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Volume 517: debated on Tuesday 2 November 2010

The Secretary of State was asked—

Mental Health Care

1. What recent discussions he has had on the likely effects on mental health patients of changes to health care provision arising from the comprehensive spending review. (20928)

The Government confirmed their determination to protect the most vulnerable in our society by protecting both the NHS and social care in the recent spending review. The Chancellor also announced funding to expand access to talking therapies.

Can the Minister give assurances that the Department of Health is having full discussions with the Department for Work and Pensions about the problems that those with mental health problems experience in returning to work?

I thank my hon. Friend for that question. I can certainly assure him that those discussions are ongoing and regular, and that we work very closely with colleagues, both ministerial and official, in the DWP. Indeed, we are evaluating two of the Department’s collaborative projects on employment advisers working with people recovering from depression and anxiety disorders.

The Rokerfield mental health day care centre in my constituency is under threat of closure. Does the Minister share my disappointment that the county council cabinet members responsible for making that decision have all ignored my invitation to speak to service users before coming to their decision? Will he urge them to visit users first?

I thank the hon. Lady for her question. I am sure she would agree that it is important that we ensure that there is adequate funding in social care so that it is possible to continue to support services of this sort. That is why I am sure she would join me in thanking the Chancellor for the statement he made two weeks ago, when he confirmed that an additional £2 billion will be invested in social care. On her specific question, I will look at the matter in closer detail and write to her.

My hon. Friend will be aware of the number of people in the criminal justice system with severe mental health problems—they make up some 15%, according to the Sainsbury Centre for Mental Health. In my area of Dudley and Walsall, almost 2,000 people are on probation or in prison, yet only 40—just 2.5%—are in contact with mental health services. Will he discuss with his colleagues in the Ministry of Justice what we can do to improve that situation?

I am grateful to my hon. Friend for that question, which underscores the legacy that the Government have been left in terms of the paucity of these services as they are now and why we need to work closely with colleagues in the Ministry of Justice, as indeed we are doing, to ensure that we provide good quality mental health support for offenders, both in prison and when they leave it.

Can the Minister assure us that he will encourage his departmental colleagues to ensure that, despite the influence of the comprehensive spending review, the confidential inquiry and the learning disabilities public health observatory will go beyond March and until the work is concluded?

The right hon. Gentleman does a lot of work in the area of learning disability. Indeed, we had a good debate in Westminster Hall earlier this year on this matter, in which I indicated the Government’s support for those observatories. We believe they play a very important role in our understanding of the issues.

Neuromuscular Care (Bristol)

2. What progress his Department has made in the provision of specialist neuromuscular care in Bristol; and if he will make a statement. (20929)

I thank the hon. Lady for her question. Of course, it is important that the commissioning of services, which is about getting the right treatment and services for people, is a decision that is made locally. The south west specialised commissioning group—SWSCG—has responsibility for commissioning specialised services for neuromuscular conditions in Bristol. I know that there have been some problems in the past, but since the Walton report the group has reviewed its provision of neuromuscular services and appointed both an additional paediatric neuromuscular consultant and a new adult neuromuscular consultant in Bristol, as part of the £l million investment for the south-west, which I am sure she will welcome.

I thank the Minister for that comprehensive response. Families who live with muscle disease, such as the Arshad family, in Brislington, in my constituency, have welcomed the work of the SWSCG but are very worried about the impact that the introduction of GP-led commissioning will have on these services. They really feel that families like them will be left by the wayside. What reassurances can she give them?

May I point out to the hon. Lady that, in fact, GPs are often very aware of the services that are needed? The neuromuscular team attached to the SWSCG has worked with the South West Muscle Group on the development of a provider register for hydrotherapy services, for example. Such things are best decided by GPs, who know exactly what people need, what treatment is needed and what care services are needed to ensure the best possible outcomes and the best possible quality of life.

The national service framework for long-term conditions such as multiple sclerosis, in which I am very interested, was much praised at the time it was launched. Does the Minister feel that it was properly funded and that it has been run properly since? Has it lived up to the expectations that we all had of it three or four years ago when it was launched?

With particular reference to the care provided in Bristol, the one thing that I would say is that commissioning is not something that has done well. There is never any room for complacency in the provision of services or in the provision of treatment. We always need to strive to do better.

Preventative Health Care

We are committed to protecting and improving the nation’s health and well-being. Since the election, we have already announced our commitment to preventative action on cancer, including improved bowel cancer screening and a campaign on signs and symptoms to promote early diagnosis; investment in a programme of reablement for those leaving hospital; and £70 million of investment this year to increase access to talking therapies.

Does my right hon. Friend agree that dedicated health spending focused on the poorest areas in most need is urgently required to narrow the health inequalities that, as a recent National Audit Office and Public Accounts Committee report show, actually widened under the Labour party?

I am grateful to my hon. Friend for that question, because it enables us to point out that over the period of the previous Labour Government health inequalities in this country widened—life expectancy, for example, widened by 7% for men and 12.5% for women between the richest and the poorest areas of this country. We are very clear. Our public health White Paper, which will be published shortly, will focus on how we can not only deliver a more effective public health strategy, improving health outcomes for all, but improve health outcomes for the poorest fastest.

There is an area of the country where public health inequalities have not widened, and it is the borough of Slough. Will the Secretary of State come to Slough and look at the work of health advocates, who are ordinary citizens who help to engage people with their health and avoid some of the conditions that have led to early deaths in Slough?

The hon. Lady might not recall, but about five and a half years ago I visited Slough to meet the health trainers, particularly in the Asian community, who were going to help people. Their focus was on diabetes. It has been a very effective pilot and we will need to work—we will do so—with local authorities and the NHS. We should work together, using dedicated public health resources of precisely that kind, to identify the risk of diabetes and to tackle it at source.

On the Isle of Wight, the local NHS has decided that contraceptive pills may be given to girls as young as 13. Their parents and even their GPs are not involved. Nowhere else, I am told, shares that approach. Many of my constituents are horrified. What is the Secretary of State’s view?

My hon. Friend will know that these decisions were made locally. Indeed, we support local decision making. We will ensure that such decisions are taken not only in the health service but alongside local authorities as part of their public health function. It is important that one is clear that a young person is competent to make such decisions. Subject to that, however, we are always clear that patients have a right to access health care on their own cognisance if they are competent to do so.

Does the Secretary of State accept that good preventative care walks hand in hand with good social care? Does he further accept that even if all efficiencies were made and every single pound of the so-called additional £2 billion for social care was to be spent, there will, as the Local Government Association and the Association of Directors of Adult Social Services warn, nevertheless be a shortfall of at least another £2 billion before the end of the comprehensive spending review? In those circumstances, why does the Treasury’s own document say:

“In social care, the Spending Review has provided additional funding needed to maintain current levels of care”?

Who is the public to trust and what are they to make of it?

First, may I welcome the hon. Lady to her position in the shadow health team? I do not accept her proposition. We are very clear about the nature of the efficiencies that can be made in social care, and we have established an efficiency group that is advising on how that can be done. In addition, in the spending review the Chancellor was able to announce that the Secretary of State for Communities and Local Government has made £1 billion extra available, and we have made £1 billion available through the NHS. On that basis, there is no need for local authorities to have to reduce eligibility to social care.


4. What recent assessment he has made of the potential contribution of StartHere to his Department’s programmes to reduce the digital divide in respect of health services. (20932)

Access to information is a key pillar of our plans to empower patients and service users. We want to open up access to trusted health and care information to everyone, including through digital channels. Independent organisations have an important role to play in helping to ensure that health and care information reaches everyone. StartHere is a good example of how such organisations can help. I am very keen to see StartHere’s response to our consultation, “An Information Revolution”.

I welcome the Minister’s positive response. Does he agree with me and, by the way, with Citizens Advice and the Royal British Legion that StartHere has the unique benefit of starting from the point of view of the person who needs information? It therefore increases efficiency and has the potential to save the health service money. Will he meet me to discuss how to realise those potential benefits?

I am grateful to the right hon. Gentleman for those comments. I pay tribute to him because he has been a champion of StartHere ever since its existence. He and I agree that it is crucial that information is provided to empower patients and citizens, not all of whom have access to websites and the internet. I am more than happy to meet him to discuss this further.

Specialist Children's Hospitals

Specialist children's hospitals will continue to be funded through local commissioning and specialised commissioning based on payment by results and local contracting while also recognising the specific additional costs of specialist paediatric services.

The Secretary of State will know that his Department has written to specialist children’s hospitals threatening to withdraw the top-up moneys that are recognised as important in treating the most critically ill children. That is outrageous and seems to run counter to the Government’s commitment not to cut funding. Will he go back to his Department and tell his officials that he will not go ahead with the reduction in top-up fees?

I am afraid that I have to correct the hon. Gentleman. We are not withdrawing specialist top-up payments; the Department has acted on the basis of a review conducted by the university of York which was initiated by the Opposition Front Bench team’s predecessors when they were in government. They set up a review on specialist top-ups which said that the payments should go down from 78% to 25%, not that they should be withdrawn completely. We are reviewing that outcome with the specialist children’s hospitals and a meeting is taking place today to consider whether the review’s conclusions were accurate and applicable.

Does the Minister agree with me and the 1999 Shields report that children’s accident and emergency, paediatrics and maternity units should be kept together in one hospital? Will he postpone the move of the Burnley children’s ward to Blackburn until the new GP commissioners are installed and can make an informed decision?

Yes, I entirely understand my hon. Friend’s point and we have discussed this at Burnley. I feel strongly—indeed, I know—that we must continue to apply the tests that I have set out for such issues of configuration, including that they will deliver improving clinical outcomes, be safe for patients and, as he rightly says, reflect the commissioning intentions of local GPs representing local patients.

How can it possibly be right that the world-renowned staff at Great Ormond Street hospital in my constituency face, under this proposition, a reduction of £16 million in the funding of that hospital? NHS funding is supposed to be ring-fenced, but from the point of view of people at Great Ormond Street, it seems to be rather more ringed than fenced.

The right hon. Gentleman must realise that if we had listened to the Labour party in the comprehensive spending review, we would have cut the NHS budget, but we did not. We resisted the Labour party’s proposal, and resources for the NHS will increase in real terms, but there is then the matter of how those resources should be deployed to best effect. The application of the proposal—we have still to agree with children’s hospitals on how it will be applied—would have the overall effect of reducing Great Ormond Street’s total income by less than 2%.

The Secretary of State’s answer simply will not do. He is in government now, not us. He is making decisions to make deep cuts to our specialist children’s hospitals. He is trying to keep the NHS out of the public spotlight, and we will make sure that the public know what his plans for the NHS are.

I have the Secretary of State’s letter. He has not answered my questions and I ask him again to tell the House why, before today, no Minister has made any statement in public or in the House about these big stealth cuts to our children’s hospitals, and how much each one of the 35 specialist children’s hospitals will lose next year in funding to treat some of the most critically ill children in our country.

I welcome the right hon. Gentleman to his place. I hope he enjoys being shadow Secretary of State as much as I did, and that he enjoys an even longer tenure. I explained to his right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) the impact on Great Ormond Street. I do not discount its importance to the hospital, and it is being discussed today with specialist children’s hospitals by a group chaired by the national clinical director, but it represents less than 2% of Great Ormond Street’s total income. This is about specialist top-ups to the tariff where the new tariff has been introduced, which in itself makes differences to the income and the accuracy of costs of services provided by those hospitals. It was all set up by the previous Government. They started the review. They published it on 16 December 2009. It was not our doing; it was their doing.

I thank the right hon. Gentleman for his welcome to me in my job. I have no intention of being in the job for six years, as he was before he came into government. We will have won an election before the end of that period.

Big stealth cuts to our children’s hospitals are not what the public expected to see when they heard the Prime Minister promise to protect the NHS budget. Will the Secretary of State admit that he is double-counting £1 billion a year in the spending review as both money for the NHS and money to paper over the cracks in social care? Will he accept the new House of Commons Library research report, which confirms:

“Including the (social care) funding is critical to the description of the settlement as a ‘real terms increase’; without it, funding for the NHS falls by £500 million—0.54% in real terms.”

When did the Secretary of State tell the Prime Minister that the Government are breaking his promise to protect the NHS budget?

I am afraid the right hon. Gentleman is wrong about that. Even if we did not treat up to £1 billion to support social care through the NHS as NHS money—we should treat it as NHS money, but even if we did not—there would still be an increase in the resources available to the NHS in real terms each year. It is NHS money. The right hon. Gentleman must accept that this year we are spending £70 million on reablement, which has the effect of mitigating need in social care and reducing emergency readmissions to hospital. We will provide NHS money, which in itself supports health gain and social care support.

Cancer Survival Rates

6. What assessment he has made of the likely effect on cancer survival rates of the implementation of his proposed reforms of the NHS. (20934)

Our health spending now matches European levels, but our cancer survival rates do not match European levels. If we brought survival rates up to the best in Europe, we could save up to 10,000 lives a year. Our updated cancer strategy will set out how our NHS reforms will improve cancer survival rates.

Does my hon. Friend agree that local charity groups, such as York Against Cancer in my constituency, play a vital role in the fight against that disease? Can he assure me that the Government will continue to support and work with the voluntary sector to provide the very best cancer care?

The Government certainly work closely with the voluntary sector in many ways to promote and develop our approach to cancer services. We value the work of organisations such as York Against Cancer because of the support that they provide through information and support for people diagnosed with cancer and their families. It is very important that we continue to support such activities.

Does the Minister agree that cancer survival outcomes are very closely linked to poverty and inequality? Although I concede that inequality widened under the previous Government, how can the present Government hope to bear down on poverty and inequality in the context of an overall policy framework that envisages a steep rise in unemployment, with all the poor health outcomes associated with that, and a commitment to protecting health spending, which is unravelling by the day?

I am grateful to the hon. Lady for her question, and particularly her acknowledgement of the previous Government’s failure to close the health inequality gap. The Office for Budget Responsibility identified that there will be growth in employment during the spending review period, and this Government are determined to make sure that we see that growth take place. When it comes to cancer survival, what we need to do most, and most importantly, is make sure that people are aware of the signs and symptoms of cancer, because if they are, they present earlier, they get a diagnosis earlier and their survival chances are greatly improved.

GP Commissioning (Financial Information)

7. What mechanisms he plans to introduce for public access to financial information about general practices under his Department’s proposals for GP commissioning. (20935)

Under our proposals, commissioning budgets will be held by GP-led consortiums, which will be established as statutory bodies, rather than by individual GP practices. The commissioning budgets will be distinct from the income that GP practices earn under their contracts for providing primary medical care. GP consortiums will have to make their accounts available to the public.

I welcome the Minister’s reply. As GP practices have always been treated as private partnerships and are not open to financial scrutiny or freedom of information requests, it is important that £80 billion of public spending is, in the way he describes, subject to scrutiny, including by this House.

May I reassure the right hon. Gentleman that the NHS commissioning board will not allocate commissioning budgets directly to GP practices? Neither will they be included in either partnership or individual GP accounts. As is the situation now, those GP accounts will remain entirely separate. Our proposals set out clear lines of accountability in respect of commissioning resources. Each GP consortium must prepare a set of annual accounts, which the NHS commissioning board will include in its consolidated account. I hope that that reassures the right hon. Gentleman.

Will the Minister confirm that patients and councillors will sit on consortium boards, and that the boards will meet in public, so that there will be real transparency and accountability at the point of decision making, and accountability will not be sidelined to health and well-being boards?

May I explain to the hon. Lady that, no, councillors will not be on the GP consortiums? They will have a full and active role to play on the health and well-being boards, so that they can take a full part in determining the local needs of the local health economy. That is the right venue for them.

Does my hon. Friend agree that as those commissioning consortiums are established, it will be important to ensure that they are subject to proper financial assurance, in the same way as Monitor applies such principles to foundation trusts? Can he assure the House that that will be one of the responsibilities of the NHS commissioning board?

There is not altogether the same comparison to be made with Monitor and foundation trusts, but I certainly understand and take on board the general principle behind my right hon. Friend’s question. I think that it is important that there is accountability.

The Government want to create about 500 new GP commissioning groups and scrap 150 primary care trusts, which the King’s Fund says will cost £3 billion. Yet, last year the current Prime Minister promised that

“there will be no more of the tiresome, meddlesome, top-down re-structures… The disruption is terrible, the demoralisation worse—and the waste of money inexcusable.”

Can the Minister tell us when the right hon. Member for Witney (Mr Cameron) changed his mind?

May I begin by congratulating the hon. Lady on her elevation to this position? I know that in the past she has worked at the Department of Health, so her experience will no doubt help her Front-Bench colleagues who do not share such a background. However, she is factually wrong, although no doubt she will not be wrong in the future, because we have never said that there will be 500 consortiums. It will up to local decision making to determine how many consortiums there will be. The hon. Lady can believe what she reads in the newspapers, but if I were her I would wait to see what actually happens.

GP Revalidation

8. What mechanisms he plans to put in place to provide for GP revalidation after the ending of primary care trusts. (20936)

The General Medical Council is responsible for the revalidation of doctors, rather than primary care trusts. In the current structures, subject to parliamentary approval, responsible officers in primary care trusts will make recommendations to the GMC on the fitness to practice of doctors in primary care. Before the dissolution of primary care trusts, we will consult on options for responsible officers in primary care.

I am very grateful for that answer from my right hon. Friend. I welcome the commissioning role that GPs are to have. Does he believe, however, that there needs to be a distance between revalidation and local GP practices, and that that would best sit at a county or metropolitan borough level?

Yes, I am grateful to my hon. Friend. Indeed, we will take account of precisely the point that he makes when we consult on how responsible officers in primary care will be established in future following primary care trusts. It is important to recognise that revalidation should be a process very like the normal appraisal of staff. However, when it comes to investigation of fitness to practise, it will be important for there to be proper independence.

This is a very important issue affecting patient safety. The Secretary of State will know that the British Medical Association has raised significant concerns about the revalidation proposals, referring specifically to the implications of the reorganisation. Does he recall criticising NHS reorganisations and their cost in his conference speech on 5 October 2009? Why, then, has he embarked on a reorganisation that will cost an estimated £3 billion at a time when the NHS will also face deep cuts because of his broken promises over funding?

May I welcome the hon. Gentleman to his new responsibilities?

We are doing this because it is absolutely essential for the NHS to use resources better to deliver improving outcomes for patients. A combination of the ability for general practice-led consortiums to combine the management of care for patients with the management of resources is instrumental to achieving that. It will deliver substantial reductions in management costs. We will achieve a £1.9 billion-a-year reduction in management costs by 2015.

Neuromuscular Care

9. What progress he has made on increasing the provision of specialist neuromuscular care in (a) the north-west and (b) England. (20937)

I thank my hon. Friend for that question. I pay tribute to the Muscular Dystrophy Campaign and a number of other organisations that have been so successful in raising these issues. A review of specialist neuromuscular services in the north-west was completed in September 2010. I understand that the focus of the review was the particular pressure areas of service provision highlighted by Muscular Dystrophy Campaign reports and corroborated locally by key stakeholders.

I thank my hon. Friend for that answer. Muscular dystrophy is a particularly terrible muscle-wasting disease that afflicts many constituents of mine. Will the Minister agree to meet me and the NHS north-west specialised commissioning group to discuss the action required to reduce the £13.6 million spent on unplanned emergency admissions for neuromuscular conditions in the region?

I know that I speak for all the ministerial team in saying that we are always very happy to meet groups to go through some of the situations. I would also urge continuing to campaign locally. If services are not provided adequately and properly, the unnecessary admissions due to that poor provision are considerable, as are the costs associated with them.

Cancer Treatment (Waiting Times)

10. What assessment his Department has made of the effect on cancer patients of changes to the maximum waiting period for cancer treatment. (20938)

I am grateful to the hon. Gentleman for his question, because it allows me to make it absolutely clear that the Government have not changed the waiting times standards for cancer services. The revision to the NHS operating framework for this year confirmed that the NHS is expected to continue to ensure that people with suspected cancers are seen within the agreed waiting times standards.

I thank the Minister for his response. I am sure that he agrees with me that the policy brought in by the previous Government to ensure guaranteed minimum waiting times for cancer patients made great strides forward, not only for patients but for their families. May I urge him to ensure that this is not changed by any Government policy changes and that guaranteed minimum waiting times remain at the forefront of treatment for cancer patients?

I am grateful for the question. The answer, of course, is yes, we are determined to maintain these targets because we believe they make a difference.

Will the Minister ensure that patients who currently do not have access to a clinical nurse specialist will have such access? Research suggests that it considerably improves experiences and outputs.

The hon. Gentleman is right that we need to ensure that we invest in cancer specialists, and in the past six months the coalition Government have set out a number of steps that we will take, and are taking now, to improve cancer survival rates and cancer services. Raising awareness of signs and symptoms, new screening methods for bowel cancer and improving the number of specialist staff are just some of the things into which the Government have already started putting additional resources, in order to make a difference.

NHS Administrative Costs

We are cutting management costs in the NHS by 45%. We will cut total administrative costs as well, and in total that will save £1.9 billion a year by 2015.

I thank the Secretary of State. I recently spent a morning in my constituency with local paramedics and was shocked to learn that the very best paramedic can earn just one tenth of that earned by the highest-paid NHS manager. What steps is my right hon. Friend taking to address those skewed priorities?

My hon. Friend will be aware that we in the Department and across government have invited Will Hutton to examine pay differentials in public services, and we have talked to him about precisely that. In my hon. Friend’s area, the earnings of a qualified member of ambulance staff would be about £37,000 on average, which of course is only about a sixth of the highest pay of an NHS manager.

Past reorganisations of the national health service have taken years to embed and affected performance negatively, and history suggests that, given the scale of the reorganisations in the White Paper, they will be no exception. Can the Secretary of State tell us how much the administrative costs of the changes will be?

Perhaps I can remind the right hon. Gentleman that the major part of the reorganisation is to eliminate strategic health authorities and primary care trusts, to focus resources on the front line, to get them into the hands of those who are responsible for delivering care and, in the process, to deliver £1.9 billion a year of savings on administration costs.

Dementia Research

12. What steps he is taking to prioritise funding for dementia research from his Department’s research budget. (20940)

Dementia is a terrible disease that devastates the lives of thousands of people in this country, and research is clearly key. The coalition programme signalled the Government’s intention to prioritise funding for dementia research. The spending review confirmed that and committed to real-terms increases in spending on health research.

Will the Minister expand on the future funding of mental health trusts? We all know the statistic that one in four people suffers from mental health problems in their lifetime, and it is a great problem in South Derbyshire.

The hon. Lady is absolutely right that it is important that we are clear about that. Currently, funding for mental health services comes via primary care trusts, and from 2013-14 onwards allocations will be provided via GP commissioning consortiums.

I welcome the hon. Gentleman’s first answer, but may I ask him to go further and place in the Library a list of all the areas of principal research that the Government are to fund, both directly and through research charities? It would be incredibly helpful for the public to understand exactly how the Government intend to handle the research programme for dementia and all other areas of health.

I am grateful to the hon. Gentleman for his question, because I chair the ministerial group that is considering how we can improve and increase the supply of research. It is examining a number of matters, including how we can ensure that there is an increase in the volume of research, how we can engage the public—he is absolutely right about that—and how we can translate research into practice quickly. Next year we will set out more detailed proposals and publish the details of all the research programmes that are under way.

Hereditary Breast Cancer Helpline

I congratulate Wendy Watson on starting the helpline in 1996. I also congratulate the hon. Lady and my right hon. Friend the Member for Derbyshire Dales (Mr McLoughlin) on the support that they have given it. I know that it has experienced difficulties in gaining funding from primary care trusts, with only 36 of the 152 PCTs providing it, but the cancer networks are working on an interim solution to fund the helpline through the transition period prior to the NHS commissioning board and GP commissioning coming online.

I thank the Minister, but what I am most concerned about is the fact that Wendy Watson is running the helpline on a shoestring from her home in Derbyshire. She is getting small grants from PCTs, but once PCTs are abolished, where will the money come from? Can the Minister commit to funding the national helpline, which is the only one of its kind, directly from the Department of Health?

I point out to the hon. Lady that with the new commissioning consortiums, those decisions will be made at a much more local level. Only 36 of 152 PCTs are currently contributing to the helpline, which is nonsense when one considers that they are being asked for only £422 each. It is right that such decisions should be made locally, particularly in view of the sort of emotional support that the helpline can give.

Preventative Health Care

In addition to what I said in reply to Question 3, I can tell my hon. Friend that we will shortly be publishing a public health White Paper, which for the first time will not only demonstrate a commitment across Government to improving public health and reducing health inequalities, but introduce a strategy and implementation programme to achieve precisely that.

I thank my right hon. Friend for that answer. Chronic obstructive pulmonary disease is responsible for 30,000 deaths a year, and it is the second largest cause of emergency hospital admissions in the UK. In response to the consultations that have been received from, among others, groups in my constituency, will the Secretary of State please tell me when the Government plan to publish the clinical strategy on COPD?

We need to continue our work with the British Lung Foundation, because that has been extremely helpful. We are in the process—through the consultation on the White Paper and other such consultations—of putting in place an outcomes framework, which will enable us to see how outcomes can be achieved for people with respiratory diseases. In the meantime, I hope that we will push forward with the commissioning guidelines, clinical guidelines and quality standards that will help to support some of the COPD initiatives that I have seen, including a successful community COPD service in Somerset.

The Secretary of State will be aware that 6,000 women a year die from ovarian cancer. Will he welcome the National Institute for Health and Clinical Excellence guidelines that were published this year, and, in so doing, will he tell us why he has decided to neuter NICE? The independent assessment that it provides was established in 1999 to ensure that, where we have a finite pool of resources, money is spent properly. Are not the pharmaceutical companies now rubbing their hands in glee?

The right hon. Gentleman has it completely wrong. We are not neutralising NICE. On the contrary, we will focus NICE on what its real job always was and should be, which is to provide independent advice to the NHS about the relative clinical and cost-effectiveness of treatments so as to achieve the best outcomes. The point that he may be misunderstanding is that by 2014 we intend to ensure that we are no longer denying access to the new medicines that patients need, because we will have a new and more effective value-based pricing system of reimbursement to pharmaceutical companies.

PFI Contracts

15. What advice his Department provides to NHS trusts seeking to renegotiate private finance initiative contracts. (20943)

This Department and the Treasury provide guidance and advice to NHS schemes to maximise the savings and best value for money they can achieve when making variations to their PFI contracts for additional services or facilities, conducting market testing exercises for support services or when assessing refinancing requests from their private sector partners.

What can the Government do to assist the Queen Alexandra hospital in Portsmouth, which is under serious financial pressure because of its PFI contract, a £37 million deficit and, thanks to false planning assumptions, not enough patients to make a super hospital sustainable?

May I pay tribute to my hon. Friend for her assiduous work in her constituency? She represents her constituents and looks after their interests regarding the provision of the highest quality health care. From conversations that I have had with her, I fully appreciate her concerns about the financial situation. I understand that South Central strategic health authority is working closely with the trust as it implements a cost-improvement programme to achieve financial balance.

Diagnostic Tests (Cancer)

16. How many diagnostic tests for cancer he expects to be carried out by the NHS in each of the next four years. (20944)

The Department collects waiting times and activity data on 15 key diagnostic tests, but these data do not include the reason for a diagnostic test, such as suspected cancer. The NHS carries out more than 40 million diagnostic tests per year. The cancer reform strategy review is looking at the scope to improve survival rates by increased use of some diagnostic tests.

I thank the Minister for that answer, although it was not quite as precise as I would have liked. How will those numbers be impacted by the Government’s decision to abandon the one-week guarantee for cancer tests and their decision not to performance-manage the abandonment of the 18-week diagnostic target?

I say in the politest way possible to the hon. Lady that we cannot abandon a target that has never been imposed in the first place. May I remind her that, as a sop to the Labour party conference more than a year ago, the former Prime Minister merely announced an aspiration? He never provided any funding or said where the funding should go, and he never provided any clinical evidence for the viability of the proposal. Saying that the Government have abandoned a target when it never existed is sheer poppycock.

The all-party cancer group’s report last year found that those with rarer cancers got a bit of a raw deal from the NHS when it came to access to treatment and drugs. How will the new cancer fund put right that wrong?

I am sure that my hon. Friend, through the tremendous work done by him and his colleagues on the all-party group, will appreciate that my right hon. Friend the Secretary of State’s initiative—providing £50 million for the rest of this year and £200 million from next year for the cancer fund—is an important step forward in helping those who suffer from cancer. I am sure that my hon. Friend will also welcome the fact that work is ongoing on refining, following the review, the cancer reform strategy, and we are looking at the scope for improving survival rates by the increased use of diagnostic tests and at improving care across the board, so that we raise our standards to the highest in Europe rather than being the poor relation.

Topical Questions

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

In the light of the 0.5% real cut in the NHS after the social care switch, to which my right hon. Friend the Member for Wentworth and Dearne (John Healey) referred, may I ask when the Secretary of State decided to break his promise on a real-terms funding increase for the NHS? Does he accept that that is not what my constituents expected when they heard the Prime Minister promise real increases for the NHS?

The hon. Lady’s constituents expect the truth, which is that we are providing increased resources for the NHS in real terms, taking it from £104 billion to £114 billion. That is completely contrary to what we were advised to do by the Labour party, which said that we should cut the NHS budget. We did not do that; we increased it.

T2. The all-party group on multiple sclerosis held an all-day seminar last week on the subject of drug pricing, during which it broadly welcomed the end of the risk-sharing scheme and looked forward to value-based pricing, which will be introduced shortly. That welcome is subject to two important conditions: first, that NICE clinical guidelines should be updated and continued; and secondly, that the NICE risk appraisal should be abandoned. Does the Secretary of State agree with me on those two conditions? (20954)

Yes; my hon. Friend is absolutely right. As we implement our plans for the value-based pricing of medicines from 2014, NICE’s role will change. It will focus on advising how best to use treatments and to develop quality standards for the NHS, rather than recommending whether patients should be able to access particular drugs. We want patients to have access to the medicines that their clinicians believe are best for them.

I wonder whether the Secretary of State can provide some reassurance to residents of Cleadon Park estate in my constituency who are concerned about the consequences of primary care trust abolition for the PCT-owned, PCT-organised and PCT-financed health centre that brings together primary and secondary care, and local authority and community services. Is there not a real danger of the sort of expensive “anarchy” of which Professor Tony Travers of the London School of Economics has warned?

Happily, I can offer the right hon. Gentleman’s constituents great reassurance that not only will the relationship between community health care and specialist health care in hospitals be improved by general practice-led commissioning—because clinicians will speak to clinicians—but the services they rely on will be improved, because we will no longer spend so much money on PCT administration. He will know that in 10 years under his Government the number of managers in the NHS increased by more than 60%.

T4. NHS Warwickshire is consulting on the future of Bramcote hospital, which serves my constituency and the wider north Warwickshire area. That could lead to the closure of the hospital which has provided valuable intermediate care to my constituents over many years. To close the hospital, NHS Warwickshire requires the Department of Health to meet substantial impairment costs. Can the Secretary of State assure my constituents that before any decision is made by the Department to pay any such costs, the views of the local GP consortiums and local people will be taken into account? (20956)

As my hon. Friend says, NHS Warwickshire is consulting on the future of intermediate care at Bramcote hospital. I hope that he will engage with that consultation and that the views of local people will be taken fully into account by NHS Warwickshire in deciding the way forward. As he knows, the Secretary of State has set out various tests and NHS Warwickshire’s decision must have the support of the GP commissioners; must strengthen public-patient engagement; and must be based on sound clinical evidence. I hope that my hon. Friend is reassured that those tests will be fully taken into account as part of the consultation process.

T8. Following the coalition Government’s announcement that the NHS budget was to be protected and, indeed, increased, can the Secretary of State tell me why a ward will be closed at Calderdale Royal hospital? Will he reverse that crazy decision immediately for the safety of my constituents? (20960)

I cannot tell the hon. Lady precisely why that proposal has been made, but I will investigate and write to her. Increasing resources overall for the NHS does not mean that everything will stay the same in every particular. There will be change, including the redirection of resources towards providing services in the community rather than in hospitals.

T5. Occupational therapists are crucial in effective rehabilitation. Will the Minister advise me on what role he sees for occupational therapists in using the £70 million investment in reablement announced by the Government? (20957)

I am grateful to the hon. Gentleman for drawing attention to the Government’s commitment to develop reablement services, especially the win, win, win that they can deliver for the individual who gets back on his feet, gets his confidence back and leads his life independently; for the social services departments, which do not have to provide ongoing support; and for the NHS, which does not have to deal with readmissions. Occupational therapists have a vital role to play in providing good quality support following discharge and are therefore critical players in the development of reablement services around the country.

T9. Is it appropriate for my constituents in Huddersfield to be lectured about healthy living standards by a Minister who is out of condition, overweight and a chain smoker? (20961)

I take it that the hon. Gentleman is not referring to me in those respects, although I can probably claim one or two of those epithets. We are none of us looking to lecture anybody: we are trying to lead a public health strategy that enables everybody to make healthier choices and lead healthier lives.

T6. May I invite the Minister to congratulate my local newspaper, the Northamptonshire Evening Telegraph, on running a successful campaign to encourage people to sign up to become organ donors? Given the success of that campaign, perhaps the Department might like to encourage other local newspapers to do the same. (20958)

I would certainly like to join my hon. Friend in extending those congratulations. Local papers can have a huge impact in raising the issue of organ donation. Donor rates have risen in this country by 20% since 2007-08, which happened on the back of the organ donation taskforce, which looked at the system in 2008. The issue is complicated and quite sensitive in some areas, but the most important thing is to raise awareness in local communities. Local papers are an ideal vehicle for that.

Since when has handing over the running of any service to a powerful producer interest been good for the consumer—that is, the public? In the absence of primary care trusts, who will do the difficult but important job of performance-managing underperforming GPs and, where necessary, weeding out incompetent ones?

The right hon. Gentleman was a member of a Government who said that they would introduce practice-based commissioning, but who then let primary care trusts override the general practice role in determining not only the proper care of patients, but how resources should best be used to make that happen. If he is defending primary care trusts, he is making a very sad choice, because in reality they know that they simply increased their management but did not succeed when it came to commissioning. The right hon. Member for Rother Valley (Mr Barron), the former Health Committee Chairman, produced a report showing that, and it is very clear that—

Order. I do not want to be unkind to the Secretary of State, but I am thirsting to hear the question from Mr David Burrowes.

T7. My right hon. Friend has shown great interest in the reconfiguration plans for Enfield hospitals, culminating in the moratorium announcement outside Chase Farm hospital in May. Would he expect the outcome of the clinical review to be simply an endorsement of the present clinical strategy, which is based on previous models of care for emergency and maternity services, or should it embrace future health care choices, opening up to GPs, patients and the public? (20959)

I am grateful to my hon. Friend. He knows that the criteria that I set out, which were repeated earlier during questions, must be applied, not only to the strategies that were previously presented, but to potential new strategies that Barnet and Chase Farm hospitals might wish to present, in order to ensure that GP commissioning intentions, future patient choice and public views are properly reflected.

Many of my constituents are being offered the swine flu vaccine in combination with the seasonal flu vaccine. Will the Secretary of State ensure that they have the choice to have those vaccines separately?

The hon. Lady will forgive me, but I do not propose to make that available, as it would be a great deal more expensive. Each year, and on an international basis, the World Health Organisation advises on what the seasonal flu vaccine should consist of, and it almost always consists of the three most likely strains combined together into one vaccine.

Is the Secretary of State prepared to make a statement on the vital work of the co-ordination of organ donation at the hospital level, particularly given that under the current system there is no specified organ donation co-ordinator at the Westmorland general hospital in Kendal?

Organ donation co-ordinators are a vital part of the team in increasing organ donation rates. The organ donation taskforce recommended 100 extra organ donation co-ordinators, but we must not forget that there are other things. For example, training for staff who are likely to come into contact with potential organ donors is vital. We have got to get those rates up.

I am not sure whether the hon. Gentleman was here earlier, but we explained in great detail about the target that never existed. The latest figures show that the median time has gone from 1.7 weeks to 1.9 weeks, but that is because those figures were for the period between June and August—the holiday time—when many people changed their bookings or appointments to fit in with the school holidays or their own holidays. The figures for September are already on course to get us back to the median for that time of the year.

I know that the Secretary of State is aware of the high level of teenage pregnancies in this country, and particularly in Hastings in my constituency. What action are we going to take to support those young women? We all know of the negative health outcomes that come with those young pregnancies.

Yes, indeed I do. It is sad to report that we have the highest rate of teenage pregnancies in western Europe. At the heart of this is the fact that we must have community strategies that are geared not least to improving the self-confidence and self-esteem of young people, so that they are able to make better decisions. We must assist them in doing that, but I would also mention the importance of ensuring that we have long-acting reversible contraception available for young people.

Each year, around 7,000 more people in the UK are diagnosed with HIV, and more people than ever are living with the virus. How will the Government’s new public health White Paper address HIV prevention?

The hon. Gentleman will know that the White Paper is yet to be published, so I will not pre-empt it, but it will be important to ensuring that there is a clear strategy for improving sexual health services. He will share our view that we want to deal with the extent of undiagnosed HIV and the extent to which people coming into contact with health care services are not offered HIV tests.

I recently met a group of Bournemouth and Poole college health and social care students whose research indicated that the average age for repeated sexual activity in the UK is now 16. With that and other information, they have set up a campaign to reduce the age for cervical screening to 20. What action will the Minister take?

I thank the hon. Lady for her question. She is right to raise the issue of the reducing age of sexual activity, and certainly the public health White Paper that we will publish later this year will have a significant impact on that. Cervical screening must be addressed, and it is important to raise the uptake rate to a much higher level to ensure early diagnosis.

Dr Clive Peedell, a consultant oncologist at James Cook university hospital in Middlesbrough, said that the coalition Government’s plans for the NHS

“are a roadmap to privatisation”.

That was his reaction to the King’s Fund report, which argues that the plans to make savings in direct NHS expenditure while dismantling local PCTs has the support of fewer than one in four doctors. What is the Secretary of State’s response to that overwhelming opposition from local doctors to the Government’s plans?

We will, of course, respond to the consultation in due course, but support for the principles of the White Paper was widespread and came from local government and the medical and nursing professions. The issues that we will address in the consultation were mainly about implementation of the principles, but support for the principles was widespread.

Will my right hon. Friend confirm that the Government’s policy is to ensure that over the next four years we deliver efficiency gains from the health service, valued by the chief executive at between £15 billion and £20 billion? As that target was first set out by the Labour party when it was in government, will my right hon. Friend take an early opportunity to invite the new shadow Secretary of State to endorse that programme, and to support its specific execution as each change is introduced?

My right hon. Friend makes an excellent point, and I invite the shadow Secretary of State to respond to it in due course. We will ensure that the NHS uses resources more efficiently to meet increasing demand and costs in the NHS. Savings of that order are required, and the NHS is on track to make them.

I would like to return to the subject raised by my hon. Friend the Member for North East Derbyshire (Natascha Engel) about the national hereditary breast cancer helpline. The Minister’s response was inept. She said that a national service will be funded by tons of different GP commissioning groups. That just will not happen. She said nice words about Wendy Watson, but her Government’s policies will see the end of that helpline unless she intervenes. Will she please ensure national funding for a national service?

As I said earlier, the cancer networks are working on an interim solution for funding the helpline through the transition period to the new commissioning arrangements. I remind the hon. Gentleman that the Labour party tried to tell people what to do from the centre and micro-managed everything. What happened was that no local decisions were made. I do not doubt the value of the helpline. It is crucial that emotional and practical support for those at high risk of breast cancer is available, and the helpline is one way of doing that. It is extremely important that such decisions are made locally. Telling people what to do from the centre does not work.

Order. I am sorry that some colleagues are left disappointed, but on such occasions demand, as in the health service, tends to be greater than supply.