1. What assessment she has made of the effect that recent preliminary National Institute for Health and Clinical Excellence guidance on the use of Velcade has had on the treatment of myeloma patients; and if she will make a statement. (95960)

I have made no such assessment. The National Institute for Health and Clinical Excellence has not yet issued its final guidance on the use of Velcade. I understand that it plans to do so in November 2006, subject to any appeals against its final appraisal determination.

The recent decision on Velcade, according to press reports, is a huge blow to thousands of myeloma patients, as it is one of the only treatments for that type of bone marrow cancer. As the decision appears to have been made on the basis of cost, will the Minister urgently review the value that NICE places on treatments that extend life, and which are crucial for patients and their families—if the reports turn out to be true?

I am grateful to my hon. Friend for her question. I pay tribute to her work with the International Myeloma Foundation, and I know of her personal interest in the matter. We are asking NICE to take some extremely difficult decisions on our behalf and, although I understand her points, it is important that it is able to do its work, and to consider all the evidence on the clinical effectiveness of treatments, free from political interference. That is the right position. There is an ability to appeal against any NICE decisions, and the final appraisal determination is still subject to such appeal. At this stage, it would be inappropriate to comment further.

My constituent, Brian Jago, was fortunate enough to receive a course of Velcade, as a result of which he does not have to move to Wales—as he was going to do—where he could have got it free. He now faces the prospect of at least another two years of high-quality life. Is not that the worst form of postcode lottery?

In making public statements, it is extremely important that we do not seek to mislead and give patients false expectations of what is available in other parts of the United Kingdom—[Interruption.] If the hon. Member for New Forest, East (Dr. Lewis) will hear me out, I will explain to him that interim guidance is issued in Wales, but NICE guidance, when finalised, will also apply in Wales. That is the system, so there will not be any difference between the two countries. The hon. Gentleman will be aware from a press release issued by NICE this week that, according to the manufacturers’ evidence, Velcade has the potential to extend life by one year. It is important to consider such matters in the round and to have a balanced discussion and, if resources can be put elsewhere into cancer care, to take such decisions so that we provide the best possible treatment to patients for the money available.

I am sure that my hon. Friend is aware that there is not a constituency in the country that does not have myeloma sufferers. Cannot more money be made available for this drug treatment, as it is the only treatment that can work and prolong life? We should have a special fund and take the decision away from NICE by making extra moneys available. Will he consider that if NICE refuses to recommend the drug?

I do not intend to take the decision away from NICE. When the Government came to power, we set up NICE specifically to introduce fairness into the system, so that decisions would be taken that balanced clinical effectiveness with cost-effectiveness. I do not dispute that myeloma is an awful condition, of which some 4,000 new cases are reported every year, and everything possible must be done to help such people. It is inappropriate to second-guess NICE’s decisions and to undermine its difficult work, which it does on behalf of all of us as taxpayers and all of us who want health resources to be used as effectively as possible. In making such extremely difficult decisions, we owe NICE our support.

Will the Minister join me in congratulating a woman who has written to me offering the use of her house in Scotland to a 39-year-old Oxfordshire patient suffering from multiple myeloma? Can he explain to her and to me what the rules are for such people who wish to travel to Scotland to use Velcade to prolong their lives? Is not it disgraceful that the millions of others who are not able to travel to Scotland must go without?

I say again that it is wrong to raise expectations about the effectiveness of a particular treatment. There is a whole series of pressures on the national health service. Of the 26 cancer drugs on which NICE has issued final appraisal determinations, it has recommended the use of 25. Those are difficult decisions. Only a couple of weeks ago, in the Opposition day debate, there was support from the hon. Gentleman’s Front Bench for NICE’s independent role in taking such difficult decisions—

What are the rules?

If the hon. Gentleman is telling me that he knows more than NICE, and that he has more expertise and evidence, I do not believe him. For residents of England, the rules in relation to NICE apply, and the primary care trust of the individual concerned would have to make any decisions about whether to fund a particular treatment. That is the position, and it remains the position.

An expert hospital consultant has written to my hon. Friend the Member for Carshalton and Wallington (Tom Brake) saying that she does not know how she will face patients if the Velcade decision stands, because she will have to tell them that there is a treatment which in her view is effective and would help to prolong their lives, but which is not available in this country although it is available in other European countries.

I accept what the Minister says about the independence of NICE, but NICE is answering the question that the Government have asked it. What is different about the process here? Why are other European countries coming up with the answer that Velcade is both clinically effective and cost-effective? Why, when we asked NICE the question, did it decide that that was not the case? Has the Minister considered how this is handled in other countries, and whether we can learn from them?

I believe that it would be irresponsible for someone in my position to build expectations in people that they can safely have access to every drug that comes along. The responsible course is to arrange an independent appraisal process—as we did with NICE—that balances clinical effectiveness with cost-effectiveness.

I see reports week after week about every new wonder drug that comes on to the market; no doubt the hon. Gentleman does as well. It is simply not right to jump on the bandwagon for political purposes whenever a new drug comes along. A broader, more balanced view must be taken of whether treatments are effective or not. We must give a clear line to the public and not raise false expectations. That is what NICE has been seeking to do and Opposition parties have supported it before. I believe that it is when decisions are difficult that we owe NICE the most support, and all parties in the House should provide that support at this time.

My father-in-law died of myeloma some years ago. It is a dreadful disease from which at least 20,000 people in the United Kingdom currently suffer—30 or so in each parliamentary constituency. Should we not back treatments such as Velcade? If no one had backed insulin two generations ago, people would still be dying of diabetes in great numbers rather than leading longer and more fulfilling lives. We really must do more to turn incurable, dreadful diseases such as myeloma into chronic illnesses. I agree that we should not jump on bandwagons, but we should show faith, provide support and produce the necessary resources to give hope to thousands of families in the United Kingdom.

It is important to keep such matters under review, but, as my hon. Friend will know, the Government have made huge progress in the treatment of patients suffering from cancer across the board, in terms of both access to treatment and the treatments available. As I have said, we do fund those treatments. Of the 26 cancer drugs referred to NICE, 25 have been approved. That clearly shows that NICE is helping people in need to obtain treatments.

I heard what my hon. Friend said about his personal experience of a family member with this condition. It is an awful condition—I do not deny that—but I should point out that every new treatment that comes along is not necessarily the best option. We must see the position in the round and ensure that funds go into improving services across the board, rather than simply paying for every new treatment that comes on the market.

On 27 September, Janice, Jacky and Marie—the “Velcade Three”—handed this letter to the Secretary of State. They have not received a reply. Why not?

I can tell the hon. Gentleman that they have received a reply. The Secretary of State wrote to the individuals concerned last week, explaining precisely the process that NICE has been through. That reply has been sent and was dated 23 October. [Interruption.] It is important—without, as I have said, raising the temperature for political purposes—to offer NICE some support at the time of this difficult decision.

The Minister will recall that I raised the issue with the primary care trust in spring this year on behalf of one of my constituents, as other Members have on behalf of their constituents.

May I suggest a way forward? Leaving it to the manufacturer and others simply to appeal to NICE is only one solution; a better one would be to recognise that what NICE said last week was that it had insufficient evidence to demonstrate cost-effectiveness. If the Department is willing to talk to Johnson & Johnson, the manufacturer, it ought to be possible to find a way forward that allows patients to receive the drug for a future period, so that definitive evidence of its cost-effectiveness can be determined. Will the Minister and the Department get together with Johnson & Johnson to do precisely that? NICE does not have the power to question the price given to it by the manufacturer.

I hear what the hon. Gentleman says, but we need to be extremely careful about the points that we make on these matters. A couple of weeks ago, he was asked by one of his colleagues about Alzheimer’s drugs and he said:

“Frankly, it is my opinion that in an independent national health service such decisions must be made independently”.—[Official Report, 11 October 2006, Vol. 450, c. 307.]

I would view that as an endorsement of the NICE process, where people who are expert in the conditions take the decisions. The hon. Gentleman does not—[Interruption.]

Order. The Minister must be allowed to reply without interruption.

The hon. Gentleman does not have a medical background and I do not have one. Yet when asked on television on Sunday whether he would allow the drug to be prescribed and paid for if he were Health Secretary, he said that he would—a direct contradiction of what he said in the House just a couple of weeks ago. There is a need for some consistency in this argument. Patients need consistency and they do not want mixed messages or double standards simply because it is politically convenient to get off the front pages of the newspapers, as the hon. Gentleman—

Order.

2. When she next plans to review the regulations on NHS charging and prescription exemptions. (95961)

The Government published on 17 October their response to the recent review of NHS charges by the Health Committee, which set out our plans for a review of prescription charges and exemptions. We will report the outcome of the review to Parliament before the 2007 summer recess.

Although I welcome the forthcoming review—the present system of prescription charges is quite arbitrary and the list of exemptions for asthma, for example, was compiled in 1968 and despite vast improvements in medical science has not changed since—will the Minister give an undertaking that the review of prescription charges will be transparent and that its findings will be published for all to see?

I can give the hon. Lady that commitment. She makes a reasonable point and I accept that the costs for people who need repeat prescriptions can be extremely high. In response to the Health Committee, chaired by my right hon. Friend the Member for Rother Valley (Mr. Barron), we said last week that we would introduce a monthly direct debit system for patients who have a pre-payment certificate, costing £7.95 a month. That is £2 a week and is an improvement, but I recognise that we have further to go. The hon. Lady is right to say that it is hard to see the logic on which the list of exemptions is based and any review should look into it further. Any changes should be cost-neutral to the NHS overall, but I acknowledge her point.

It is not just a matter of being cost-neutral; can the Minister assure us that the proposals will be evidence-based?

My right hon. Friend knows that the Department of Health specialises in precisely that sort of rigour and I am sure that it will be followed in this particular instance.

3. What steps she is taking to ensure that more health services are delivered in the community in the Suffolk Primary Care Trust area. (95962)

Last week, we announced a new project to shift ear, nose and throat services in Ipswich closer to people’s homes. A senior audiologist will run a clinic three times a month from a town centre GP practice with good public transport access and parking. That will mean that far more ENT patients will not need to go to hospital for their treatment, which I believe will be welcomed as part of a much broader programme to shift services closer to people’s homes.

Does my right hon. Friend agree that care closer to home projects such as the primary care audiology clinic established in a GP centre in my constituency offer patients better health care, make better use of resources and should allay people’s concerns about whether changes in acute hospital set-ups are matched by the introduction of community-based health services?

My hon. Friend is absolutely right. Partly thanks to advances in medical practice and modern medical technology, it is now possible to give patients care in a local GP surgery, health centre or, indeed, in their own homes, which could until recently be provided only within an acute hospital. What we found in the huge public engagement that led up to the “Our health, our care, our say” White Paper in January was that where it is safe and right, people prefer treatment to be given to them in their GP surgeries or, if possible, in their own homes.

Does the Secretary of State think that there is a greater likelihood of an increase in spending and better health service provision in an area such as Ipswich, represented by a Labour MP, than in an area such as North Wiltshire?

The hon. Gentleman is absolutely wrong. There is more money going into the NHS in every part of the country than ever before—funding that was of course made possible by an increase in national insurance contributions, which the hon. Gentleman and his party opposed. In deciding how much money should be allocated to each local primary care trust, we take into account the age of the population, especially the proportion aged 65 or older, and the burden of disease, including the fact that in some communities life expectancy is far lower and the death rate from, for instance, cancer and heart disease is far higher. We believe in fair funding; it is a pity that the hon. Gentleman does not seem to do so.

It is clear that in Suffolk, as elsewhere, community services are being run down. The number of district nurses has fallen by 15 per cent. since 1997 and we need at least a third more podiatrists, instead of the present savage cuts. At the same time, acute services are being cut in Ipswich and, across the country, 81 community hospitals are under threat, including Walnut Tree, Hartismere and Aldeburgh in Suffolk. However, the Royal College of Nursing said that 71 per cent. of newly qualified nurses cannot find jobs—nurses who were recruited and trained at vast expense to the taxpayer on the basis of Labour’s cack-handed work force planning. How does the Secretary of State expect to build up the delivery of health services in the community when she is overseeing cuts in district nurses, specialist nurses such as those caring for people with Parkinson’s disease, community hospitals—

Order. I expect that the Secretary of State will manage to reply.

The hon. Gentleman referred to services in Suffolk. I find it extraordinary that he did not refer to the fact that the NHS is investing nearly £1.5 million in Felixstowe to turn an old general hospital into a modern community hospital, with a day-treatment centre, 16 in-patient beds and a range of clinics and services that will provide better care for people in that part of Suffolk. I am surprised that he did not mention the investment of £600,000 in the Mount Farm surgery in Bury St. Edmunds. I am surprised that he did not mention Bluebird Lodge and Ravenswood, which opened in April this year, or the fact that Suffolk PCT, which is reviewing community services, has £3 million of revenue and more than £2 million of capital to invest in other community services and buildings. It would be absurd to say that a pattern of community and cottage hospitals that were built—

Order. I think that the Secretary of State has made her point.

4. What plans her Department has to deliver more health services in the community in the Hull Primary Care Trust area. (95963)

I am glad to say that, following the strategy of moving services into the community, we have recently announced a dermatology service in Hull, which is one of the 30 care closer to home demonstration sites that we announced last week. It will make care more convenient for patients in my hon. Friend’s constituency.

I very much welcome the move of the NHS into the community, but I am concerned about the delay in receiving that good quality community facility in Orchard Park, which is one of the most deprived wards in my constituency. Will my right hon. Friend look into the delays that have been caused by Hull city council dragging its feet on planning permission?

I very much understand my hon. Friend’s concern about the delays in the Orchard Park scheme. My understanding is that there were changes to the design and the site that have caused some delays. I am told that the local NHS is now finalising its discussions with Hull city council and they should close the agreement for the scheme in a matter of weeks. It will then go ahead along with the other LIFT—local improvement finance trust—schemes in Hull that are so significantly improving local health care for my hon. Friend’s constituents.

rose—

Order. St. Albans is too far away from Hull.

5. What assessment she has made of progress towards reducing inequalities in health. (95964)

Last year’s status report on health inequalities shows progress in some areas, notably in terms of child poverty and housing quality. The inequalities in deaths from coronary heart disease, stroke and cancer have also been reduced. Although life expectancy is improving for all groups and infant mortality is at an historically low level, the long-term trend in widening health inequalities has continued. That suggests that there is more work to be done.

I am glad to say that that has not been the pattern in Slough. Health inequalities, both in my constituency and between it and the surrounding areas, have narrowed, but the biggest killer remains coronary heart disease—whose primary cause is poverty—followed by diabetes, smoking and obesity. Those are the biggest predictors of early death. Will my hon. Friend assure me that tackling those factors in the poorest areas will be a high priority for the Government?

I very much want to take this opportunity to congratulate all those in Slough’s local authority and health services on their efforts to reduce health inequalities. For example, some fantastic work has been done on testing for diabetes in the south Asian communities. However, I agree that more has to be done, and that is why health inequality targets will be mandatory in the local area agreements from next year.

St. Albans is nowhere near Hull, but the issue is the same. I have written to the Secretary of State about the inequalities in provision that prevent equality in health outcomes in my constituency, where district nurses are in short supply. They seem to have to beg, borrow or even steal supplies to treat patients. [Hon. Members: “Steal?”] I use the word in a general sense. I know that the right hon. Lady has received my letter. Will the Minister ensure that my constituency gets the right amount of funding to enable the right amount of health care to be delivered to those patients who are suffering under the present system?

I hope that everyone heard that plea for more funding for the NHS. I cannot comment on the hon. Lady’s letter as I have not seen it, but more health professionals are working in the community than ever before. The inroads on health inequalities that we are achieving are due to the fact that we are working on prevention as well as just treatment. Moreover, there is more help in the community available for those who have suffered heart attacks or cancer. Those who plan health services must look closely at what works and what does not. There are plenty of good examples around the country, and I urge the hon. Lady to come and see how that planning can be done well.

When this Question Time is over, will the Minister look at the indices of health deprivation and inequality in the borough of Thurrock? I remind her that I advised against abolishing the Thurrock PCT. Contrary to my wishes, it was abolished and merged with something else, even though the Government planned widespread growth in my area. The inequalities in single-practice GPs, and their age profile, need to be addressed by the urban development corporation and the Government. The new PCT is not sufficient for purpose: it is unable to address the inequalities in my constituency today, or the ones that will come about unless my hon. Friend intervenes.

I want to say two things to my hon. Friend. First, I accept that the reorganisation of the PCTs may not have been everyone’s desired outcome, but we have made sure that dealing with health inequalities is an essential part of their role and responsibility when it comes to commissioning services to meet the local population’s needs. Therefore, every PCT, regardless of shape, must look at where the health inequalities are in its area and make sure that it delivers appropriately.

Secondly, we are devoting more attention to dealing with the different determinants that affect people’s life chances and health. Our work with local authorities is very important in that respect, as are the mandatory targets for health inequalities in local area agreements. The forthcoming White Paper will ensure that there is a good working partnership with local communities in the delivery of health. However, I will look at what my hon. Friend has said and get back to him.

Does the Minister accept that the health indices are a broad measure of difficulties, but that rural areas face particular problems? In those areas, the indices do not point out the inequalities and poverty that exist. In her drive to ensure that GPs are able to provide better services for their communities through undertaking more diagnostic services, will she ensure that those in rural areas are given additional funding? That is needed, because it costs more to take such services into rural areas than into towns and cities.

The hon. Gentleman makes an important point. Based on disease, it is clear that in some parts of the country greater numbers of people suffer from cancer, heart disease and so forth, and we have to address that. We also have to recognise issues around older populations and access to services, which is why I ask the hon. Gentleman to join us in continuing to make the case for services outside hospitals, such as the use of mobile units where people actually live, rather than expecting them to go to a building that, with the best will in the world, does not necessarily serve their interests. That is also why we have improved opportunities for nurses to do many of the tasks that, 20 years ago, could be done only by GPs.

I invite my hon. Friend to consider how better partnership working might improve our severe health inequalities in Liverpool. Does she know that last month, in the very same week that the NHS announced its welcome stroke care pathway, Lib Dem-led Liverpool city council announced the proposed closure of one of the two venues from which the pathway was to be run, dispersing the staff who had just been trained to run it? I invite her to give the NHS the strongest possible encouragement to continue with its excellent work, which seems to be one of the few ways in which we can make a serious effort against health inequalities in Liverpool.

I thank my right hon. Friend for that information. There is no doubt that stroke and conditions such as diabetes and coronary disease are among the biggest diseases facing the NHS. The issue is not just about helping people so that we can prevent them from acquiring those diseases, but about giving them support to allow them to live longer once the disease has become part of their life. Although it is difficult for me to comment in depth, I suggest that the Lib Dem council has taken a rather short-sighted approach in respect of the unit.

If the Minister truly believes that those who suffer from cancer should have an equal chance wherever they live, will she explain to the Parliament of the United Kingdom why those who live in Scotland seem to stand a better chance than those who live in England?

It was a decision that Parliament made when we decided to devolve different powers to Scotland. In fact, we have the shortest waiting times on record and we are working to reach our 18-week target. Fewer people are dying from cancer, coronary heart disease and stroke than ever before—[Interruption.]

Order.

Thank you, Mr. Speaker.

We want the sort of services that meet people’s needs, which currently may not be met. That means re-evaluation of services run in hospitals, to see where better they might be provided, so that we can make sure that everybody, regardless of where they live, has access to a good service.

Eight people in the UK die every day from mesothelioma—an asbestos-related cancer contracted predominantly by poorer working-class people who were exposed to asbestos in their workplace. One of the best ways to address inequalities in the health service is to treat those people, so when will the Minister put her weight behind prescribing the drug Alimta, which is the only effective treatment for mesothelioma, so that it is freely available on the NHS to those people who need it?

At this point, all I can say to my hon. Friend is that I am sure that NICE will listen to representations from people on the advanced case list, but as the Minister of State, my hon. Friend the Member for Leigh (Andy Burnham), said earlier, we have to have an independent approach to the licensing of drugs and to guidance for the NHS. However, I appreciate my hon. Friend’s points, and if he would like to make representations to NICE on behalf of his constituents, I am sure that they will be listened to.

When Health Ministers, their officials and the Labour party chairman pore over the NHS heat map that they have created to put Conservative and Liberal Democrat areas out into the cold, and when they divert health funding away from the constituencies of their political opponents, what account is taken of the likely impact on deteriorating health inequalities in those parts of our country where there is no immediate prospect of party political advantage for Labour?

I reject the hon. Gentleman’s assertion. I do not believe—[Interruption.]

Order. It is becoming a habit on the Opposition Front Bench to shout down the Minister when she replies. I will not tolerate that. The Minister is entitled and expected to reply.

Thank you, Mr. Speaker.

I have been in a number of debates with members of the Opposition Front Bench and on many occasions I have heard them say that they understand and appreciate that there are different health inequalities—at least that is what they purport to think in those debates. The fact is that there are inequalities in life expectancy, and higher rates of cancer and heart disease in some parts of the country than in others, and within areas. That is why my hon. Friend the Member for Slough (Fiona Mactaggart) is right to raise her point about her needs in terms of the wider health prospects for people living in Berkshire. The Conservatives’ approach to funding is—

Order. We need not worry about that.

6. What progress has been made in improving care for cancer patients in Hendon; and if she will make a statement. (95965)

As in England as a whole, cancer patients in Hendon are treated faster than ever before. At the Royal Free Hampstead NHS Trust, where most cancer patients in Hendon are treated, 100 per cent. of patients are seen by a cancer specialist within two weeks of GP referral and receive treatment within two months.

I am sure that my right hon. Friend would agree that that record would not have been achieved without the setting of targets. Will she commend the new out-patients’ oncology department at the Royal Free, which has state-of-the-art facilities? Will she also look at ensuring that patients who go to Barnet hospital who are in need of tertiary care are referred to the Royal Free, rather than Mount Vernon hospital as at present? That would enable them to take advantage of the excellent record at the Royal Free and would mean that they could have treatment closer to home, using transport links rather more effectively.

My hon. Friend is quite right to point to the advances that have been made in terms of the extra investment that has gone into cancer treatment, and the increased number of cancer consultants and clinical nurse specialists. That has made a real difference to the outcomes for cancer patients. Of course, the cancer networks look at the referral patterns and I shall certainly make sure that the cancer network that oversees his area is aware of the points that he has made.

Is it still intended to move the Mount Vernon cancer centre, which also serves the people of Hendon, to central Hertfordshire, as promised at the last election, or is it the case, as the local health trust now says, that it is precluded from including a cancer centre in the proposed new hospital in central Hertfordshire for financial reasons, if indeed such a hospital is ever to go ahead? Will the Minister clarify that?

The East of England strategic health authority is reviewing acute hospital services in the east of England and the needs of cancer patients will, of course, be taken into account in that review. Any reconfiguration of cancer services will be in line with the NICE guidelines for improving outcomes, which are designed to improve the overall quality of care for cancer patients.

7. What steps her Department's sexual health unit is taking to promote sexual health awareness and education in schools. (95966)

We are fully committed to ensuring that all young people receive high quality personal, social and health education. We have made sex and relationships education a mandatory requirement of the new healthy schools standard, which 80 per cent. of schools are working towards. That is a voluntary programme. We have continued to fund a PSHE certificate for teachers and nurses to improve the quality of delivery, and we have announced the creation of a new PSHE subject association in line with other curriculum subjects in order to raise the status of sex and relationships education.

Will the Minister consider adopting the proposals outlined in the recent Institute for Public Policy Research report by Julia Margo, which recommends the teaching of sexual health and education at primary school, before children reach secondary school level, as a way of dealing with the rise in the number of teenage pregnancies and sexually transmitted infections?

I have not seen the IPPR report yet, so I cannot commit myself to it, but it is important that we are able to have a mature debate about sex and relationships education. That education has to be age-appropriate, but it is part and parcel of how we support young people as they grow up so that they can make informed decisions at appropriate points in their lives and be confident adults. [Interruption.] I do not understand the shouting and sniggering that is coming from the Opposition Benches.

There has clearly been a wish from parents to have more support. My colleagues in the Department for Education and Skills are looking at how they can support parents in having the right conversations with their children at the right time, because that is where some of the support needs to be directed.

The Minister will be aware of the report on her Department’s website that shows a clear correlation between educational qualifications and the method of contraception used. For example, a woman with no qualifications is four times as likely to be sterilised as a woman with a degree, and a woman with a degree is three times more likely to use condoms than a woman with no qualifications. Does that not signal to the Minister that we are getting PSHE badly wrong? We need more information earlier, and it would be better to have specialist subject teachers to deliver that part of the curriculum, rather than geography or maths teachers.

As I said earlier, we think that part of the way in which quality will be raised will be through the PSHE certificate for teachers and nurses, which will increase their confidence in delivering the subject. However, there are good examples of schools that are working in partnership with others—both inside and outside the school—to deliver the sort of sexual health services that young people require. We need to make sure that appropriate information is given, although that can be delivered by a number of different individuals and organisations. Young people certainly complain about the patchy nature of PSHE. As they grow into young adults, clearly the process must be continued with good advice about the range of contraceptives available that NICE supports the use of, and the promotion of by our GPs.

8. How patient and public involvement will be improved by replacing PPI forums with local involvement networks. (95967)

Local involvement networks will provide flexible ways for a much larger number of people to engage with their local health, as well as social care, organisations to help to shape services and priorities in ways that best suit communities and the people in them.

Would the Minister be interested to hear about the good work that is taking place between Croydon’s PPI and the Mayday trust? For example, there was an unannounced visit last week to eight wards and recommendations were made on both the quality of fare and patient care. Such lay-visiting puts as its first question, “Would I like my relative or myself to be in these conditions in the hospital?”, but surely that will not be available under the new and more formalised local involvement networks.

I am certainly aware of the good PPI work that goes on in the hon. Gentleman’s area. However, when we consulted on the future of patient forums and PPI, many of the forums told us that some of their inspection work was duplicated by the Healthcare Commission. We will want LINks to examine the services provided in a specific area by following the patient pathway, in a sense, rather than by being attached to individual buildings and simply inspecting those. I assure the hon. Gentleman that we will expect the Healthcare Commission to involve LINks when it carries out inspections, but we do not want the duplication of inspection activities that exists at the moment.

Given the many changes facing the national health service, does my right hon. Friend agree that we need a stronger and more effective system of patient and public involvement than that which we have had thus far? She will have the opportunity to meet forum members from all over the country at a meeting next Monday in the House, which I am sure will be most productive. Does she acknowledge that the transition from the existing system to LINks must be sensitively handled so that we can maintain the involvement of volunteers and continuity, and deal with all the changes and the comments about them that will be required? Does she accept as well—

Order. One supplementary is fine.

I certainly agree, and I congratulate my hon. Friend on all the work that he does on the all-party group to promote patient and public involvement. Patient forums have done an excellent job and we do not want to lose the expertise that has been built up. I will examine the ways in which we can work with local authorities, which will handle the contracts for the local involvement networks, to ensure that they are able to bring existing members into the new system. However, one advantage of the new system is that LINks will examine not only health services, but social services, so they will be able to consider some of the joint commissioning between the two and work closely with some of the overview and scrutiny committees. Such a system will provide a better overview of access to local services. It will ensure that local services are of a high quality and give people the right to challenge them if they are not.

Will the Minister explain how the Department of Health can issue a paper entitled “Patient and Public Involvement in Commissioning”, suggesting that patient petitions be used in primary care trusts, in which there is not a single mention of the local involvement networks that the Government established to provide precisely that sort of communication?

We have made connections between local involvement networks and the possibility of petitions. We have said that local involvement networks can, through the overview and scrutiny committees, approach PCTs and ask for a response within 20 days if there are complaints about a service. LINks will be able to work with PCTs, and can ask them why they have made particular priorities in an area, whether they are adequately assessing local health need, and whether they are prioritising spending to effect any changes needed. They will be able to challenge service delivery and involve a much wider group of people than are currently involved in patient forums. As I have said, we are building on the good work that has already been done by patient forums, but are involving more people and giving them greater powers.

My right hon. Friend will recall her visit to Leicester, during which she paid tribute to the work of a Leicester PPI forum. She will know that it was through the work of that PPI forum, in partnership with the local health authority, that the incidence of MRSA was discovered. How can we be reassured that the issue raised by the hon. Member for Croydon, Central (Mr. Pelling) will be addressed? I take the Minister’s point about duplication, but we need to be reassured that the same rights that were available to the previous forums will be available to her new commission.

I certainly pay tribute to the members of the patient forums in the constituency of my right hon. Friend the Member for Leicester, East (Keith Vaz); their enthusiasm was boundless and their dedication and commitment to ensuring good services was plain for all to see. However, I stress again that it is important that there should be no duplication of the work of the Healthcare Commission and the Commission for Social Care Inspection. We want to give LINks the opportunity to consult local people if there have been a lot of complaints to the patient advice and liaison services, or the independent complaints and advocacy service, about local services. If it is believed that there is a particular problem, LINks can refer it to the PCT and, if necessary, onward through the overview and scrutiny committees to the appropriate regulators. We would expect the regulators to involve LINks in their inspection processes but, as I say, we do not want duplication of a process, which is what happens at the moment.

I put it to the Minister that she totally misunderstands the central point made by my hon. Friend the Member for Croydon, Central (Mr. Pelling) and others. We all agree that, at a time of massive change in the NHS, a strong patient voice is required. However, given that LINks will not have the powers that patient forums had to monitor and inspect the NHS and access information, and given that PCTs will be obliged to listen to the recommendations of LINks, but will not necessarily be obliged act on them, is the Minister not at least a little concerned that LINks will turn out to be nothing more than toothless talking shops?

LINks certainly will not be toothless talking shops. When we carried out our consultation, it was clear that some people felt that there was duplication, and that their inspections were not taken that seriously. We want to empower LINks to gather people’s views about local services and to hold to account primary care trusts and local authorities for the way in which they assess local need and commission services. I know that the Opposition would reinstate a top-down approach—

No. Order. I call Mr. David Kidney.

9. What the average waiting time was for patients requiring diagnostic tests in England in the latest period for which figures are available. (95968)

The average waiting time for the 15 key diagnostic tests on which we collect monthly data was five and a half weeks for patients waiting at the end of August—down from seven weeks in January, when the NHS first started collecting diagnostic data.

I thank my hon. Friend for that answer. Everyone connected with Staffordshire general hospital has performed magnificently in the past couple of years to reduce long waits for diagnostic tests such as MRI scans. However, managers have told me that there is still an enormous challenge if they are to meet the Government’s ambitious target for 2008 of a maximum wait of 18 weeks from GP surgery to operating theatre. Will my hon. Friend tell me—and, through me, those managers—about the support available over the next 12 months to make sure that waits for diagnostic tests are not the weak point in that very ambitious target?

I agree entirely with my hon. Friend. I, too, pay tribute to the staff of Staffordshire hospital, who have worked to make the health service the high-quality service that the people of Stafford have the right to expect. As for the specific question of imaging scans, from April 2006, people who do not receive an appointment within 20 weeks are offered the choice of a scan from another provider within that period. We are driving the system to ensure that there is a guaranteed minimum standard. The great prize for the national health service is the historic 18-week target from the door of the GP surgery to the door of the operating theatre. The achievement of that target would be the greatest manifestation of a modern health service, and it would effectively mean the ending of waiting lists in the NHS. We will ensure that our staff receive all the necessary support to enable us to deliver that historic goal.

Is the Minister concerned that the independent orthopaedic treatment centre in my constituency is not conducting diagnostic tests or, indeed, any tests on people who live on their own or do not have a telephone? That is clear discrimination against the single elderly and the poor, and it is a double whammy because, instead of being treated in Banbury, as in the past, the single elderly and people without telephones, who tend to be poorer members of the community, have to go to Oxford. That is disgraceful cherry-picking by those independent treatment centres, and the Minister and the Government should be ashamed.

If the health service was entirely independent I would not be able to intervene. However, that is not the case, so I shall certainly look into the concerns that the hon. Gentleman has raised, speak to the relevant health managers and strategic health authority, and write to him with a response.

10. What estimate she has made of the effect of the present funding formula on services provided by Burnley, Pendle and Rossendale primary care trust. (95969)

In 2003, following a review by the independent advisory committee, we introduced a fairer funding formula to ensure that primary care trusts can commission similar levels of health services for populations in similar need. As a result, Burnley, Pendle and Rossendale PCT has benefited from an increase in funding of £60 million or about 20 per cent. over 2006-07 and 2007-08.

I welcome that answer, precisely because that extra money will be used to help to improve mortality rates in my Burnley constituency, which, regrettably, are worse than the national average across the board. Can my right hon. Friend guarantee that the allocation of funding will always be based on health need?

I can certainly give my hon. Friend an assurance that we will continue to use a fair funding formula that takes into account the fact that different populations in different parts of the country have different health needs, whether that results from a higher proportion of elderly people or from a concentration of communities with a much higher risk of cancer, heart disease, circulatory and other diseases as, indeed, is the case in her constituency, where the average life expectancy is about two and a half years less than the English average, and about five years less than, to take a random example, the average for South Cambridgeshire.

What estimate has the Minister made of the increased costs of the reconfiguration that resulted in the downgrading of Burnley general hospital and Rochdale infirmary, and what is the impact on funding formulae? One of my constituents suffered an accident in Whitworth on Saturday night and was collected by an ambulance that came from Preston. How many extra ambulances are needed to serve those communities?

These matters must be taken into account by the primary care trust and by the hospitals. As the hon. Gentleman indicates, there has been a review of emergency and acute services in east Lancashire, which I believe is under debate by the overview and scrutiny committee. He will understand that I believe that such decisions, about which my hon. Friend the Member for Burnley (Kitty Ussher) has been to see me with some of her constituents, should ideally be made locally. But the overview and scrutiny committee has an important role to play in that, and it would be inappropriate for me to comment further at this stage.

May I tell my right hon. Friend that a recent consultation in my constituency in Rossendale showed a clear demand for the retention of community health provision in the Rossendale valley, and that before the end of the year the East Lancashire Hospitals NHS Trust, the PCT and Rossendale borough council will be submitting a bid for funding to establish a health campus in the Rossendale valley? I hope that, when that arrives on her desk, she will give it serious consideration.

My hon. Friend refers to an extremely exciting proposal for a health campus. As she knows, the funding that has been made available by my right hon. Friend the Chancellor is now almost entirely devolved to primary care trusts, following the much fairer funding formula. It will therefore be for the local primary care trust and the strategic health authority in the north-west to decide whether, as she hopes, that project should be a priority for further funding.

11. What consultations the Government undertake with users of the health service before reforms are implemented. (95970)

The Government are committed to ensuring that there is a strong voice for the people who use the NHS, as well as for those who work in it. That is why patients and the public, as well as all other stakeholders, are involved in and consulted on changes to the health service.

I am grateful for that response, and I am grateful to Lord Warner for meeting two Longridge GPs and Councillor David Smith from Longridge last night, who was speaking up on behalf of the people of Longridge. During the changeovers with the primary care trusts, Longridge was moved from Preston into East Lancashire. Anybody who knows the area knows that Longridge people look towards Preston for all their services. That is where all the bus routes go. Already patients are being told that for diabetes care they need to travel many miles out of their way into east Lancashire. Lord Warner said that he would investigate and I look forward to that, but may we re-examine the processes in the consultation so that local people are listened to effectively?

I am aware of the meeting that took place. I gather that it was quite constructive, and that in the course of it there was even an exchange of Lancashire cheese. The issues that the hon. Gentleman mentions can be difficult. One reason for changing the boundaries to that of the local authority was to make them coterminous with the health service to ensure that some of the shared services between local government and health services could be delivered more effectively. For public health purposes, there can also be good reasons for coterminosity. However, I understand that there are some issues in relation to referrals and that Lord Warner has agreed to consider those and discuss them with the strategic health authority.

If consultations in Bedfordshire reveal anger and a rejection of the likely downgrading of Bedford hospital, annoyance at the unequal funding of rural and semi-rural areas, and an immediate demand to have fitted in the hospital an MRI scanner, which has been bought and paid for but which is gathering dust in a warehouse, will anyone on the Front Bench be listening?

May I reassure the hon. Gentleman that not only has there been extra funding in his area, but there have been increases in staff numbers and equipment? When there are changes to services, a clear pattern must be followed. There is local consultation and the matter can be referred to the overview and scrutiny committee, so that if there are issues about inadequate consultation or detriment to services, those can be referred to the Secretary of State. I hope that the hon. Gentleman will encourage his constituents to participate in consultation processes.

12. What role she expects food retailers to play in the strategy to tackle child obesity. (95971)

Food retailers have a vital role to play in tackling obesity, and I think that they are beginning to make a difference through reducing the amount of fat and sugar in processed food, providing clear front-of-pack labelling and supporting their customers to make healthy choices. We are seeing more evidence that where retailers take a proactive approach to healthy eating, it can actually improve their profit margins. I suggest that that is a win-win situation.

I recently presented IT equipment to schools in my constituency as part of the Tesco computers for schools initiative, and it occurred to me that much of the money that families spend to obtain the vouchers goes on crisps, sweets and chocolate, which make children obese. I suggested to Tesco that it should amend its scheme by excluding such products from the eligible spend for the vouchers or by giving double points for fruit and vegetables. Will my hon. Friend support that idea? Does she agree that it is a great opportunity for Tesco, Britain’s leading food retailer, to send a powerful message and to lead the way in the fight against childhood obesity?

It is a good idea for retailers, both Tesco and others, to reward healthy purchasing. There are many ways in which retailers can work to support their customers. I am happy to raise the matter with the retailers, whom I meet regularly. I congratulate my hon. Friend on his initiative.

13. How much was spent by the NHS on management consultants in the last year for which figures are available. (95972)

The Department does not collect information from NHS organisations that would allow an analysis of the cost of management consultants.

Perhaps I can help. Advice was given at the Mesothelioma UK patients and carers conference in Manchester on 5 October that £179 million was spent on management consultants. How can I explain that to my constituents who are waiting for Alimta, which will cost £5 million a year?

I am sure that my hon. Friend agrees that there is a role for management consultants, when they add value to the decisions and issues that managers in the national health service must address. We hope and expect managers to exercise proper judgment in deciding when to use management consultants. If management consultants add value and lead to an improvement in patient care, Government and Opposition Members would say that they have an important role to play. However, we also accept that good judgment must be exercised when consultants are used.