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Stroke Care

8. Mr. Harry Barnes (North-East Derbyshire): What actions he proposes to take to reduce death and disability among those who do not have access to organised stroke care. [81815]

The Parliamentary Under-Secretary of State for Health (Mr. John Hutton): The national service framework for older people was launched in November last year and will focus on those parts of the national health service that are particularly important to older people. The provision of effective stroke care is one of the key issues that it will consider. The national service framework will set national standards and define service models, put in place strategies to support implementation and establish performance measures against which progress--for example, in providing effective stroke care and agreeing time scales--can be measured.

Mr. Barnes: Has the Minister seen the Stroke Association's report entitled "Stroke Care: A Matter of Chance", which shows that the provision of specialist stroke units varies considerably around the country? For example, 70 per cent. of stroke victims in Northern Ireland can be treated in that way, but only 37 per cent. in the south-west of England. There is no such unit in north Derbyshire, the area that I represent. I welcome the Minister's remarks about the national service framework for older people, and I know that the Stroke Association is working within that framework. Will my hon. Friend confirm that the next set of priorities and planning guidance to be formulated for the national health service will add to the existing provision? Some hon. Members know that other hon. Members are only a stroke behind them.

Mr. Hutton: I am grateful to my hon. Friend for that question, and I am aware of his situation. We welcome the Stroke Association's report, which showed that three quarters of consultants have access to an organised stroke service. Such access is increasing. We are very conscious of the need for consistency around the country. That is why we have organised the national service framework and tasked it with producing consistent national standards for the development of effective stroke care. The national priorities guidance already covers stroke care. We have set rigorous targets for trying to reduce morbidity from strokes by 2010.

Mr. Shaun Woodward (Witney): Given the Minister's obvious concern for patients who suffer from strokes, and his awareness of the role that day care centres attached to community hospitals can play, can he say whether the Department has decided to save the pioneering work of the Burford community hospital? Has not the time come to put its worried patients out of their misery by saying that the Government will save it?

Mr. Hutton: I welcome the hon. Gentleman's interest in the matter. All I can say about the proposals for

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Oxfordshire is that my right hon. Friend the Secretary of State is continuing to review the matter and has not come to a decision.

Dr. Vincent Cable (Twickenham): I welcome the Government's commitment to addressing the problem, but is the Minister aware that the deficiency of stroke care is so serious that, in many hospital trusts, stroke rehabilitation is being rationed on the basis of the age of patients? Will he try to ensure that that practice, which is wholly contrary to the spirit of the NHS, is stopped?

Mr. Hutton: We have repeatedly stressed that discrimination against older people in the NHS is fundamentally inconsistent with the service's basic ethos, and we will not tolerate it. I know that the hon. Gentleman has a particular interest in the matter. We are not complacent about the situation, which is why the national service framework is reviewing the provision of effective stroke care. We want those services to improve.

Medical School Places

9. Mr. Alan Johnson (Hull, West and Hessle): How many of the bids received by his Department for new medical school places focused on primary health care. [81816]

The Secretary of State for Health (Mr. Frank Dobson): The Government are committed to providing 1,000 extra places in medical schools so that we can produce more doctors. Twenty proposals have been received to create the extra places by extending existing medical schools or establishing new ones. All the submissions address primary health care issues.

Mr. Johnson: I thank my right hon. Friend for that answer. He will know that the University of Hull and its NHS partners have submitted an excellent bid based on primary and community care-based clinical excellence. Can he assure me that the largely untapped resources outside the traditional, established medical school areas will be fully and fairly evaluated in that exercise?

Mr. Dobson: I assure my hon. Friend that, in so far as it is within my power--ultimately, the decision lies not with me but with the Higher Education Funding Council--I want to ensure that all the applications are thoroughly scrutinised so that we get good-quality proposals and value for money. I cannot say any more about the individual bids, except that most of them appear to have been top quality.

Mr. Peter Luff (Mid-Worcestershire): On new medical school places, does the right hon. Gentleman think that his clear intention, which he has tried but failed to conceal, to make junior doctors continue to work unreasonably long hours will make it easier or more difficult to fill places?

Mr. Dobson: On the assumption that the hon. Gentleman needs medical treatment to clean out his ears, I repeat that it is not the intention of the Government that any junior doctor should be expected to work longer hours.

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Residential Care

10. Dr. Lynne Jones (Birmingham, Selly Oak): What measures he is taking to improve the regulation of residential care. [81818]

12. Ms Sally Keeble (Northampton, North): What measures he is taking to improve the regulation of residential care. [81820]

The Parliamentary Under-Secretary of State for Health (Mr. John Hutton): We intend to establish eight new independent commissions for care standards to register and inspect all residential care homes, nursing homes, all children's homes and other care services. We are also developing national regulatory standards in relation to the provision of care and we shall ensure that those standards are met. Those measures will provide stronger protection for vulnerable people in residential care and other care settings, and provide a more coherent and consistent regulatory framework.

Dr. Jones: I welcome the proposals to improve the consistency of care standards, but one of my concerns is that, after years of Tory Government constraint on capital investment, many local councils, such as Birmingham, are facing unacceptable delays in bringing the physical conditions in their residential homes up to their own registration standards. That is forcing them into privatisation deals against the wishes of residents. Will my hon. Friend ensure that adequate capital resources are made available to local authorities so that we can honour our commitment to pensioners to put a halt to Tory policies that have forced councils to sell off old people's homes?

Mr. Hutton: I am aware of my hon. Friend's concerns; we have discussed those issues on the Floor of the House on previous occasions. I am sure that she would agree, however, that the main issue for all hon. Members is to ensure that, right across the spectrum--whether in private care, independent care or local authority care--there are consistently high standards in the quality of care. That is the real issue--not who is providing that care. We made those policies extremely clear in our modernising social services White Paper.

However, I point out to my hon. Friend and to the House that the recent local government settlement provided record new resources for social services--more than £523 million of additional resources this year. We are keen to encourage social services departments to explore new, innovative ways of packaging and financing the provision of residential care. That is the best way to meet what our constituents want--better care, better standards and better provision.

Ms Keeble: I welcome the proposals for the commissions; I hope that they will lead to a substantial improvement in the care of people in all sectors--private, independent and council. However, will my hon. Friend give me assurances on three questions? First, could the commissions look at personal living allowances, which, in some homes, are used to supplement costs instead of going to people so that they can pay for personal expenses? Secondly, can there be provision for lay visitors, or advocates, for people in homes, and can such

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visitors have right of access, to supplement inspections? If people are concerned about a particular issue, there would be someone in whom they can have confidence to take it up, and that person would have right of access to the home. Thirdly, could the commissions consider the particular needs of ethnic minority people in care? Often, skin care, diet and so on are not properly provided for, especially in the case of children and elderly people. Will my hon. Friend give me assurances on those three matters?

Mr. Hutton: We are considering the whole issue of personal living expenses--the personal living allowance--as part of our wider response to the recommendations of the royal commission. We shall announce some proposals when that consideration has been completed.

My hon. Friend asked a specific question about the provision of services for ethnic minorities. It is up to local authorities to ensure that there is a balanced range of provision to reflect the needs of the local population. That is very much the responsibility of the social services departments.

As for complaints procedures and the role of independent advocates, there are already requirements for proper complaints procedures to be in place in every local authority in England and Wales. We envisage that one of the responsibilities of the new commissions for care standards will be to ensure that those procedures are working properly--that will fall four-square within the remit of the new commissions.

Mr. Tim Boswell (Daventry): Does the Minister accept that, although there are certainly merits in a greater degree of consistency in the regulations for residential care homes, that presupposes that there is a residential care home sector to be regulated? Homes in both the private and the public sectors face the impact of the working time regulations and the national minimum wage, in addition to the general course of inflation, because they are major employers. In those circumstances, does the hon. Gentleman not find it odd that, for example, Northamptonshire county council--the county of the hon. Member for Northampton, North (Ms Keeble) and myself--can offer only an additional 2.5 per cent. to providers? That is totally inadequate to maintain that service.

Mr. Hutton: I am sure that the hon. Gentleman will agree that it is most important for workers in this sector to have the same basic employment entitlements as anyone else. I am sure that he is not arguing--although perhaps some of his right hon. and hon. Friends are--that the minimum wage legislation and the basic entitlements to statutory rights at work should not apply in care homes. That would be a most unfortunate position for him to adopt. We have given local authorities a record amount of resources this year. Later in the summer, we shall produce some proposals to try to improve the commissioning process--whereby local authorities purchase care from the independent and private sectors. However, it is wrong--even by implication--to suggest that there is a crisis in the independent care home sector. That is not so. That sector continues to grow and expand.

Rev. Martin Smyth (Belfast, South): We recognise the importance of the private, independent and voluntary

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sectors in residential care, and welcome the Government's commitment to improve that care to the highest standards. To what extent are such homes regulated in respect of dealing with waste, both clinical and other, bearing in mind that it has an impact on the economy and on health care, and that, as I understand it, residential homes outstrip the national health service in terms of the amount of waste that they generate?

Mr. Hutton: I am afraid that I do not have any specific information to enable me to answer the hon. Gentleman's question today, but I shall be happy to correspond with him. One of the strong advantages of our proposals is that the new commissions for care standards will bring together both regulators from social services departments and inspectors from health authorities, so that we have a proper spread of expertise located within the regulatory and inspection bodies. That is a significant step forward and, as I said, I shall be happy to correspond with the hon. Gentleman in more detail on the technical questions that he raises.

Mr. Bob Blizzard (Waveney): Residential care home owners in my constituency have raised with me their concern about the inconsistency of some of the inspectors who currently operate through local authorities: they feel that, often, the judgment of the facilities in their home depends on which inspector turns up. Therefore, although they welcome the new commissions, they are concerned that some of those inconsistent inspectors might simply reappear with a new title. What can my hon. Friend say to those people to assure them that there will be greater consistency under the new arrangements?

Mr. Hutton: I can tell my hon. Friend, and he can pass the message on to care home owners in his constituency, that the issues he raises are precisely why we are intent on developing proper national regulatory standards. We have received from the Centre for Policy on Ageing specific proposals on which we intend to consult nationally in the near future. Through the combination of clear national standards and an improved regulatory and inspection mechanism, we shall overcome some of the problems that my hon. Friend raises. Of course, the final decision on which inspectors are employed by the new care commissions will be taken by them, not by me.

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