1. What plans there are to improve NHS dental provision in Shropshire. (310016)

The Department has invested a record £2 billion in dentistry and set up a national access programme to help the national health service deliver its commitment to providing, by 2011, access for all who seek it. It is, of course, the responsibility of Shropshire County primary care trust to plan and develop appropriate services, including dental services, to meet the needs of its resident population.

I thank the Minister for that answer, but I must tell her that my experience of trying to find an NHS dentist in Shrewsbury for myself and my family has been an absolute nightmare. Can she provide me with a list of NHS dentists in Shrewsbury and Atcham that are currently taking on patients, so that I can share that with my constituents?

I am sorry that the hon. Gentleman and his family were troubled with uncomfortable dental pain at some time, but I know that he accessed the advice line and that he was assisted. I would be happy to talk outside the Chamber about any particular points that he wants to make on that. Of course, access to NHS dentistry has grown in Shropshire. Over the past 12 months the number of people who have seen an NHS dentist has risen by more than 11,000. I am aware that the PCT is tendering three new contracts—in Market Drayton, Oswestry and Bridgnorth—which are due to start in April 2010, and a new contract was tendered in 2006 for Shrewsbury as a high-priority area.

2. What recent representations the health taskforce on violence against women and girls has received on the role and response of health services in respect of trafficked people. (310017)

The taskforce has heard evidence from many groups representing women and children who are victims of all forms of violence, including trafficking. The taskforce on the health aspects of violence against women and girls, chaired by Sir George Alberti, is currently considering the report and the recommendations of the sub-group on harmful traditional practices and trafficking, which it established for that purpose.

Is the Minister aware that many trafficked women display multiple problems, both physical and mental, and that when they go to accident and emergency units in hospitals, as well as to general practitioners, they are not readily identified as trafficked women, but viewed as victims of violence? Will she therefore consider whether we could improve training for both GPs and hospital staff, so that when they actually meet battered or mentally disturbed women who have been trafficked, they recognise that, rather than seeing them simply as victims of violence?

First, I am sure the whole House congratulates the hon. Gentleman on his work with the all-party group. He has been such a force for good, and not only in our own country: he has often visited other European countries to see what is happening.

I know that Devon black and minority ethnic community development workers engage with vulnerable communities, but the taskforce is such an important one and the questions are so relevant. The training that health care workers receive for meeting difficult situations will be covered in Sir George Alberti’s report, which we expect to be published in early February. A specific training mandate will, I feel, be put in place from those recommendations.

I doubt whether anyone can match the hon. Member for Totnes (Mr. Steen) for the work he has done on this issue, but my limited experience of it prompts me to ask whether the interface that trafficked women have with health services in the voluntary sector can be assisted by overcoming the linguistic barriers, which are part of the problem. In many cases there is a heavy dependence on people who are themselves part of refugee communities to act as translators. Often, they have real difficulties facing the Home Office when addressing their own problems regarding deportation. Will the Minister ask for a coherent interface between key workers and those within the refugee communities in that process, to ease the problems that those women face?

My hon. Friend raises some more excellent points. Those areas are covered by the research and the report’s findings, and we are working across Government with other Ministers, particularly Home Office Ministers, to address that very point.

3. What account is taken of relative levels of deprivation in determining NHS resource allocations. (310018)

Deprivation is accounted for in the NHS funding formula, which reflects both deprived and older populations’ greater need for health care. An additional health inequalities component in the formula directs funding to the places with the worst health outcomes, targeting health inequalities better than ever before.

Can the Secretary of State tell the House whether he has any further plans to try to reduce health inequalities by targeting resources further towards the most deprived areas of the country? Does he agree that the Opposition’s premium pledge is just a sham, because the policy is already being implemented by the Government?

I can say to my hon. Friend that next year County Durham PCT will receive £1,800 per head of population, £200 more than the England average, reflecting the fact that there are higher levels of disease and deprivation in her local community. Obviously that has been a component of the formula since 1999. The Advisory Committee on Resource Allocation in the NHS keeps the matter under review, and it says that the decision is an interim step to give more money to tackle health inequalities. We keep the matter under review, and I can advise my hon. Friend that Professor Marmot will shortly give us his report on further action to tackle health inequalities, which we shall consider in due course.

Surely the purpose of the NHS is simply to treat individuals, wherever they happen to live around the country, with the treatment that they need to deal with their particular problems. Will the Secretary of State confirm that all health spending will be given on that basis, and that basis alone, rather than basing it on the socio-economic environment in which an individual lives?

I am told that there is a general election not too far off. May I respectfully point out to the hon. Gentleman that it might help him to read his party’s draft manifesto from last week, which included the commitment to

“weight public health funding so that extra resources go to the poorest areas”?

He is going to be standing on that manifesto in a few months, so he had better read it—and pretty quickly, I would say.

Can my right hon. Friend tell us what the level of resources per head was 10 years ago?

I can say to the Chairman of the Select Committee on Health that the England average next year will be £1,600 per head of population. Turning the clock back 10 years, we see that it used to be £426 per head of population. That figure demonstrates the change that this country voted for when it elected a Labour Government. The country was saying, “Our NHS needs to be put back on its feet. We need to invest in it to give people in all parts of the country the best possible health care.” In that figure alone we can see the difference that this Labour Government have made.

The Secretary of State will be aware that GP practices in deprived communities lose out financially and that there are 18 per cent. fewer GPs working in poorer communities. He will also be aware that the Health Committee heard evidence of the failure of the incentive scheme for payments to GPs to do anything effective about health inequalities. There is evidence supporting the call for radical action to change the way in which the qualities and outcomes framework works. When will the Government take action to change the current completely unacceptable situation, whereby GPs in richer areas are paid better than those in poorer communities?

Of course we keep such matters under review at all times. However, the funding formula for general practice contains a minimum practice income guarantee, which protects precisely those practices to which the hon. Gentleman referred. I would also point him towards the respected international Commonwealth Fund, which late last year published a comparison of primary care in the 12 most developed countries around the world. It is a source of huge pride to me and to every Member on the Government Front Bench—indeed, to every Member on the Labour Benches—that primary care under this Labour Government is the envy of the world.

Is my right hon. Friend aware that the alternative formula that was put forward in this Chamber three years ago by the hon. Member for South Cambridgeshire (Mr. Lansley) would reduce the funding going to our local NHS in Gloucestershire by £109 for every man, woman and child who lives there? Will my right hon. Friend resist that 9 per cent. cut to our local NHS?

What I would say to my hon. Friend is that we have sat in the House over the past five years of this Parliament and heard every member of the shadow health team criticise the Government for allocating more resources to communities with higher health needs and more deprivation. So when we read what the Opposition’s policy in their draft manifesto is, I do not know how they have the brass neck to sit there today and look as though it was always their policy: it beggars belief. The Opposition need to spell out which PCTs will win and which will lose under the new policy. I suspect that my hon. Friend’s PCT might lose from a policy that gave more money to deprivation, on top of what we give such communities today.

May I just say how much we will miss David Taylor at our Health questions and health debates? He was always here, and always had good insights and real commitment to the national health service. He will be much missed, as he was a good colleague to us all.

Will the Secretary of State confirm that patients should be able to expect equivalent access to treatment from the NHS wherever they are in the country? Will he explain why in his Leigh constituency, the NHS spends over 40 per cent. more on cancer services per cancer patient than it does in my constituency?

I would like to begin by echoing the shadow Health Secretary’s remarks about David Taylor, who was a regular attender at Health questions and health debates; I am sure that his voice will be sorely and genuinely missed by Members on all sides of the House.

The answer to the hon. Gentleman’s question is that my constituency has more deprivation and ill health than his does, and that is picked up in the funding formula. I am amazed that the hon. Gentleman is asking this question when his manifesto of last week said in terms that his party will adopt precisely the same policy—so how can he stand at the Dispatch Box and criticise the fact that my constituency of Leigh, a former mining area, receives more for its greater health needs?

The Secretary of State just doesn’t get it. I was quoting the figures on the amount spent by the NHS in each of those areas per cancer patient—not the overall allocation between the areas, but the amounts spent per cancer patient. Let me give him another example. Perhaps he can explain why, although higher NHS allocations go to more deprived areas, the money is spent on responding to the consequences of ill health rather than on preventing disease, which is the reason why it is allocated. Why is there one hospital bed for every 245 people in the north-east of England, but one bed for every 408 people in South Central?

I am genuinely confused, because for five years, from his side of the Dispatch Box, the hon. Gentleman has accused us of spending too much money in constituencies such as mine. The reason why my area can spend more on cancer is that, historically, smoking has been higher in the constituency. It was the hon. Gentleman’s manifesto of last week that said that the Conservatives would weight public health funding so that more went to deprived areas. So he would give my constituency more money than it gets today—yet every one of the Conservative Front-Bench team has criticised our funding plans. The hon. Gentleman should either accept the situation today and tell us which primary care trusts will get more and which will get less, or realise that his policy will have no credibility whatever.

He still doesn’t get it, does he? Will he explain why the local PCT in his constituency presently spends £39 a head on its management costs but just £31 a head on its healthy individuals programme, which is preventive spend. That is the point; this is about prevention. What is needed is higher public health budgets for the areas with the poorest health: less bureaucracy, more prevention—that is our health premium. Will he not just accept that we need real help to reduce health inequalities through preventive health care—because we can’t go on like this?

It is our policy to allow local PCTs to decide where they spend the money on the areas that they think will have the most impact, whether that be prevention or cancer. For the last five years the hon. Gentleman has accused me of giving too much money to those areas, and now he has completely abandoned that pledge. It would appear that it is not him but his party leader who is now writing his shadow health policy. Let me tell the hon. Gentleman, who sits there and gives out the orders, that he has had his policy on single rooms dropped, and he has had his policy on health resources dropped, so why does he not book himself—

Order. I am extremely grateful to the Secretary of State, and I know that he wants to say something about other parties’ policies, but he must now focus exclusively upon his own.

My right hon. Friend will know that my constituency has had significantly increased funds. None the less, we have very high death rates from heart problems and cancer in low-income wards. How can we manage that situation? What education and community programmes are there to help people in low-income families understand the serious dangers from smoking and poor nutrition?

My hon. Friend is right. We need to give the resources to areas such as hers so that they can spend them on smoking cessation programmes and improving access to primary care. Research has shown that communities of that kind benefit greatly from improved primary care, and also that national targets have played an important role in improving health outcomes in the most deprived communities. I assure my hon. Friend that that will remain a central tenet of this Government’s health policy.

4. What recent assessment he has made of the effectiveness of psychiatric intensive care units in the provision of mental health care. I note that the Minister of State is to answer this question, which will give the Secretary of State a chance to calm down. (310019)

Acute care services, including psychiatric intensive care units, remain an essential component of the Government’s drive to improve and modernise our mental health services. Moreover, as a result of nine consecutive years of increased mental health spending, more people with acute mental health problems are being treated in the community than ever before.

I give the Government full credit for the creation of the psychiatric intensive care unit at Woodhaven hospital in my constituency. That is why I am so concerned about the fact that it has been “temporarily” closed for the last three months. Six patients from the New Forest who are in desperate need of its assistance have been farmed out to Havant and Basingstoke. May I appeal once more to the Minister to intervene to ensure that Ellingham ward at Woodhaven is reopened as soon as possible?

The hon. Gentleman has raised this matter with me before, both at Question Time and during debates in Westminster Hall. Since our debate last October, Hampshire Partnership NHS Foundation Trust and Hampshire primary care trust have established an independent review panel to examine their proposals to change services provided by the psychiatric intensive care unit. An updated report will be sent to the Hampshire health overview and scrutiny committee on 26 January, and the full report will be completed within a month. The independent review will be conducted by a panel of experts, including an independent consultant psychiatrist and an independent director of nursing.

I hope that that reassures the hon. Gentleman that his concerns are being heard, that action is being taken and that an independent review will ensure that we secure the best possible outcome for patients, based on a clinical assessment of their needs.

6. What plans he has to increase the speed of treatment of people presenting to their GPs with symptoms consistent with cancer. (310021)

Over 94 per cent. of patients currently see a cancer specialist within two weeks of urgent referral for suspected cancer by their GP. Of those subsequently diagnosed, 85.7 per cent. commenced treatment within 62 days. We have plans to offer patients in England access to diagnostics that may confirm or exclude cancer within one week.

Can my right hon. Friend confirm that if the Government’s cancer pledge that patients will be referred within a week comes to fruition, it will save 10,000 lives every year? That is very significant, given that cancer is still seen not simply as a major killer but as a major condition, in terms of people’s view of health care in this country. Is there any chance of my right hon. Friend being able to persuade Opposition parties that consensus would be in the national interest?

I can confirm that the aim of reducing to one week the wait that people experience during what is probably the most stressful time of their lives is very much the Government’s policy. The national cancer director has estimated that that would indeed save 10,000 lives every year. As my hon. Friend says, the key challenge is early diagnosis. We must focus, and are focusing, all our efforts on that. I do not believe that some of the policies promoted by others would get us anywhere. In fact, they would return us to the days of a postcode lottery for those important services.

I am well aware that that exchange constituted an attempt to shed light on Conservative policy. Of course the Conservative party wants to see improvements in the provision of cancer services. As the Secretary of State said, there must be a much greater focus on prevention, earlier presentation leading to earlier diagnosis, faster access to innovative drugs and treatments, swifter implementation of survivorship initiatives, and implementation of quality indicators. All those will improve under a future Conservative Government. The key question that the Secretary of State needs to answer is why, despite the Government’s 12 years in office, Britain’s five-year cancer survival rates are still among the worst in Europe.

Without going into all the nonsense and waffle with which the hon. Gentleman began his question, may I just give him his answer? In a letter to me last year, which prefaced the “Cancer Reform Strategy” annual report, the national cancer director said that there had been a further fall in cancer mortality in the last two years for which figures were collected. Overall, therefore, there has been a decrease of 19.3 per cent. among under-75s since 1995-97. In his words:

“We are well on track to achieve the target of a 20 per cent. reduction by 2010.”

The hon. Gentleman did not say that he would remove targets, but he needs to explain how we would achieve such improvements if we were to simply drop all the targets.

7. What proportion of GP surgeries are open in the evenings and at weekends. (310022)

Some 77 per cent.—three quarters—of GP surgeries in England are open outside normal surgery hours, offering their patients routine appointments. We expect this figure to continue to rise.

I thank my right hon. and learned Friend for that answer. As somebody who, unfortunately, had to make extensive use of GP services over the Christmas recess, including the out-of-hours service at the new Tameside walk-in centre, may I say how massively convenient it is now that my local GP services are operating extended hours? However, what more is being done for patients of GPs who are not yet offering that provision?

My hon. Friend is right to say that we need to do more to ensure that extended hours are offered. We intend to give patients a right to register with a practice of their choice—perhaps one that offers extended hours. Furthermore, neighbouring doctors can apply to be paid for seeing patients of practices that do not offer extended hours. The Government’s extended hours policy has been an increasing success—but of course if the Tories are elected, they will get rid of it.

This is an issue of great concern to my constituents. I note the Minister’s response to the previous question, but is he confident that the full range of GP services, such as pharmacies and access to a nurse, are available during weekend and extended hours in south-east London?

We are increasingly moving towards getting a larger range of services, particularly for GPs. Levels of nursing and pharmacy services vary between practices, but we want to ensure that we increase the number. However, when the hon. Gentleman stands on his party’s manifesto, he will have to recognise that his party would get rid of those requirements: that appears to be its announced policy.

What contribution are the new GP-led health centres making to greater access to GPs? In my own area, a new health centre is being built in Biddulph. It will be the first time that my constituents have had access to out-of-hours GP services in the evenings and at weekends.

The new GP-led health centres are providing a real incentive for practices that up to now have not offered extended hours. They can see that GP-led health centres are there, and that some patients will start to use them unless GPs start to offer the extended hours. GPs can also see that, with £161 million available in the coffers of PCTs, additional funding is available for GP practices that offer extended hours.

8. What his estimate is of the amount of charitable giving to NHS institutions in the latest period for which information is available. (310023)

In 2008-09, NHS trusts and primary care trusts in England received contributions from all charitable sources totalling £62 million in expenditure and £65 million in fixed assets. The Department does not collect that information for NHS foundation trusts, which report directly to Monitor.

Is the Minister aware that the Burnham-on-Sea memorial hospital extension was funded by its magnificent league of friends, and that that form of local charitable giving would be betrayed if it were regarded as part of the general NHS budget and used by the Government to make offsetting reductions in the funding for the NHS trust concerned? Will the Government give an absolute assurance that such a change, which is being considered, will not happen?

I can tell the right hon. Gentleman that that is not the case, and never will be.

And never has been.

Indeed, as my hon. Friend says, it never has been the case.

Charity trustees will continue to have full responsibility for charitable funds; they are not, and will not be, part of NHS budgets. There is a question about accounting requirements—I think that that is what the right hon. Gentleman was referring to—but that is not a matter of Department of Health jurisdiction. However, I continue to work with the Treasury, Monitor, the Charity Commission and other stakeholders to seek ways of strengthening the independent governance of NHS charities, to ensure that we meet that standard without invoking the requirement for consolidation, and that matter is currently under discussion.

(Liverpool, Wavertree) (Lab): What are the latest figures for charitable giving to the Royal Liverpool Children’s NHS Trust? If my hon. Friend does not have those figures to hand, may I, through him, pass on an invitation from the hospital to our right hon. Friend the Secretary of State? The hospital invites the Secretary of State to visit it so that, on his way to Goodison Park, he can see for himself the tremendous contribution that charitable giving makes to the new hospital that will be built with funds from the £1.2 billion committed by this Government to Merseyside for new hospitals.

My right hon. Friend is absolutely right to say that charitable giving makes a huge difference. Many people who have experience of the national health service want as a result to make a gift or donation to thank it for the support and care it has given them, or a loved one. Many charities work closely with NHS institutions and NHS charities. This is a cause for celebration, and I want to make it clear today how much we value that, and that that independence is absolutely right. There is no question whatever that charitable funds could be used as part of NHS budgets; I want that very important message to go out from the House today.

But the Minister will be aware that this question is causing enormous concern. Why has the confusion been allowed to continue for so long, given that the Charity Commission alerted the Treasury and the Department of Health to the problem in August 2008? The Charity Commission has made it clear that such an arrangement is not necessary or appropriate for charities in the state sector. The accounting rules concerned apply in the private sector. Why can we not rule it out once and for all?

As I hope I have already suggested, we are actively looking into the dilemma that the hon. Gentleman describes, and I hope that he and all other Members of this House, as well as charities and the NHS, will join me in ensuring that we do not spread confusion and mislead people about the consequences of looking at those accounting standards. Let us be absolutely clear: we very much welcome people making contributions through charities to support those receiving health services. The role of NHS charities is crucial. Only one in 10 NHS charities are even affected by this possible accountancy change. It makes no difference to the NHS; it is not part of the NHS. I would hope that the hon. Gentleman would join me in ensuring that we put the record straight, and do not mislead or misguide people and deter them in any way from making such contributions.

My local hospital—the wonderful Chorley hospital—is part of the Lancashire Teaching Hospitals NHS Foundation Trust. Why can we not ask for information, but our question has to go to Monitor instead? Surely, as a Member of Parliament, I should have the same rights as other MPs in being able to ask questions for Ministers to answer. Does the Minister not agree?

My view is that Members of Parliament can ask Monitor for information, and can receive that information. I think that is entirely appropriate, and I would encourage Members who have questions they want to ask of Monitor to put them with the usual vigour with which they put question to Ministers here at the Dispatch Box.

Despite the answers that the Minister has just given—this is of particular relevance to those of us who are trustees of charities and are finding that this problem is exercising us a lot in respect of our various fiduciary duties—the Government are still allowing there to be a risk of charitable donations being subsumed into hospital accounts. When people give to charity, they expect that money to be for extra things, rather than for those that are part of the established costs in the NHS budget. Will the Minister give an absolute guarantee that under the Treasury’s new rules there will be no danger whatever of money given to charity being counted as part of the NHS budget, and that there will be no resultant offsetting?

The short answer is yes. The long answer is that NHS charities are not part of the NHS, have never been part of the NHS and, under this Government, never will be part of the NHS. They are independent bodies, governed by an independent regulator, doing fantastic work in providing fantastic services. I hope that the hon. Gentleman—and the hon. Member for North Norfolk (Norman Lamb), who speaks for the Liberal Democrats—will stop putting out misleading information, and instead will reinforce the fact that NHS charities remain independent.

9. What recent guidance his Department has issued to GP practices on their use of 0844 telephone number systems; and if he will make a statement. (310024)

The Department issued guidance and directions to the NHS in England on 21 December, just before Christmas, that patients should not be expected to pay more than the cost of a local call to contact the NHS, including doctors’ surgeries. GPs will have this year to end the practice completely and get out of any contracts that cause that to happen.

I thank the Minister for that response, but he will be aware that the practice is continuing. He says that it must end this year, but there is an awful lot of this year left, so when does he expect the practice to end? Not only does it make it expensive for people to call their local general practitioner, but older people in particular often prefer a human being to answer the phone, rather than be responded to by a machine.

I agree that we need to ensure that this practice of some GPs charging more than a local rate for contact ends as quickly as possible. We have made it absolutely clear to GPs that they must get out of these contracts—a number of practices have signed up to and are legally bound by them—and they have the year to do so. We have engaged with some of the companies involved and, to be fair to them, they have said they are prepared to negotiate equitable arrangements with the GPs to see whether we can get them all out of this as soon as possible. They have all got to be out by 21 December, but we want them to be out now, or as soon as they possibly can be.

This situation is not just in the hands of GPs; the provider that the patient is using is also ripping them off. For instance, when someone phones a GP’s surgery on an 0845 number from a call box, the charges will be over the top, and people will still be charged even on the new 0300 numbers. Will the Minister examine why these patients are still being ripped off by their providers, as well as by GPs?

Our objective is to ensure that anyone trying to contact the NHS locally pays a local rate, and we need to ensure that such practice is adopted. If the hon. Gentleman has evidence to suggest that particular issues are arising, I would be happy to discuss them with him.

10. When he expects to publish his proposals for the regulation of practitioners of acupuncture, herbal medicine and traditional Chinese medicine, following his Department’s consultation on the matter; and if he will make a statement. (310025)

More than 6,000 responses to the consultation, which closed on 16 November, have been received and are being analysed. Our response will be published as soon as possible.

This has been going on since 2004, so surely the Department can give us a date. Is the Minister aware that the Northern college of traditional Chinese medicine, which is in its 21st year, has had its university accreditation withdrawn by the university of Central Lancashire because there is no statutory regulation of this sphere? That is the fault of Ministers and something needs to be done—they need to get on with it.

I understand the hon. Gentleman’s frustration with the amount of time that has been taken, but I know that he also understands that any regulation would need to be balanced and proportionate. These are complex issues and we want to get this right. I assure the House that Ministers are keen to see publication as soon as possible.

11. When he expects redevelopment of Purley hospital to take place. (310026)

Croydon primary care trust and the Mayday Healthcare NHS Trust are firmly committed to the redevelopment of Purley hospital. It is for those organisations to determine a timetable, and both have assured me that they will seek to keep the hon. Gentleman informed of the progress. I understand that he had recent meetings with at least one of them.

I would have thought that the Minister would include a degree of humility and an apology in his answer. It is eight years since his predecessor stood at that Dispatch Box promising a new hospital in Purley. We are in desperate need of services in the south of our borough, so will he please give orders straight away to get on with this development and do so in such a way as to ensure that if there is a change of Government in a few months’ time, the orders will stand and the development will still go ahead?

I am not surprised that the hon. Gentleman is anxious to avoid there being a change of Government, because we know that the new announced policy of his party may well mean that he will not get his hospital—I understand his concern.

I shall now deal with the specific point about Purley hospital. As the hon. Gentleman knows, it was to be developed by a private sector company called Translloyd, but as it was unable to get a retail developer on to the site, the original plan was declared to be no longer feasible. Translloyd still owns the site and Croydon council is trying to find ways to release it for development. As he knows, the problems arose in 2008.

12. To what extent levels of deprivation in local communities are taken into account by his Department in determining NHS resource allocations. (310027)

As my right hon. Friend the Secretary of State has said, deprivation is a key feature of the NHS funding formula, which reflects both deprived and older people’s needs in health care. We are clear that we want to ensure that that remains part of the formula.

I am grateful to my right hon. and learned Friend for that answer. I wanted to ask him further about the deprivation experienced by pensioners in the community in view of the very tragic deaths of two of my constituents, Derek and Jean Randall, in quite appalling circumstances. In view of my lack of confidence in some of our local arrangements, will he ensure that his Department has very careful national oversight of the local review of the case that is going to take place? Will he ensure that any lessons that can be learned that apply nationally are rolled out and applied nationally to ensure that no one else has to endure something like this? It is completely inappropriate in 21st century Britain that pensioners should experience such ordeals and should die such very tragic deaths.

My hon. Friend is right. The case of Derek and Jean Randall is deeply tragic and we need to ensure that it is fully and properly investigated. I understand that a local multi-agency safeguarding board is undertaking a serious case review. I cannot comment until all the details are available—I have only read the front page of the Daily Mail today, and it certainly seems a very worrying case. I want to ensure that this is fully investigated and that the results of the investigation are open. We will take a keen interest in the outcome and we want to ensure that any lessons that need to be learned are learned and that this sort of thing does not happen in the future.

Will the Minister tell the House whether the level of deprivation featured in the decision of the Department of Health to end the reciprocal health agreement with the Government of the Isle of Man? That agreement, which has been in place since 1948, is to be ended on 1 April this year. This is a very serious matter. May I have an answer?

My right hon. Friend the Secretary of State will be meeting the Manx Minister in due course. We are not minded to change our policy on this. We take the view that our approach is the right one, and we will see what the outcomes are of the discussions with the Isle of Man.

13. If he will bring forward proposals to protect small pharmacy businesses from the effects of in-house pharmacies opening in supermarkets. (310028)

Independent pharmacies play an important and valuable role in providing pharmaceutical services. The NHS pharmaceutical services regulations treat all providers equally and there are no plans to change this.

After a powerful campaign by the local community in my constituency, we were able to keep open Mr. Mistry’s pharmacy, a local community pharmacy in my constituency, and Tesco withdrew its application to have an in-house pharmacy nearby. That is a good outcome for everyone in the community, but will the Department pull together some of the big supermarkets and the representatives of the pharmacy associations to discuss a sensible way forward so that such battles do not take place and local communities keep effective pharmacy services?

Pharmacists such as Mr. Mistry and many others up and down the country provide an excellent service to their local community, and my hon. Friend is quite right to campaign for a vibrant and diverse range of pharmacies. The truth is that the public value and use a range of provisions from supermarkets through to local pharmacies. Perhaps we can look to the provisions of the Health Act 2009, which will mean that the local NHS will be able to assess local needs and to meet them.

Does the Minister accept that there is a particular problem in rural areas, where the predatory practices of supermarkets might lead to the closure of pharmacies, depriving large geographical areas that are thinly populated? Will she take some steps specifically in that case?

The provisions of the Health Act will mean that the local NHS will be able to assess local needs, to fill the gaps and to monitor quality better. This is all about being driven more by the needs of the patient, whether they are in rural or urban areas, than by those of the provider of the services, as is the case at present. It is important to say that the supermarket sector provides some 5 per cent. of the market, whereas the larger contractors—such as Boots, the Co-op and Lloyds pharmacy—provide something like one third. There is no evidence that supermarkets are driving the smaller operator out of business.

14. What his most recent assessment is of the performance of NHS ambulance trusts regarding ambulance turnaround times; and if he will make a statement. (310029)

Information on ambulance turnaround times is not collected by the Department, so in a sense we do not have that information. There is quite a wide range of data in relation to how long people get for lunchtimes and so on. We do, of course, keep response times and that sort of data.

Does the Minister agree with Unison that the new eight-minute target for ambulance response times could put patient lives at risk by forcing ambulance crews to go from two to one? Would it not be better to find a bottom-up solution and force ambulance trusts to publish their data on websites so that the public could see individual ambulance response times?

We certainly take the view that improving the response times of ambulances is very important. That is why the new response times have been put in—to take away the period of time for the call, which was one of the issues causing delays. In the past, the clock did not start ticking until after the call was put through, whereas we now include the time from the point at which the call is made. That is a better reflection of the standard of service that patients get. As for publishing every ambulance time, I think that might be somewhat bureaucratic, but information can now be provided in general terms about average ambulance times.

T1. If he will make a statement on his departmental responsibilities. (310041)

Today, Sir Michael Parkinson has published his report on his year as the national dignity ambassador. I thank him on behalf of the Government for the time that he has given to raising awareness of the issues that affect us all and for the personal insight that he has brought to considering how we can improve care for older people. The fact that there are now 12,000 dignity champions working at a local level illustrates the difference that Sir Michael has made, and we will look to build on that.

As the cold weather continues, staff across the NHS, particularly ambulance services and accident and emergency staff, have been working extremely hard to minimise the impact on patients. Although it is under greater pressure, I can tell the House that the NHS in all parts of the country is coping well. I am sure that Members on both sides of the House will want to join me in thanking health and social care staff for their efforts to help to protect vulnerable people at this time.

I certainly endorse the last part of the Secretary of State’s comments. May I bring to his attention the rather long waiting list that people who suffer from acute back pain have to go through before they see a consultant? As a long-standing and regular sufferer myself, I know that it is no laughing matter. The waiting time is such that if the problem is serious, it can progress a great deal in that time. If it is a less serious problem, it will no doubt have corrected itself in that time. Whichever situation applies, the waiting time is far too long. Can the Government do anything about that?

The hon. Gentleman is right to say that back pain creates many problems, not just for the people involved but for the economy in general. That is why we now have a system of self-referral to a physiotherapist. I believe that all patients should have that right. We will also be looking at the development in the chief medical officer’s recent report on pain clinics and how chronic pain is managed, including how chronic and acute back problems can be managed.

T4. In 1997, there were 284,000 people waiting more than six months for NHS treatment. What is the figure today, and what are the Government doing to prevent the situation from sliding back to the bad old days when the Conservatives were in power? (310045)

My hon. Friend is quite right: we must prevent a drift back to the bad old days. In his area, Yorkshire and Humberside, in 1997, there were 26,719 people waiting more than 26 weeks. In November—these are the latest figures I have—the number was zero, so nobody was waiting. Whereas we will lock in that achievement as a right, the Conservative party would remove the guarantee. The Conservatives will have to explain to the public why they would do that.

T2. This morning, I faxed to the Public Health Minister’s office some documents provided to me by the investigative journalist Jane Symons. Those documents show that the Human Fertilisation and Embryology Authority has not only spent millions of pounds pursuing, ultimately failingly, an individual clinician, but that the new chief executive who was brought in to sort out the problem had argued for an externally led inquiry last year. Why has that inquiry not happened? Does the Minister have any proposals to ensure that we know why millions of pounds of taxpayers’ money was wasted in that way? (310042)

I am grateful to the hon. Gentleman for his courtesy in forwarding the documents, but I remain of the view that it would not be in the public interest to pursue an inquiry. There have been a number of significant changes at the authority since the time of the incidents covered in the memo, which I would be happy to write to him about. However, the interim chief executive has acknowledged that the authority is not free from criticism, and there is to be an internal governance review to consider all these issues.

T5. Given the very harsh winter that we are suffering at present, I have no doubt that my right hon. and learned Friend the Minister of State will recall the annual winter crises that we used to have more than a decade ago. People—mainly elderly people—were lying on trolleys in our hospitals for days before they died, after which their bodies were stuffed in refrigerated vans outside. What can he do to assure me that those crises will never return to this country, and how do we manage to cure that problem? (310046)

Elderly people are of course now able to benefit from flu jabs, winter fuel payments, pension credits and, when it gets very cold, cold weather payments. In 1997, the NHS spent £426 per person on health, but today it spends £1,612. Whereas the Tories were frozen in the ice of their own indifference to older people, this Government actually care.

T3. Will the Minister match the very helpful answer that I had from the Minister of State at the Department for Transport on Thursday about how that Department and the Department of Health have been working closely together to provide the preventive medicine of road gritting, so that hospitals receive fewer people with fractures? In Croydon’s Mayday hospital, fractures are currently up 40 per cent., but at the beginning of the crisis they were up 316 per cent. (310044)

It is certainly the case that we need to ensure that the NHS works with local authorities to make sure that ambulances can get through, that ambulance crews can get to their ambulances, and also that the service is geared up to deal with the various problems arising from the recent very bad weather. We need to make sure that the various bodies work together, and the information that we have so far suggests that they are doing so.

T9. The Autism Act 2009 was a great success for Back Benchers across the House, in co-operation with a caring and receptive Government. It calls for the autism strategy for helping adults with autism and Asperger’s syndrome to be published. Will my hon. Friend the Minister of State make sure that it is published before we are diverted by other matters a little later in the year? (310050)

I am grateful to my hon. Friend for his comments. The 2009 Act was a landmark piece of legislation, which was passed on a cross-party basis. I can reassure him that the autism strategy is due to be published before 1 April this year. Discussions on the strategy are going on as we speak. Indeed, the external reference group that has been advising us on it—and which involves service users, family carers, voluntary organisations, professionals and so on—met only today to consider its contents. The strategy will be backed up by a clear delivery plan, and further guidance for health and social care providers later this year. So yes, the Government are going to deliver on autism.

T6. What does the Secretary of State consider will be the most effective way to reduce binge drinking in the young? (310047)

I recognise that the public mood is changing when it comes to alcohol—not just binge drinking, but the general intake of alcohol by the wider population. There is rising public concern, as reflected in last week’s report from the Health Committee. The hon. Gentleman will remember the report on obesity that was published when I used to serve on the Committee with him. That report changed the nature of the debate, and it is possible that last week’s report will come to do the same. We are looking at the next steps on tackling alcohol, and considering the consultation on the mandatory code and the measures to combat the irresponsible promotion of alcohol. We are also considering going further on labelling, but of course I remain open to further discussions with him and the Committee on how we may go even further.

rose—

Order. I want to get several more colleagues in, so I need very short questions and short answers.

I thank the Secretary of State for agreeing to meet the Chief Minister of the Isle of Man about the future of the reciprocal health agreement. Will he get his officials to look particularly at the impact that that decision could have on his and my constituents who are TT enthusiasts—motorcyclists—and the impact that it would have on NHS North West if the Isle of Man took its elective surgery purchases away from there to Edinburgh, Belfast or Dublin?

As the Minister of State, my right hon. and learned Friend the Member for North Warwickshire (Mr. O'Brien), mentioned a moment ago, I have agreed to meet the Manx Health Minister to discuss these issues. As a north-west MP, I know that the island has a long-standing relationship with the north-west of England and its health service, and I will commission the work that my hon. Friend mentions on the potential effect of purchasing being switched. I am not minded at present to change our position but I will, of course, listen to what the Minister has to say.

T7. I thank the Minister of State, the right hon. and learned Member for North Warwickshire (Mr. O'Brien), for his support for the Better Healthcare Closer to Home project so far. Is the Department on track to complete the review of the project by the end of this month, and is the Treasury ready to pick up the baton immediately afterwards? (310048)

We want to move the project on as fast as we reasonably can, and we hope to be able to get things sorted through by the end of the month. Let us remember that there are some local decisions to be made over which we do not have entire control, but the objective is to get the project moving.

Has my right hon. and learned Friend received any recent requests from the Ministry of Justice for up-to-date estimates of the increase in the number of secondary pleural plaques in order to enable it to come to a decision on a compensation package?

My hon. Friend has indicated that she wants to ensure that we are working with the Ministry of Justice on the matter. I assure her that we will be in regular contact in future with the Ministry of Justice to develop the Government’s strategy as a whole in relation to pleural plaques.

T8. I strongly endorse the question asked by my hon. Friend the Member for Carshalton and Wallington (Tom Brake), but may I ask the Minister about another matter, which is related to autism, which has been raised already? Eight out of 10 GPs confirm that they feel they need more training so that they can better understand autism and care for the condition better. What will the Government do to ensure that there are sufficient resources, will and determination to deliver that extra training? (310049)

The consultations that we have had and the development of the strategy, which we will publish shortly, have made clear the importance of the GP understanding, knowing, diagnosing and being able to refer on appropriately individuals who may have any condition on the autism spectrum. An important part of the strategy that we wish to pursue is the training of professionals—not only GPs, although they are a key and vital part of the front-line services. Training of professionals and raising awareness among professionals of what autism is, how to respond to it and what services are available is a critical part of the strategy going forward.

At the last Health questions, I raised the issue of lab technicians who make dentures and crowns for dentists, and I thank my hon. Friend the Under-Secretary of State for agreeing to meet me and my constituent, Andrew Taylor, this afternoon. In advance of that meeting, can she confirm what her Department is doing to encourage UK dentists to use UK lab technicians?

I look forward to meeting my hon. Friend in the next half-hour to discuss that in more detail with officials.

It is estimated that there are more than 20,000 men and women in this country who are HIV-positive, and who have not been tested or diagnosed and therefore do not know that they are HIV-positive. Does my hon. Friend agree that the Department should aim to reduce that figure by at least 50 per cent.? What action is the Department taking to achieve that objective?

Obviously, early identification is crucial. We have talked at some length with the all-party group on AIDS about measures that we can take, and I am happy to continue those conversations.

I have a young mum in my constituency dying of breast cancer and desperate to prolong her life, with two young daughters who rely on her. She has been prescribed Herceptin. It is not working because of the size of the molecules. She is told by her specialist that Lapatinib would work for her. It costs less than two thirds of the cost of Herceptin, yet she is being denied it. I wrote to the Secretary of State on 19 November and I have chased him twice since, but I have still not had a reply. Will he please look at the matter urgently?

I have indeed been looking into the issue of Herceptin, and I am aware of the way in which the National Institute for Health and Clinical Excellence has approached it. These are important and difficult issues, and I can assure the hon. Gentleman that, if he has an outstanding letter on this matter, I will chase it up with my officials.

I was listening to what the Minister said about ambulance response times. They are of course important, but more important are patient outcomes—whether a patient lives or dies and what actually happens to them. What progress is the Department making on ways of measuring patient outcomes so that ambulance trusts can be more sophisticated in the way they deploy their resources?

I have heard the term “outcomes” being bandied about, but it is not always entirely clear what the Opposition mean by it; they seem to have different views of what it means at different times. As far as the Government are concerned, the important thing is that we ensure that the ambulance service is there when patients need it, that its response times are within the criteria that we have set for it, and that targets are met. The Opposition would get rid of the targets that save lives; we would keep them.

Was the threat of 65,000 British swine flu deaths an unscientific exaggeration that has cost the country dearly, not only financially but in terms of stress and distorted NHS priorities?

We had to take every possible step to keep the country safe through what was declared a world health pandemic, not by this Government but by the World Health Organisation. We saw the events in Mexico in the spring, followed by the exceptional spike in flu cases in this country in the summer. There were understandably high levels of public concern, and I make no apology for making all the necessary preparations to keep the public safe through that. We have come through the pandemic because of the strength of the plans and preparations that this Government put in place.

Does the Secretary of State agree that, to allow waiting times for cancer treatment to be monitored, specific data should be collected individually for each of the most common cancers, so that a better picture can be seen? I was not sure from his previous answer.

I refer the hon. Gentleman to the report issued by the national cancer director at the end of last year. He will see in it the publication of data, primary care trust by primary care trust, that have not been published in this form before. The report shows how many patients are being referred on the two-week urgent referral pathway, and there is a whole wealth of data on survival rates. I am always prepared to go further, however. The complaint from the Opposition is always that we collect too much data, but if the hon. Gentleman wants me to go further, I am prepared to consider doing so.

On Saturday, I met the Plymouth and South Devon Dystonia Support Group, which was celebrating its first anniversary. Will the appropriate Minister please meet me to discuss research and development, and treatment and support for that group of sufferers?

Yes.

The Minister of State, Department of Health, the right hon. and learned Member for North Warwickshire (Mr. O’Brien), made a welcome announcement over the Christmas break about payments to the Thalidomide Trust. Did I miss the statement to the House confirming that announcement? The news was very welcome, but I would just like to know whether it is now on the record.

I hope that I might be able to say a bit more about that in due course.

The Secretary of State knows that I have raised concerns about the awarding of the contract for the Eccleshill independent sector treatment centre in Bradford. He will now be aware that the decision to award that contract has been suspended for another five months. I have said that it should not go ahead in the light of the concerns, and that there should be a public consultation. Can he tell me why that decision was made, and whether we will now get that consultation?

We are still looking at that matter and I hope that I will be able to give the hon. Gentleman a fuller answer on the details in due course.

Earlier, the Secretary of State referred to the Health Committee’s report on alcohol, and said that he was open-minded about it. Does that mean that the Government are prepared to consider minimum pricing for a unit of alcohol?

I suggest that the hon. Gentleman look at this Government’s record on tackling tobacco over the past decade. That shows that we will continue to take the bold steps necessary to improve the health of the nation. I have said that we will do more on labelling, and on our mandatory code. Pricing is of course a key issue in this debate. I do not know whether he has concluded that minimum unit pricing is now essential, but we must also consider the issues of deep discounting and selling below cost price, which also form part of the equation. This is a time not for shouting across the Floor of the House but for both parties to address the issues and to ask whether the public mood has changed and whether we need to take a different approach to alcohol in our communities.

The Royal British Legion says that little effective progress has been made on the veterans’ NHS priority treatment scheme. What steps is the Minister taking to ensure that PCTs and hospitals monitor progress on this and that veterans get the care to which they are entitled?

Yesterday I was able to make an announcement, together with Combat Stress, one of the veterans’ organisations, to ensure that we deal in particular with some of the issues that arise as a result of people being involved in combat. We also want to ensure that GPs are more fully aware of the rights of veterans. We have asked that all PCTs ensure that they have somebody at a director level who is responsible for ensuring that this information gets out, and that strategic health authorities have someone in place at a director level—on the board—who is responsible for ensuring that this sort of information gets out and that veterans, who have served their country, get the service from the NHS that they deserve.

Order. I think that the inquisitorial appetite has been satisfied.