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Medical Audit
7. Mr. Nigel Beard (Bexleyheath and Crayford): If he will make a statement on progress in establishing a system of medically auditing the effectiveness of various therapies employed in the NHS. [57355]
The Minister of State, Department of Health (Mr. Alan Milburn): In July we published "A First Class Service" which set our plans to establish the new national institute for clinical excellence early next year.
For the first time, NHS professional staff and their patients will be able to look to a single authoritative source for clear guidance about the effectiveness of therapies.
Mr. Beard:
I welcome my right hon. Friend's answer and the long overdue steps that are now being taken to disseminate best practice throughout the national health service with the national institute for clinical excellence and the Commission for Health Improvement. Does my hon. Friend agree that the rapid development of medically relevant biotechnology is now likely to provide new therapies that mimic the body's own biochemical processes, allowing the early diagnosis of disease and providing indications of predisposition to disease in certain circumstances, all of which are likely to revolutionise medical practice? Can my right hon. Friend assure the House that new arrangements for medical audit will promote the early introduction of those innovations into the NHS and that there will be the fullest collaboration between the NHS and British companies and research organisations to progress those new developments towards medical use?
Mr. Milburn:
I can give my hon. Friend that assurance. As he rightly said, we could be on the verge of some extremely exciting medical breakthroughs that will revolutionise patient care and the life chances of thousands, if not millions, of patients. It is important, therefore, that we achieve our aim, which is to ensure the introduction of more effective treatments into the national health service more quickly than has been possible before. We will do that through the national institute for clinical excellence and our new national service frameworks. We will also do it by abolishing the old internal market which inhibited collaboration and so fragmented decision making that we ended up with thousands of competing health units instead of a single national health service. We want to see a single national health service, providing care according to clinical need rather than depending on where a patient lives or who happens to be their GP.
Mr. Tim Loughton (East Worthing and Shoreham):
Is the Minister aware that one direct casualty of the abolition of GP fundholding and a move to commissioning groups has been the provision of physiotherapy services? In West Sussex, many of my constituents who need physiotherapy because they are elderly or have suffered severe accidents are now faced with either not having those essential services or having to pay for them privately, which many of them cannot afford to do.
Mr. Milburn:
The hon. Gentleman is wrong about that. Before too long--hopefully within the next three weeks--
Booked Admissions
8. Mr. Michael Jabez Foster (Hastings and Rye): What action he is taking to promote booked admission pilots in the NHS. [57356]
The Secretary of State for Health (Mr. Frank Dobson): On 24 September I announced 24 pilot schemes to develop systems of booked admissions so that patients can arrange to go into hospital at times that suit them. A total of £5 million pounds has been made available this year and £20 million will be provided for further schemes next year. We hope that, eventually, the entire system will go nationwide.
Mr. Foster: I thank my right hon. Friend for that reply. Does he agree that, as my constituents can book their holidays and various appointments by telephone, it is about time that they were also able to book by telephone their hospital appointments, rather than waiting anxiously for that brown paper envelope through the letter box?
Mr. Dobson: I certainly agree with that. It is a strange irony that it is difficult for people to make bookings and other arrangements in the national health service--which, for more than 50 years, has served the United Kingdom 24 hours a day, every day of the year--because of its communications system.
We want to enable people who have been told by their GP, "I think you need an out-patient appointment, because they should do some tests at the hospital," to be able--there and then, from the GP's premises--to book an out-patient appointment that suits them. At an out-patient appointment, if they are told by the specialist, "I think you'd better come in as an in-patient," they should--again, there and then--be able to make a booking, preferably for a day of the week and time of the year that suits them. Such a change would be a good step forward and would in many ways reflect the fact that, although services are available 24 hours a day, every day of the year, the system gives a different impression.
Mr. Philip Hammond (Runnymede and Weybridge):
We welcome development of a booked admissions system. However, booked admissions will help only those who are fortunate enough to have secured a specialist out-patient appointment to get on to the waiting list initially. The Secretary of State has been asked repeatedly to publish figures on the number of people waiting for out-patient appointments. The figures are already collected and reported to the NHS executive by hospital trusts; all he has to do is to add up the figures. Is not the reason why he refuses to publish the figures that they will
Mr. Dobson:
I have heard of people trying to change the goalposts once the match has started, but the hon. Gentleman seems to want to change the stadium. In the first six months of this year, the national health service dealt with 67,000 more out-patients than previously.
Miss Ann Widdecombe (Maidstone and The Weald):
What about out-patients?
Mr. Dobson:
If the right hon. Lady would just keep quiet and let those who are supposed to answer the questions do so, and stick to her appointed job of asking questions, we might get somewhere.
There is some evidence of a build-up in the number of people waiting for out-patient appointments. We have never denied that. I am asking managers and others in the national health service to make use of the additional funds that we are providing to deal with waiting lists and the £250 million extra that we are providing to deal with the winter to try to pay more attention to those people.
Hitherto, figures have been collected on a basis established by the previous Government--to show how well the then Government were doing in meeting the patients charter. Those figures have been collected, and they will continue to be published. However, I should like to move towards more detailed and up-to-date figures. It is very revealing that the new Government have not only started publishing monthly in-patient waiting list figures but, for the first time, have started collecting such figures monthly. The hapless crew on the Conservative Benches collected the figures only once every three months.
Dr. Howard Stoate (Dartford):
May I, on behalf of my GP colleagues across the country, welcome my right hon. Friend's initiative in ensuring that patients will be able to book out-patients appointments directly from GPs' surgeries? May I also ask him to ensure that, once the initiative has been implemented, out-patient appointments will be booked on the basis of clinical need, to ensure that patients who need to be seen as soon as possible are fast-tracked through the system--thereby eliminating a very significant cause of waiting?
Mr. Dobson:
Ever since we were elected, we have tried to make it clear that clinical need should be the major determinant of how quickly people are treated. I hope that, as the information technology system becomes more sophisticated, doctors' and other clinicians' capacity to express their views, and to have their views heeded, will be improved, as that will be to the benefit of everyone. Both patients and those who treat patients like to know that everyone is being treated fairly. People are comfortable doing something that they believe to be fair, and very uncomfortable if asked to do something that they do not think is fair.
9. Mr. David Rendel (Newbury):
When the White Paper on tobacco will be published. [57357]
The Minister for Public Health (Ms Tessa Jowell):
Soon.
Mr. Rendel:
Given that there are now hundreds of deaths every day from tobacco-related diseases, does the Minister agree that it is vital to discourage children from ever taking up smoking in the first place and that school nurses have an important part to play in that? What steps does she intend to take to ensure that there are no further cuts in the community school nursing service such as, sadly, are now threatened in Berkshire?
Ms Jowell:
I entirely agree with the hon. Gentleman about the importance of protecting children from the impact of tobacco advertising and of taking every effective step to make it very hard for them to get hold of cigarettes. However, there is more to it than that--we have to change young people's attitude towards cigarettes and, in turn, change their behaviour, making them not want to buy cigarettes. I entirely agree that school nurses have a very important role to play in this, as do parents and teachers and the whole range of professionals with whom children come into contact. Measures to prevent children from smoking are already an important part of the healthy schools programme and will feature very specifically in the tobacco White Paper.
Mr. Kevin Barron (Rother Valley):
Is my right hon. Friend aware that the answer that she gave to the initial question simply means that the frustration felt for many months now by the health lobby will continue? However, more important than the publication of the White Paper is that it should be comprehensive and should address the issues around smoking, which has for decades been the biggest killer in this country. I am pleased that we now have a Government who are prepared to take on these issues on behalf of the public.
Ms Jowell:
I thank my hon. Friend and pay tribute to the very great efforts that he made while in opposition to try to protect children from the impact of tobacco advertising. It is in no small part due to his efforts that we now have, for the first time, a comprehensive Europe-wide ban on the advertising and promotion of tobacco. The way in which that will be implemented in the United Kingdom will be set out in detail in the forthcoming White Paper. There is impatience about the publication of the White Paper and getting the policy implemented. We have worked with impatience and a sense of urgency over the past 18 months because absolutely nothing was done in the previous 18 years.
Mr. Andrew Lansley (South Cambridgeshire):
If the Minister believes that school nurses have an important role to play in this and other respects, will she explain why Cambridge and Huntingdon health authority has effectively abolished the role of school nurses? Will she undertake to evaluate what the adverse implications of that have been before other health authorities, such as that mentioned by the hon. Member for Newbury (Mr. Rendel), go down the same path?
Ms Jowell:
No doubt the hon. Gentleman will be pleased that his constituents will be receiving
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