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Oral Answers to Questions

Volume 512: debated on Tuesday 29 June 2010


The Secretary of State was asked—


Late detection of cancer is one of several reasons why our cancer survival rates are below the European average. That is why we will focus on improving those outcomes and achieving better awareness of the signs and symptoms of cancer. These aims will be part of our future cancer strategy.

Over half the men who receive a testing kit under the national bowel cancer screening programme throw it away. What action is the Secretary of State taking to improve the take-up of screening, particularly by men, and what provision has he made within the NHS budget for the extra costs of increased take-up?

I am grateful to the hon. Lady for that question, and I have had the privilege of twice visiting the national bowel cancer screening programme at St Cross hospital in Rugby—it looks after people in parts of the midlands and the north-west—and indeed, I have visited the Preston royal infirmary, which deals with bowel cancer screening follow-up. As I said in my first reply, one of the things we aim to do is to increase awareness of the signs and symptoms of cancer. It is unfortunate that, as a recent study established, only 30% of the public had real awareness of what the symptoms of cancer would be, beyond a lump or a swelling. We have very high rates of bowel cancer, so it will be part of our future cancer strategy to increase awareness of those symptoms and to encourage men in particular to follow up on them.

The recent inquiry of the all-party parliamentary cancer group into cancer and equalities heard expert evidence to suggest that if people can survive the first year of cancer, their chances of surviving for five years are almost identical to the chances in the rest of Europe. Does the Secretary of State therefore believe that a one-year survival indicator is a good idea both for encouraging early diagnosis and for matching the survival rates of the best in Europe?

My hon. Friend makes an extremely good point. When we set out proposals for an outcomes framework, I hope that he and others will respond, because that is one of the ways in which we can best identify how late detection of cancer is leading to very poor levels of survival to one year. I hope that we can think about that as one of the quality indicators that we shall establish.

I welcome the Secretary of State to his new position and wish him well in his role. I understand that he is keeping the two-week target for seeing a cancer specialist, but abandoning the work that the Labour Government did on the one-week target for access to diagnostic testing. Professor Mike Richards stated in the annual cancer reform strategy that improving GP access to diagnostic tests is essential to the drive for early diagnosis of cancer. Can the Secretary of State spell out some of his current thinking on what the alternative would be if we no longer have the one-week target?

Let me make it clear to the hon. Lady and the House that only 40% of those diagnosed with cancer had actually gone through the two-week wait. Establishing a better awareness of symptoms and earlier presentation across the board is, as we have been discussing, important to achieve. I am afraid that the hon. Lady is wrong: I have not said that we are abandoning any of the cancer waiting-time targets at the moment, but that we have to be clear about what generally constitutes quality. For example, seeing a cancer specialist without having had prior diagnosis is often pointless, whereas getting early diagnosis is often a serious indicator of quality.

NHS Targets

2. What assessment he has made of the effects on NHS waiting times of NHS targets in the last 10 years. (4460)

Targets focused the NHS on bringing down waiting times, but also put process above clinical judgment and patient choice. Changing the way in which we manage waiting times will empower both patients and clinicians. NHS targets have dictated clinical priorities and harmed patient care. Focusing on long waits has meant less progress on reducing average waits than could otherwise have been achieved.

I noticed that in his answer the Minister did not say that any assessments had taken place. How many representations has he received from clinicians, people working in the NHS and the public demanding the removal of the 18-week target, for instance? Targeting is about making people better and getting them seen more quickly, so is not the real reason for dropping targets the fact that the Minister wants to undermine the NHS again?

I am sorry, but the hon. Gentleman, for whom I have considerable respect, is just plain wrong. There have been a number of representations over the last seven weeks or so. In addition, as my right hon. Friend the Secretary of State and his shadow team went round the country over the past five years, they were constantly told by GPs and clinicians from hospital to hospital that politically motivated targets were distorting clinical decisions and patient care.

Does my hon. Friend agree that by far the most important way of improving the service delivered by the NHS is to focus on the three key indicators of clinical outcomes, patient experience and value for money? Can he assure the House that the Government will pursue those, particularly against the background of increasingly scarce resources, in order to deliver the objective we all have: a better-quality NHS?

I am extremely grateful to my right hon. Friend, who is absolutely right, and I can give him the categorical assurances he is seeking, but I would also like to add one more: we need information to empower patients, because if patients are going to be at the heart of the NHS they must have the information to take the decisions that are important to their health care.

Order. May I gently ask the Minister to face the House? I am sure that Opposition Members will want to see his face.

We do, Mr Speaker, very much; we want to see him squirm.

First, let me say that we welcome the Minister back to the Department of Health; he was a Minister in the Department 13 years ago. As I have said before, we trust that he finds the NHS in much better condition than when he left office. Last week we had an independent verdict on those 13 years. The independent and respected Commonwealth Fund said that the NHS was one of the best health care systems in the world, and, indeed, that it was top on efficiency: a ringing endorsement of Labour’s stewardship of the national health service. That verdict reflects the huge progress on waiting times that has been made over those 13 years. So does not the abolition of the 18-week target, which the Minister announced last week, put all that progress at risk? Will he today give us a straight answer to this question: can he guarantee that waiting times will not rise, and that patients will still be treated within 18 weeks?

I thank the right hon. Gentleman for the kind comments at the beginning of his remarks; things went downhill thereafter, but that is politics.

The right hon. Gentleman needs to understand that patients have to come first in a national health service, and the trouble with the approach he took was that he wanted politicians and bureaucrats to micro-manage it from the top down, rather than having a bottom-up system that listened to local people. One of the key aims is to ensure that people get the finest and best treatment possible, and I am afraid that his approach—a straitjacket of targets in certain areas—did not work then, and will not work now.

I shall take that as a no, because the Minister did not answer the question; he could not give that guarantee. He says that we must put people and patients first, yet at a stroke he has taken power away from patients and handed it back to the system, turning the clock back to the bad old days of the Tory NHS. Let me quote some comments by Jill Watts, chair of the NHS Partners Network, which represents private providers. In the Financial Times on 18 May, she is reported as saying the following about the loss of targets:

“Waiting times will go up and if people want a procedure they have a choice: they can wait or they can look to pay”.

Is that not always the Tory choice on the NHS: wait or pay?

The right hon. Gentleman is not right. We have not taken that attitude; we never have taken that attitude. We want to have a system whereby the health service is not in a straitjacket of targets that disrupt and distort clinical decisions. We want to empower clinicians and GPs to take decisions about who should be treated when according to their clinical judgment.

It is not waffle. The right hon. Gentleman is clinging to an outdated philosophy, and he is in denial about the need to change it.

NHS Dentists (Chesterfield)

3. If he will take steps to increase the number of dentists providing NHS services in Chesterfield; and if he will make a statement. (4461)

I assure the hon. Gentleman that the Government have committed to improving access to NHS dentistry, and the introduction of the new dental contract, focusing on achieving good dental health and increasing access to NHS dentistry, will be vital.

I thank the hon. Lady for her response. The Stubbing Road medical centre is a brand-new building in Chesterfield providing doctor services to people who are among the most deprived in Derbyshire. One floor there was also meant to provide dental services, but in the last week we have been told that that might not—indeed, that it will not—go ahead, although the primary care trust is paying the rent on the building and its new suite. Can the hon. Lady assure the people in the Rother ward who have been waiting so long for those services that the guarantee that everyone in Chesterfield will have access to an NHS dentist by March 2011 will remain in place?

I cannot comment on the specific circumstances, but I would be happy to meet the hon. Gentleman if he would like. I must point out to him, however, that the number of people now seeing an NHS dentist remains lower than when the previous Government introduced the new contract in 2006. He mentions children, but there is no doubt that the inequalities in the oral health of children are scandalous.

Order. I hope that the hon. Gentleman will apply the ingenuity required to stay within the terms of a question relating to Chesterfield.

Thank you, Mr Speaker. Given my declared interest, it was too great a temptation not to contribute.

Does my hon. Friend not agree that for dentists, the biggest disincentive to providing an NHS service in Chesterfield—and, in fact, in the rest of England too—is the contract that she just mentioned, with its targets, its “units of dental activity”, its clawbacks and so on? Will she ensure that any new system that she introduces enables and encourages dentists to offer a choice between national health and private dentistry, thus encouraging those who have opted out to opt back in again?

I thank my hon. Friend for his question—he speaks eloquently and with much knowledge on this subject—and for highlighting the perverse incentives in the contract. It is absolutely critical that we take those out of any new contract.

NHS Targets

On Monday 21 June I published a revision to the NHS operating framework in which I removed the central management of three process targets that had no clinical justification. We will carry on focusing on quality and outcomes, getting rid of top-down process targets.

Does my right hon. Friend agree that meeting targets does not necessarily mean improving health care, and that the last Government were far too focused on the process of health care, rather than on improving the patient experience?

My hon. Friend is absolutely right. I was here just a few weeks ago, announcing a public inquiry into the events at Stafford general hospital. Of course, in that hospital the adherence to ticking the box on the four-hour target was one of the things that contributed to the most appalling care of patients. We have to focus on delivering proper care for patients—the right treatment at the right time in the right place—and delivering the best outcomes for them. We will focus on that—on quality—not on top-down process targets.

Is it really true that the coalition Government are going to scrap the right for people to see their GP within 48 hours? If so, will the Secretary of State publicise that, so people know that the right has been reduced? If it is true, is he not just axing public service quality under the pretence of dealing with so-called bureaucracy?

It is astonishing—the Labour Government spent money trying to achieve the GP access target, and the hon. Gentleman might at least have recognised that the latest data, published two or three weeks ago, show that public satisfaction with access to their GPs, and the things that the Labour Government had been paying for, had actually gone down. A consequence of the 48-hour access target was that patients were unable to access their GPs more than 48 hours in advance. Is it not reasonable to expect GPs to be able to manage their own services in order to deliver better patient experience and outcomes across the board? I think we can reasonably expect that.

It has been reported today that historically speaking, as a result of targets, an obstetrician in a hospital could herself have a caesarean section but then have to refuse one to a patient, because of the pressures that targets put on the local NHS trust. Can the Secretary of State give us an assurance that any woman in the NHS who needs a caesarean section will have one, and that no targets will be imposed?

My hon. Friend is referring to World Health Organisation targets, which have not in themselves been applied within the NHS, and it certainly would not be my intention to impose such targets. I agree with the implication of her question, which is that a woman who needs a caesarean section should have access to one. I am also well aware that when a woman does not require a caesarean section we should seek, through a process of discussion and providing information, to avoid that wherever possible. Birth should be considered a normal event, rather than being subject to excessive medicalisation.

Low Vision

5. What his most recent assessment is of the adequacy of the level of support provided for people with low vision. (4463)

It is for primary care trusts and local authority social services departments to make decisions on commissioning, having assessed the evidence and needs in their areas, and taking account of standards and best practice.

Is the Minister aware of the excellent scheme in Wales that allows people with low vision to refer themselves to a high street optician or consulting ophthalmologist, and thus to have almost immediate access to the aids and support that they need? More than 87% of people are seen within two weeks under that scheme, whereas some areas in England have an 18-month waiting list, so will he examine the scheme to see whether it can be introduced in England?

I am grateful for that question. Obviously, the devolved Administrations are responsible for health care in their own areas, so we have an opportunity to learn lessons from each other. This Government will examine the evaluation of the scheme that the Welsh Administration are undertaking to see whether it provides any lessons for our system.

Will the Minister say whether the money provided by the primary care trust is ring-fenced? Will he ensure that the time-sensitive nature of such conditions, especially wet and dry macular degeneration, will be taken into account across all the English PCTs?

We need to achieve that not by ring-fencing budgets but by making sure that clinicians can deliver clinically evidence-based practice so that those with age-related macular degeneration receive the treatments that they need. Ring-fencing is not the way to go; we need to ensure that local commissioners have access to the right evidence, are empowered by patients and listen to clinicians, in order to deliver the right services.

Cancer Surgeons

I thank the hon. Lady for her question—to which the answer is that we recognise the crucial importance of high-quality surgery in improving outcomes for cancer patients. Since 2003, cancer-related surgical training programmes have been developed when new technologies and procedures have proved that patients would benefit from their introduction. Through the national cancer action team we are supporting training in laparoscopic surgical procedures for colorectal cancer, and we will be introducing surgical training for lower rectal cancer.

As procedures for cancer surgery, including robotic surgery, are getting more and more complex, does my hon. Friend feel that there is a case for an earlier selection of specialism for surgeons, to ensure that the NHS maintains its reputation for clinical expertise and to influence positively cancer survival rates in the United Kingdom?

As I said in my original answer, we recognise the crucial importance of high-quality surgery. The hon. Lady has made the important point that we must equip our surgeons with the right skills to carry out highly complex and specialist procedures. That means that we must deliver specialised training for that purpose to our existing work force.

Does the hon. Gentleman recognise that the 18% fall in the breast cancer rate between 1998 and 2008 was due not only to the expertise of cancer surgeons but to the target culture to which he is so opposed? What would he say to the 3,500 women who, because of those targets, did not die in 2008?

I imagine that that would be an answer the previous Government should be giving, and they should be sorry. [Hon. Members: “What?”] The reality is that this Government are clear that we are sticking with the targets in relation to cancer, but we are also clear that we need to raise awareness of the signs and symptoms of cancer, and ensure that people present themselves at an earlier stage and get access to the appropriate diagnosis, so that they get the right treatment.

Healthy Eating

I thank the hon. Lady for her question. May I correct the hon. Member for Bolsover (Mr Skinner), who suggested from a sedentary position that one of us might be getting the sack, by saying that I doubt it, because it is the previous Government who have just got the sack? In answer to the hon. Lady’s question, I say that there is no doubt that anything that the Government do must have a strong evidence base. It is for individuals to take responsibility for their health, and that includes healthy eating. However, the Government can help people make better choices—for example, by providing information, advice and so on.

I am little disappointed in that answer. Maternal nutrition before and during pregnancy is essential to the birth of a healthy baby. The Joseph Rowntree Foundation has shown that a healthy diet costs a minimum of £43 a week. A young woman on jobseeker’s allowance receives only £51.85 a week, so can the Minister explain what she will do to ensure that young women on such low incomes can choose a healthy diet?

I am sorry that the hon. Lady was disappointed. Clearly, she does not feel that the Government should take a strong evidence-based approach to public health. I should point out to her that although life expectancy has increased, the gap between the rich and the poor has widened. If we look at the difference between spearhead areas and the country as a whole, we can see that the gap went up by 7% for men and 14% for women. We are determined to reverse that.

Will the Minister join me in condemning the vote in the European Parliament not to back the traffic light system of food labelling, which is the clearest way of communicating nutritional messages? That followed a lot of lobbying by companies such as PepsiCo, Tesco and Kellogg’s. What will she do in terms of speaking to European colleagues to get that important scheme back on the agenda?

Again, the hon. Gentleman raises the point that anything we do must have a strong evidence base. We are considering a number of schemes at the moment. What is important is that people have the information on the pack of food that they buy, so that they can make good choices about what they eat.

Last week’s Budget scrapped the health in pregnancy grant, which helps all pregnant women to eat healthily in the final 12 weeks of their pregnancy. The previous week, the Government scrapped the free school meals pilot for 500,000 children, thrusting 50,000 children back under the poverty line. They have also scrapped free swimming for under-16s and pensioners just as the long summer holidays begin. Is that not the most extraordinary start for a Government who promised to rename the Department of Health the “Department of Public Health”? With so many broken promises in their first seven weeks, how can we trust a word that they say about public health?

The hon. Lady and I have exchanged niceties in a slightly calmer atmosphere in another setting. I find it staggering that Opposition Members cannot understand that what matters is not what we spend but how effective that spending is. They simply cannot understand it. In fact, Labour has said that it would cut the NHS, whereas we have said that we will not. The sick must not pay for Labour’s debt crisis. We did not get us into this mess, but I would point out to the hon. Lady that everything that we do must be based on evidence. It is not what you spend, but what you spend it on, that matters.

Community Hospital (Eltham)

8. What recent representations he has received on the new community hospital for Eltham; and if he will make a statement. (4466)

The Department of Health is in contact with strategic health authorities regarding ongoing community hospital programme funding. This includes contact with the London SHA for Eltham and Mottingham community hospital and other schemes in the region.

I am grateful for that answer, as far as it went—but there is a great deal of expectation in the community in Eltham that that project will be delivered. It has been in the pipeline for quite some time and will provide 40 respite beds, diagnostics such as blood tests and X-rays and, I hope, dialysis at a local level, as well as a GP-led walk-in urgent care centre. May I urge the Minister to revisit the project, and when I ask a future question, to come back with a better answer?

I am a bit perplexed by the hon. Gentleman’s comments, because I have answered the specific narrow question that he asked—but let me try to cheer him up, if I can. We understand that he has been a redoubtable campaigner for the hospital, and we support the principle of community hospitals. The Department, as the hon. Gentleman knows, allocated £4.58 million to help the community hospital in Eltham and has already given about £1.9 million to NHS Greenwich, the primary care trust, for it. I hope that the hon. Gentleman will not have to come back to me with another question, because I trust that I am now going to cheer him up: I can announce today that the balance of the money will be paid and made available during the current financial year.

I congratulate my hon. Friend on that announcement, which will bring considerable pleasure to people in south-east London. He is well aware that proposals are being made within our area of south-east London to reorganise health provision, which are causing considerable concern. Will he ensure that vital services are maintained in our area for patients?

I am grateful to my hon. Friend. As he rightly says, I am aware of the situation. As he will be aware, we believe that local people, local clinicians and local GPs should have an input into any reconfiguration of health care provision. As my right hon. Friend the Secretary of State said when he announced the changes to the criteria, there will be an assessment of whether they apply to the reconfiguration to which my hon. Friend refers. Once that has been done and decisions have been reached, we will be able to move forward in the proper way.

Alcohol Health Warnings

A public consultation on options for improving health information on the labels of alcoholic drinks closed on 31 May. The responses to that exercise are now being analysed, and we will set out our plans for next steps through announcements in the coming months.

I welcome all those on the Government Front Bench to their new posts. The tobacco health warning regime introduced by the previous Government has produced excellent results in improving the health of our citizens. Does the Minister believe that a parallel scheme for alcohol would achieve similar progress and benefits?

I thank the hon. Gentleman for his warm words of welcome. It is important to note that sometimes such warnings are not transferrable between products. As he rightly says, there have been a number of initiatives on smoking that have, without doubt, had an impact on the number of people who smoke and the number who have given up. Whether those are transferrable to alcohol we do not yet know, but we will be looking at all the evidence available.

The Minister will be aware of a recent Alcohol Concern report that points out that a minimum alcohol price of 50p a unit would cost a moderate drinker only about 23p a week, but would reduce alcohol-related illness significantly, and would save the NHS millions. What discussions has she had with colleagues in other Departments about such a minimum price?

We have had a number of conversations about all aspects of alcohol policy, and what to do about the 7% of hospital admissions that are due to alcohol and the £2.7 billion cost—some estimates put it much higher, at about £5 billion—to the NHS. Without doubt, we have to change the public’s relationship with alcohol. We are committed to a ban on selling below-cost alcohol, which is important—but it is also important not to disfranchise responsible drinkers, as plenty of people enjoy alcohol responsibly. What we have to do is stop irresponsible drinking and protect people’s health.

I thank the Minister for that answer. She will recognise the problems that binge drinking causes our health service, our police and our local communities. I am delighted that she has recognised that there has been an agreement to ban the sale of alcohol at below cost price, but will she assure us that the Government are taking this issue seriously, and that we will hear an early announcement?

The hon. Gentleman is right; this is a cross-departmental issue. This is not just about health; it is important for local government as well. We need a multi-faceted approach. As I have said, we will look at all the evidence to see what works, and to make those changes not only in law and order, as he pointed out, but in people’s health.

There are cross-references between the labelling on alcohol and on other products, and the evidence clearly shows that with food labelling, the public find colour-coded, front-of-pack labelling far easier to understand. What has the Minister learned from that, and will her Department, with other Departments, seek an opt-out for retailers that want to continue, voluntarily, with front-of-pack colour-coding on their products?

It is important not to pre-empt the consultation that has already gone on, and to collect all the evidence together. To find out the best method for getting that information to the public in a way that they find accessible, we have to look at what works.

NHS Decision Making

11. What steps his Department is taking to increase participation by local people in NHS decision making. (4469)

I have stopped top-down reconfigurations where the NHS has not listened to local people. Our coalition agreement is clear that we will give patients more control over their own health care, and give patients and the public a stronger voice in the design of local health and care services.

NHS managers have justified cuts in community hospitals in Walton, Cobham, Molesey and other parts of the country on efficiency grounds, but in 2009, because of targets, almost 1 million patients were discharged and then readmitted within 30 days, at a cost of £1.6 billion. What plans has the Secretary of State to strengthen local democratic control over community hospitals and the vital services that they provide?

My hon. Friend has raised an important issue. Let me make two points. First, we need to strengthen not only the local public and patient voice but the voices of GPs who are involved in commissioning, so that they can act on behalf of their patient population in commissioning the services, and design of services, that they need. Secondly, as I have made clear in the revision of the operating framework, we must look at results. When someone goes into hospital for treatment, we must consider not just their treatment in the hospital, but their subsequent rehabilitation and re-ablement. I believe that that will allow greater use of intermediate care beds in the way that my hon. Friend has described.

I thank the Secretary of State for agreeing to meet me—together with representatives of my local primary care trusts, local mums and midwives—to discuss maternity services in Salford. In the light of his new criteria for reconfigurations, will he confirm that he is prepared to reconsider the decision to close Salford’s maternity services, and to recognise the views of thousands of people throughout Salford and Eccles, including me, who opposed it at the time?

The right hon. Lady knows that we will meet to discuss the issue. However, as I said when I was in Greater Manchester, it is not for me to reconsider the application of the new criteria from 21 May. That is for local people to reconsider. It is for GPs, the public, local authorities and, indeed, PCTs in Salford and district to start thinking about what they consider to be viable and successful future services for mothers-to-be.

In helping local people to become more involved in NHS decision making, will my right hon. Friend agree to consider my Ambulance Response Times (Local Reporting) Bill, which received its Second Reading during the last Parliament? The Bill requires all ambulance trusts to publish local as well as regional response times and patient outcomes so that—as is already the case in Crewe and Nantwich—they have access to those details and can deliver better response times, with the help of local initiatives such as Community First Responders.

Waiting Times

12. What his policy is on maximum waiting times in accident and emergency departments; and if he will make a statement. (4470)

From April 2011, the accident and emergency four-hour waiting time standard will be replaced by a set of clinical quality standards, developed with clinicians, which will support quality care without the damaging distortion of the four-hour tick-box target. On the basis of clinical advice, I have immediately reduced the threshold for meeting the four-hour standard from 98% to 95%.

I am sure that the Secretary of State will want to join me in congratulating the staff at Wythenshawe hospital in my constituency. Last year 85,000 patients were seen in the accident and emergency department, 98% of them within four hours. Can the Secretary of State explain to my constituents why he has decided that this year 4,500 of those patients will not need to be seen within that time?

As I told the right hon. Gentleman, I made that decision on the basis of clinical advice. It was clear that the 98% standard was distorting clinical care for patients. There is no benefit for patients if, for the purpose of meeting a four-hour target, they are discharged inappropriately, transferred to wards when they have not been thoroughly looked after in the accident and emergency department, or indeed put in an observation ward for 48 hours, which is under the scrutiny of the accident and emergency department but ticks the box. None of that helps patients. I will focus on what is actually in the best interests of patients, and delivers the right outcomes for them.

Cigarette Packaging

Evidence of the impact on public health of plain packaging of tobacco needs to be developed further, because no jurisdiction globally has yet introduced it. However, Australia will do so from 2012. We will monitor developments there with considerable interest.

Smoking costs the NHS £2.7 billion a year, six times the cost of a new hospital for north Tees and Hartlepool. In the north-east, approximately 10,000 children between the ages of 11 and 15 are smoking. We want all of them, not just half of them, to lead a fulfilled life. Will the Minister ensure that the assessment of plain packaging is expedited, so that we can be given an answer as soon as possible?

The hon. Gentleman is right to raise the impact that smoking still has on the health of children in particular—I believe that 200,000 take up smoking each year. We still have 80,000 smoking-related deaths in this country. It is important to watch what happens in Australia and see where the evidence points for the future.


We are committed to addressing the health care needs of people with autism and are fully supportive of “Fulfilling and rewarding lives: the strategy for adults with autism in England”. Consultation on statutory guidance for health and social care bodies to support the strategy will begin shortly.

May I thank the Minister for that reply? We have all been inspired by the parents of children with autism. One thing that they depend on perhaps more than anything is respite care. That provision has improved in the past few years, but with the pressure on budgets, will the Minister do all he can to ensure that respite care does not become an easy target for cuts, given the importance of the service to parents of children with autism?

I am very grateful to the hon. Gentleman for that question. He is right; carers are a valuable and valued resource. They make an incredible difference to the quality of life of the people for whom they care. The Government are determined, as we have outlined in the coalition programme for government, to develop respite services further and make them available through direct payments for those people.

Given the success of central Government in persuading child and adolescent mental health services to take the needs of those with learning difficulties more seriously, will the Minister commit to doing the same for those with autism, given that only 11% of CAMHS have specialist provision? Will he make a commitment to do the same thing for those with autism, please?

The hon. Gentleman makes an excellent point. We shall be getting some guidance from the National Institute for Health and Clinical Excellence in a year’s time, and absolutely the answer is yes.

May I congratulate the Minister on his new role. As my hon. Friend the Member for Gedling (Vernon Coaker) mentioned, carers of people with autism rely on respite care. However, carers organisations are reporting that cuts to local authority funding are already leading to cuts in funding for charities and other providers of support care. How do the Government plan to deliver the promised increase in access to respite care through improved community support provision, when that is already starting to fall away?

The hon. Lady makes an important point, but perhaps she will be a little cautious with her question, not least because the previous Government made a lot of promises to carers in respect of the amounts of money that were to be invested, only for carers to find that on the ground the money was not delivering changes in services. So this Government are determined to ensure that we not only make promises but deliver on them. That is the commitment that this Government have made.

Warrington Hospital

15. What percentage of patients at Warrington Hospital were treated within 18 weeks of referral in the last 12 months for which figures are available. (4473)

At the Warrington and Halton Hospitals NHS Foundation Trust, in the 12 months up to April 2010, 93.2% of patients admitted to hospital for treatment and 97.8% of patients whose treatment did not require admission to hospital waited 18 weeks or less from referral.

I am grateful to the Minister for that reply. What percentage of patients does the Minister now believe will be treated within 18 weeks, and which people exactly does he think deserve to wait longer than that?

May I reassure the hon. Lady that in my lexicon no one “deserves” to wait longer. What I want, and my right hon. and hon. Friends want, is a first-class health service that makes decisions based on clinical reasoning and gives treatment swiftly and relevantly to those who need it. My right hon. Friend the Secretary of State has made some changes to some of the targets to ensure that clinicians and clinical decisions dominate, not political decisions by politicians and bureaucrats.

Long-term Care

16. What progress he has made on establishing his proposed commission on funding long-term care; and if he will make a statement. (4474)

The coalition agreement sets out our plans to establish an independent commission, which will consider how we ensure responsible and sustainable funding for long-term care. Further details on the commission will be announced shortly.

I am grateful to the Minister for his response. Can he assure us that when the commission is established it will consider all options for funding long-term care, including a compulsory inheritance levy?


17. What recent representations he has received on the appropriateness of the remit of the National Institute for Health and Clinical Excellence; and if he will make a statement. (4475)

Since 7 May, the Department has received about 120 representations from hon. Members, noble Lords and members of the public on a range of issues concerning the National Institute for Health and Clinical Excellence, including its remit.

May I urge the Secretary of State to get NICE to go back to what most people think it is for, which is monitoring the cost-effectiveness and clinical effectiveness of drugs? Many people do not think that it does a particularly good job on that, anyway, but it is currently indulging in empire building, with its ridiculous drivel in recent weeks about smoking breath tests for pregnant women, compulsory sex education for five-year-olds and subsidies for food companies to make healthier food. Surely it ought to go back to what it should be doing, and do it better, rather than empire building, as it is doing.

In 2005 the previous Government charged NICE with producing public health guidance as part of its work. As I establish a more integrated and effective public health service, I shall consider how the advice of NICE fits into that strategic framework.

Topical Questions

My responsibility is to lead the NHS in delivering improving health outcomes in England; to lead a public health service that improves the nation’s health and reduces health inequalities; and to lead the reform of adult social care that supports and protects vulnerable people.

When the new Secretary of State intervened to stop the reorganisation of health services in London, he said that there would be no forced closures. Can he give me an unambiguous and categorical assurance that he will not allow the closure of the accident and emergency department, the children’s surgery or the maternity services at King George hospital in Ilford? Yes or no?

The hon. Gentleman’s question seems rather churlish, given that he wanted to stop the top-down configuration that NHS London imposed so that people in his area—GPs, the local authority, local people and patients—could have an opportunity themselves to decide how services might best be designed for local people. That is the pledge that I have made. Those criteria will enable that process to be led locally, rather than imposed and forced on people.

T4. St Catherine’s hospice is used by many of my constituents, and they will be pleased to be able to go ahead with the hospice’s planned improvements, which will be funded through the capital grants programme. Does the Secretary of State agree, however, that the excellent work of such hospices goes far beyond the hospice building? What will his Department do to ensure that hospices play a greater role in providing services to the local community? (4487)

I am very grateful to my hon. Friend, who will know that I entirely understand and applaud the work of St Catherine’s hospice, because we have visited it together. She makes a very important point, because those whom I know in the hospice movement want to think not just about the service that they provide in their buildings, but about an holistic service for patients’ families and for those who require palliative care. I might just say that on Saturday I made it clear that up to £30 million will be available in this financial year to support children’s hospices, specifically, in extending their work so that they can provide a service in the community for children with life-limiting illnesses.

The right hon. Gentleman will remember our exchanges at the election hustings, where there was a real difference between us: we said that we would protect the NHS budget in real terms, and I stand by that commitment; the right hon. Gentleman said that he would increase the NHS budget. After last week’s Budget, however, we now know the price of that commitment: 25% cuts to social care will mean vulnerable people either left without the support that they need or facing higher charges to pay for care, and huge pressure on carers. It means also that the NHS itself stops working, because it cannot discharge people from hospital when there is no support in the community. That unbalanced approach to public spending is dangerous and will decimate services on which the NHS depends. Is it not time to drop a pledge that had more to do with votes and nothing to do with people’s lives?

So there we have it, Secretary of State. [Hon. Members: “Secretary of State?”] I meant “Mr Speaker”—you are far more elevated than a Secretary of State, Mr Speaker.

The shadow Secretary of State’s belief is that the NHS budget should be cut. I fail to see how that could help social care. We are going to look much more positively at how we can join up the work of the NHS and social care. What my colleagues and I have announced on 30-day support for patients leaving hospital, including rehabilitation and re-ablement, will do precisely that, relieving some of the pressures on social care by seeing the NHS as a more holistic service for patients.

T5. Does the Secretary of State accept the conclusions of the Science and Technology Committee’s report “Evidence Check 2: Homeopathy”? Earlier, the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton) gave a commitment to an evidence-based approach and today the British Medical Association passed a motion about homeopathy. Given the financial constraints in which we all share, can the Secretary of State defend spending millions of pounds of NHS money on methods that simply do not work? (4488)

I thank the hon. Gentleman for his question. He obviously knows how much is spent on homeopathic treatments, although no one else seems to know exactly. The decisions should be taken by doctors locally, and the effectiveness, safety and efficacy of a treatment should be taken into account. The estimate is that 0.001% of the drugs bill is currently spent on such treatments. At present, we are looking at the Science and Technology Committee’s report. We hope to respond to it before the summer recess.

T2. My right hon. Friend the shadow Secretary of State referred to the Commonwealth Fund report, which said that Britain’s NHS was the most efficient. Does that not make it clear that after 13 years of a Labour Government, the NHS is not just so much better for patients, but efficient? To say that it is not is an insult to the people who have worked so hard to make it great. (4485)

I have looked at the reports of the Commonwealth Fund for a number of years; it regards the NHS as efficient because it spends relatively little in comparison with other health economies. In this country, we need to recognise that the NHS does not spend very much in comparison with other countries but it could spend it more efficiently. There has been declining productivity for 10 years. [Interruption.] The shadow Secretary of State needs to recognise that NHS management costs went up by 63% while nursing costs went up by just 27%. My colleagues and I are committed to halving NHS management costs and to reducing the costs of the NHS, through efficiency, by £20 billion. Every penny of that will be reinvested in meeting the rising demand for the NHS and the improvements in quality that we require.

T7. What encouragement is the Secretary of State giving to primary care trusts to restore minor injury services to towns such as Melksham in my constituency? It saw its minor injuries unit close under the last Government. (4490)

I am very grateful to the hon. Gentleman for that question. It is up to local communities and local health providers to identify what they believe are the local needs of their communities and then go through the procedures, measures and mechanisms to seek to achieve what they want—in this case, that could be a new A and E. It is not for Ministers to promise such provision; there are proper procedures, from the local area upwards, for achieving such aims.

Order. I have just had Members complaining that they cannot hear. The Minister must face the House. It is a very simple point; I have made it to others and they have understood it.

One of the concerns of a great many of us recently has been the availability of cancer care drugs. [Interruption.] Right across—right across, Mr Speaker, the whole United Kingdom, and Northern Ireland in particular, a great many people have not been able to access cancer care drugs and have had to endure sickness and illness without them. Can the Secretary of State assure the House today that cancer care drugs will be made available and that those who are ill and suffering from cancer can rest easy?

We have been very clear that it is a scandal that we have some of the finest cancer research anywhere in the world and some of the best cancer medicines have been developed in this country, yet in the past in this country NHS patients have often been the last to have access to those drugs. That is why at the election we made it clear that we will introduce from April next year a cancer drugs fund, the purpose of which will be to ensure that patients get access through the NHS to the cancer medicines that they need, on clinical recommendation and advice, and that they are not unduly delayed in getting that access.

T9. I am sure that the Secretary of State will remember visiting my constituency earlier in the year and listening to constituents’ concerns about the withdrawal of spinal injections on the NHS. Given that the PCT’s decision is set to become another example of the postcode lottery in the health service, will his Department consider the ongoing debate about spinal injections in York and support the attempts of my constituents as they seek to shape local health services around their specific needs? (4492)

I am a bit confused as to where to look. [Interruption.] Right, I will look forward.

My right hon. Friend the Secretary of State well remembers his visit in April to meet the York and District pain management support group. He made it plain at the time that it should be for GPs and their patients to decide what treatment should be given, as opposed to a decision by the PCT to veto spinal injections for all sufferers of long-term chronic back pain. We will, in due course, set out our proposals to put more power in the hands of patients and GPs.

T3. Does the Minister agree that it is crucial for patients to have information if we are to make a reality of choice within the NHS? In that respect, does he agree that if we are to give people a real choice as regards the choose and book system that GPs operate, there is a need to ensure that patients have the information about the success rates of different hospitals, and different surgeons, as regards operations? (4486)

I agree with the hon. Gentleman—it is just that that did not happen under a Labour Government in the way that it should have done. For example, the national quality registers in Sweden have 69 areas of clinical practice for which such comparative data are published. I have made it clear that one of our priorities is that we focus on outcomes and on giving patients real empowerment. To do that, information for patients on outcomes will be absolutely critical.

T10. I have here a letter from my local PCT indicating that the clinical review of the safety of a proposed children’s walk-in centre in Southport is to be conducted by Dr Sheila Shribman and the Minister’s Department. Will the Minister arrange to meet me and relevant officials to ensure that the Department is properly aware of the background to this vital access issue and that we have a clinical network suitable for patients, as well as for practitioners? (4493)

I thank the hon. Gentleman for that question, of which he gave our office prior warning. It is important that decisions made locally focus on outcomes for people, that they are about choice, that they have support from local clinicians and commissioners, and that they are based on sound clinical evidence. I would be happy to meet him to discuss this further.

T6. Every year in the north-east, 300 children are born with congenital heart disease. These very sick children receive expert treatment locally in the world-class cardiothoracic unit at Newcastle’s Freeman hospital. Can the Minister assure my constituents, who value this vital local service, that the findings of Sir Ian Kennedy’s review of children’s heart surgery centres will be implemented without financial constraint? (4489)

I should tell the hon. Lady that it is premature to make any commitment about the review, because we now need to have proper engagement with local people, patients and those who are responsible to focus on how we can make absolutely certain that the outcomes that we achieve for children requiring cardiac surgery are as good as we can possibly make them.

Will the Minister review the problem of highly priced patient lines and introduce competition so that patients in Harlow and elsewhere no longer pay extortionate prices to watch TV or make phone calls?

I am extremely grateful to my hon. Friend for raising an issue that I know is of concern to many people. Although I cannot make promises about the outcome of any review, he has my assurance that we will be looking into this, and that we take on board the concerns that have been expressed over a number of years.

The Secretary of State has halted the reconfiguration of services in south-east London, which was clinically led, the subject of detailed public consultation and approved by the reconfiguration panel. The outcome is to leave my PCT and hospital trust acutely troubled about their ability to deliver the improved health services that were promised under “A picture of health” and to meet their financial targets. What does that say about the Government’s commitment to evidence-based policy making?

What we have done in London is to give those who would be most affected by decisions to reconfigure services the opportunity, where decisions have not already been made, to have a local say. That includes patients, the public and GP commissioners. The delay, in so far as there is any delay, need not be great if those proposals are fully subscribed to by local people and by their GPs as commissioners.

Would my right hon. Friend accept that there is widespread anecdotal evidence of the effectiveness of homeopathic medicines? There are 500 doctors in this country who use them, and nobody is obliged to have them if they do not want them. Will he therefore heavily discount the illiberal views of our hon. Friend the Member for Cambridge (Dr Huppert)?

May I thank my hon. Friend for his question and pay tribute to him for his continued and persistent lobbying on this subject? I gather that he has been elected a member of the Select Committee on Health, so I welcome him to that position and I am sure that we will meet again at some point.

What is important is that decisions about treatment are made by clinicians, and they will base their decisions on the safety, efficacy, efficiency and outcomes that a particular treatment will provide.

The North Tees and Hartlepool NHS Foundation Trust believes that its strategy for one hospital to replace the North Tees and Hartlepool university hospitals is the right strategy, despite the project being dropped by the Government. Does the Minister accept that the trust’s strategy to provide a new hospital and health facilities closer to communities to meet their health needs is correct, that the trust should be encouraged to press ahead with alternative funding models that could still deliver the new hospital, and that its members and the public at large can expect Government support to realise that strategy?

What I would look for is for the foundation trust to meet the criteria that I published on 21 May in relation to any reconfiguration of services that it proposes for its area. As a foundation trust, I would also expect that, having secured the freedoms associated with that status, it should not ask the Department of Health to meet the whole capital cost of whatever it proposes.