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Clinical Treatment (Priorities)
15. Mr. Desmond Swayne (New Forest, West): If he will make a statement on the priorities for clinical treatment in the NHS. [81823]
The Secretary of State for Health (Mr. Frank Dobson): Clinicians make decisions about clinical priorities, in consultation with patients and based on the clinician's assessment of need. These decisions should be taken within the broad framework of priorities which the Government have set out in the national priorities guidance, and from now on should reflect guidance from the National Institute for Clinical Excellence and, as they are established, national service frameworks covering coronary heart disease, mental health, the care of old people and diabetes.
Mr. Swayne: Does the right hon. Gentleman agree that the increase of some 200,000 in the number of patients who have to wait more than 13 weeks to get a first appointment with a consultant is a worrying denial of any clinical priority?
Mr. Dobson: The last advice that was issued to the national health service on clinical priorities--under the present Government on 18 July 1997--said:
- "Clinical priority must be the main determinant of when patients are seen as outpatients or admitted as inpatients. The first service priority of the NHS is to treat emergency cases quickly and appropriately. For elective patients consistent principles must be applied when planning outpatient clinics . . . and inpatient . . . admissions to ensure that patients with the greatest need are seen first."
Kali Mountford (Colne Valley): I am glad that my right hon. Friend thinks that appropriate decisions should be taken by clinicians. Given that, two weeks ago, a report was published that throws doubt on the use of oral contraception by young women, will he ensure that it is clinicians who advise young women about the use of oral contraception, so that there is no repeat of the problems that we had some five years ago when, following the publication of a similar report, women were forced to resort to abortion or unwanted pregnancies?
Mr. Dobson: It is always important to ensure that reports on any existing form of treatment are carefully written by the people who produce them. Sometimes, unfortunately, even people who claim to be scientists or clinicians go for their 15 minutes of fame, rather than a proper, balanced presentation of the research that they have undertaken. They should always bear in mind the possible adverse impact of trying to gain publicity for its own sake.
Mr. David Davis (Haltemprice and Howden): In the past two weeks, there have been two independent reports on stroke and cancer treatment, which indicate that 5,000 unnecessary deaths occur each year and that several thousand more people are invalided in one way or another as a result of being unable to get proper treatment on the national health service. Will there be a change in the Secretary of State's policy priorities on clinical treatment to reflect that?
Mr. Dobson: There has been a huge change in policy priorities under this Government, which are intended to
deal with the historic situation described in those reports. We recognise that there are massive variations in the availability of services across the country. It is preposterous that in some cases, people are more likely to get treatment the nearer they live to the specialist hospital that provides such treatment. That is an absurd situation. We are giving top priority to the reduction of coronary heart disease and strokes, and to dealing with cancer.We also recognise, as the previous Government utterly failed to do, the inequalities in health. It is clear that poor people are ill more often, die sooner and frequently get less good treatment from the national health service than they should. We must do something about that. The previous Government did nothing about it. We have changed the priorities.
Mental Health (Drug Administration)
16. Mrs. Helen Brinton (Peterborough): If he will make a statement on the use of compulsion in community mental health drug administration treatments. [81824]
The Parliamentary Under-Secretary of State for Health (Mr. John Hutton): Our review of the Mental Health Act 1983 will bring to an end the requirement that compulsory treatment can be provided only in a hospital. A principal objective of the review is to create a new legislative framework that will support care and treatment in a wider range of settings and in the least restrictive environment possible, for which the current legislation fails to provide.
Mrs. Brinton: I thank my hon. Friend for his reply. Is he aware of the considerable concern surrounding the Government's current review of the Mental Health Act 1983? Can he assure me that the changes that the Government will no doubt introduce will not result in an increasing number of patients being subjected to compulsory treatment in their communities?
Mr. Hutton: I am aware of those concerns. We have been trying to take them into account as we develop our proposals. The purpose of the review is to make sure that the legislation better protects patients. We will make it absolutely clear that any further provisions relating to compulsory treatment under any new legislation will be fully compliant with our obligations under the European convention on human rights--in other words, there will be proper safeguards.
Of course, any decision about whether a patient needs to be compulsorily detained is a matter for proper clinical assessment and risk assessment, and it is not Ministers who make such decisions. I am not sure whether it would be helpful for me to offer an opinion about the numbers. Those are ultimately decisions taken by the professionals.
Dr. Peter Brand (Isle of Wight):
It is true that a clinical assessment must be made, but it is done within a
Mr. Hutton:
Any eventual proposals will be published by the Government for consultation. However, the hon. Gentleman is not right to say that it is Ministers who determine the individual assessments, or even the framework of the assessments. That is not so, and it is not and never has been provided for in the legislation. Those are issues for clinical assessment and clinical judgment. We intend to legislate for a better framework of mental health law, which will better provide for the needs of mentally ill people. We have made no secret about that and I am confident that it will produce a better framework of law in the long term.
17. Mr. John Gunnell (Morley and Rothwell):
When he intends to publish regulations implementing the ban on tobacco advertising. [81825]
The Minister for Public Health (Ms Tessa Jowell):
We hope to publish regulations implementing the ban on tobacco advertising before the summer recess. They will be accompanied by a revised regulatory impact assessment and a further period of consultation will be allowed for before the regulations are laid before the House.
Mr. Gunnell:
I thank my right hon. Friend for that reply and for the progress that she is making. I hope that she proposes to make the regulations mandatory because it is important to have action and to have it followed up. If the regulations are not initially mandatory, I hope that they will soon become so. Is my right hon. Friend aware that billboard advertising of tobacco has now been banned in the United States of America--I was informed of that by the British Medical Association--which is a firm measure? It would be helpful if American companies that advertise their wares in the United States had similar difficulties when advertising them here--that goes for other legislation too. I am anxious that we should have tough legislation to stop such tobacco advertising.
Ms Jowell:
I thank my hon. Friend. I can confirm that the ban will be statutory and will have the effect of law. We are banning tobacco advertising because we are determined to cut preventable deaths from cancer and heart disease, to protect children and to tackle health inequalities.
Points of Order
3.32 pm
Mr. Tam Dalyell (Linlithgow): On a point of order, Madam Speaker. Have you had any requests from the Foreign Office or the Ministry of Defence to make a statement on the justification for the use of graphite-based weapons in Yugoslavia to dismantle and disrupt electricity supplies? Has there been any consideration of the likely effect on Serb soldiers fighting in Kosovo and how they might react to what they hear is going on in their home towns? In particular, has any study been made of the effect of the policy not only on hospitals, but on the nuclear plant at Vinca; and of the possible radiation consequences of disrupting electricity safety supplies? Has there been any request for a statement on the concerns of the Bulgarian Government about their nuclear power station at Kozcoduy, where pollution in the Danube is creating problems with the coolant systems which the Bulgarians think could result--I am not saying that it would--in Chernobyl-like problems?
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