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Health Issues (Public Consultation)

4. Mr. Hinchliffe: To ask the Secretary of State for Health what steps he takes to monitor local public consultation processes on health issues. [612]

Mr. Horam: The Secretary of State reviews all trust mergers and all substantial variations in service provision that are contested. In doing so, he takes account not only of the responses, but of the adequacy of the consultation exercise.

Mr. Hinchliffe: What steps does the Secretary of State take to ensure that commitments given in public consultation exercises on closures or changes of use are followed through? For example, in Wakefield, when the county hospital was closed, we had a clear commitment that it would be replaced by a purpose-built geriatric unit. When Manygates maternity hospital was closed, we had a clear commitment that we would be given a purpose-built

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maternity unit. When the neurosurgery from Pinderfields general hospital was transferred to Leeds, we had a clear commitment that we would have a rehabilitation centre at the hospital. None of those commitments has been fulfilled. What is the Secretary of State doing about that?

While I am on my feet, let me ask the Minister to explain the shambles that has occurred in the public consultation process on the proposed merger of the two Wakefield trusts. The consultation process was stopped half way through and passed over to the health authority because the Government had wrongly advised local people on the way to handle the issue.

Mr. Horam: The hon. Gentleman is wrong. We have nearly doubled the length of time for consultation in Wakefield--and that consultation involves the merger of the two trusts. I am surprised that the hon. Gentleman is cavilling at that, as he opined some time ago that there were too many trusts in the Wakefield health authority. Perhaps we can discuss those issues at greater length during Thursday evening's Adjournment debate.

Mr. Dunn: I thank my hon. Friend the Minister for taking the trouble to visit my constituency yesterday to see for himself the site of the proposed district general hospital at Darenth park. Will he take it from me that, whatever the consultation that took place in north-west Kent, all the communities in Dartford, Gravesham and north Sevenoaks are united in their determination to support the Government's private finance initiative, which will lead to the new district hospital at Darenth park?

Mr. Horam: I take my hon. Friend's point. Darenth park is a heartening example of the progress being made through the private finance initiative. I should re-emphasise that that is the way to obtain new hospitals without having to wait in the queue for public expenditure. The initiative has been successful in Darenth park, and I am sure that the consultation process there will be successful.

Mr. Pearson: Is the Minister aware that many district health authorities are leaving it to an advanced stage of the NHS trusts' capital investment planning process before going out to public consultation, even though the capital investment plans may involve a major strategic change such as the closure of hospitals? Does he consider that to be acceptable? Will he consider reviewing the NHS management executive guidelines on consultation involving the consumer to make it explicit that consultation, if it is to be genuine, must occur as early as possible and well before hundreds of thousands of pounds are wasted on management consultancy fees?

Mr. Horam: I take the hon. Gentleman's point. It is sensible to have something concrete to consult about. When plans are embryonic, consultation can occur too early and, as the hon. Member for Wakefield (Mr. Hinchliffe) said, it can go wrong. It is important to consult in the right way and at the right time.

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"Fetal Sentience"

5. Mrs. Ann Winterton: To ask the Secretary of State for Health what response he intends to make to the document "Fetal Sentience", a copy of which has been sent to him. [613]

Mr. Horam: Prevention and relief of unnecessary pain is a primary concern in clinical practice. The Royal College of Obstetricians and Gynaecologists has set up a working party to conduct an independent review on the evidence of fetal awareness and to consider whether there is any need for change in current practice. I understand that the working group will report in the new year.

Mrs. Winterton: Does my hon. Friend agree that that authoritative paper, written by 15 of the world's top doctors and scientists, shows that the structures necessary for the perception of pain are present and functional from the 10th week following fertilisation? Does he agree that the onus should now be firmly placed on those who claim that the unborn child feels no pain during abortion and that they should prove their case? Is it not a good time to review the workings of the law in this sphere, bearing in mind that 4.5 million abortions have taken place--90 per cent. of them merely for social reasons?

Mr. Horam: I assure my hon. Friend that the working party set up by the royal college will look into all the scientific and medical evidence that comes before it. I am sure that it will give a balanced view. On my hon. Friend's second point about reviewing legislation, that is a matter for Parliament.

Mr. Alton: Notwithstanding that reply, is it not a matter for the Government rather than the royal college to examine how legislation works? Given that, since 1990, we allow abortion up to and even during birth in the case of a handicapped baby and up to 24 weeks gestation in the case of a perfectly healthy unborn baby, is it not time now to consider from a legislative point of view the latest scientific evidence about foetal sentience and the pain and awareness experienced by the unborn child? Will the Minister contrast the lack of care that is shown towards the unborn with the Animals (Scientific Procedures) Act 1986, which gives protection even to an amoeba?

Mr. Horam: The hon. Gentleman knows a great deal about this. As he is aware, there is conflicting medical evidence on foetal awareness. Clinicians who are expert in the field must undertake a balanced study of the evidence. Of course the Government will give full consideration to the working party report.

Dr. Spink: Does my hon. Friend agree that there is a lack of knowledge and understanding of foetal sentience, even in the House? Does he agree that it is time for the Parliamentary Office of Science and Technology to examine the matter and report to the House?

Mr. Horam: I take my hon. Friend's suggestion, which we shall consider. However, it is right for the evidence to be studied by the royal college, which has undertaken to be specific in its report. It is better for the matter to be

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examined by one group rather than by two or three, especially if one of those has Government status. The royal college is the right body to consider the evidence.

Mrs. Anne Campbell: Is the Minister aware that several highly critical papers have appeared in the British Medical Journal, suggesting that foetal pain is a misnomer? Will he give the House an assurance that he will wait until a report is published by Dr. Anne McLaren before he makes any Government pronouncement on the issue?

Mr. Horam: Yes, I take the hon. Lady's point. That is why I used the phrase "foetal awareness", which is perhaps a more accurate description of what we are speaking about and could include pain. Clearly, the subject requires careful consideration.

Sir Patrick Cormack: Does my hon. Friend not find it rather odd that many of those who lobby for animals to be treated as sentient beings also lobby for abortion on demand?

Mr. Horam: I hear my hon. Friend's point.

Dental Services

6. Mr. Ainger: To ask the Secretary of State for Health how many dentists in England were providing national health service treatment for children and adult patients without restriction in 1985 and in 1995. [614]

Mr. Malone: The number of dentists in the general dental services in England was 14,255 at 30 June 1985 and 15,927 at 30 June 1995.

Mr. Ainger: That answer does not strictly address the question. Does the Minister recall the statement made by the Secretary of State on 15 October this year, when he said that there was continued steady growth in NHS dental services? How does he justify that statement when, in the past two years, 1,900,000 fewer people have been registered with dentists in England and Wales, and more than half the population of England and Wales is not registered with a dentist at all? Does he accept that there has been a serious decline in NHS dentistry over the past few years, and that it is time that the Government addressed it?

Mr. Malone: No, I do not accept what the hon. Gentleman says. I read the exchanges between my right hon. Friend the Secretary of State and the hon. Gentleman before I came to answer the question. My right hon. Friend was right: under this Government, NHS dental services are growing. A record number of NHS dentists are providing them. In Wales, that figure in 1985 was 741; it has gone up to 849. I accept the point behind the hon. Gentleman's question. There are problems in certain parts of the country, which we are addressing--in the long term through the purchaser-provider relationship, as the Select Committee on Health recommended, and in the shorter term through the access fund that we announced, through which 22 schemes are getting under way, and more flexible use of the existing legislation allowing us to appoint salaried dentists.

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Sir Alan Haselhurst: Against that welcome background of an increase in the number of NHS dentists, will my hon. Friend nevertheless have regard to the problems that can be created by dentists choosing to leave the NHS, which results in a shortage such as there is now in Saffron Walden? Will he undertake to re-examine the scale of access funds?

Mr. Malone: My hon. Friend is right to point out that there are local difficulties, and of course there are mechanisms now by which we can address them. The access funds that have been announced will, I hope, be evaluated quickly, and if they are proven to be effective, we shall see whether they are the mechanism that we should use to alleviate that particular local need.

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