children aged between six months and five years. I take the point the hon. Lady raises very seriously. We want to ensure continuity of supply of vaccines to all surgeries around the country. We are confident that all GP surgeries have had a supply of vaccine, but we will continue to take a close look around the country to ensure that all surgeries have enough vaccine to be able to continue vaccinating in the priority groups.

Having five years ago been given exclusive rights to dip its corporate snout into the private finance initiative hospital trough, Laing O'Rourke must have industrial-strength chutzpah now to sue the Secretary of State for Health for abortive costs on that collapsed project. Does that not lay to rest, once and for all, the illusion that PFI transfers risk to the private sector?

PFI has produced a large number of hospitals and clinical facilities for the NHS; it has, in many areas, been an enormous success. What I would say is that sometimes difficulties arise and we must deal with them.

T9. Who takes responsibility in government for the fact that figures released today show that there were nearly 40,000 extra deaths last winter in this country because of cold? That is the highest figure for nearly 10 years. What will the Department of Health and other Departments do to have a proper insulation strategy for homes in Britain, rather than a piecemeal system that leaves many people dying when they would survive in other countries? (300172)

Obviously, the causes of winter deaths in excess are complex. The fact that last year’s winter was colder than average will explain some of the extra deaths, but I assure the House that the Government are working hard, and will continue to do so, to improve the uptake of grants, benefits and sources of advice, so that homes are more energy efficient and people have the help they need with heating and bills.

A few days ago, work began on Bolton One, which is a £30 million project delivering a new swimming pool, a walk-in health centre and teaching facilities for the university of Bolton. Will the Minister congratulate that university, Bolton council and Bolton primary care trust on this innovate new partnership?

T10. There are concerns about the future of the Feilding Palmer cottage hospital in Lutterworth, in my constituency. It is much valued by local people and there has been talk of it closing. People like to be treated close to their home, and I believe that such an approach is public policy for all parties. Therefore, will the Minister inform PCTs that they should make every effort to allow local people to decide where they are treated and that where people have a facility such as the Feilding Palmer cottage hospital they may be treated close to home, rather than 20 miles away in the city of Leicester? (300173)

What is also shared by the Front-Bench team of the hon. Gentleman’s party and our Front-Bench team is the view that reconfigurations—changes that are being made—should be clinically led and locally decided.

Today’s Western Morning News reported that Cornwall council is holding an urgent meeting to discuss the relocation of upper gastro-intestinal cancer services to Derriford. Devon county council has also requested that the Secretary of State re-examine the issue. Will he agree to a meeting to discuss the impact of this central policy on local access to services?

I am happy to agree to meet the hon. Lady and some of her parliamentary colleagues, but may I just say that we also need to accept that decisions have to be made in the health service about where facilities are placed? Such decisions are difficult and they are best arrived at locally.

What advice can the Minister give to a constituent whose eight-year-old son is suspected of having Asperger’s syndrome and who is having to wait three years before a test might confirm that? He could pay £1,000 for a test to be carried out privately, but that would not necessarily be accepted by the local education authority. Is this not a disgrace?

Decisions on the care of children with autism will come under the remit of the children and young people’s plan, the legislation for which was recently passed. It will make sure that disabled children and children with autism in an area are covered by a plan that will determine the level of need locally and the services to meet that need.