The Parliamentary Under-Secretary of State for Health (Mr. John Hutton): Guidance was issued on 16 April 1999 to the NHS on the development of new NHS smoking cessation services. Up to £60 million will be available over the next three years, initially in health action zones, to develop these new services.
Ms Stuart: I am grateful to my hon. Friend for that answer. Birmingham health authority leads the field in smoking reduction. Recently, about 110,000 free guides to a smoke-free Birmingham were delivered to C2, D and E households. In his reply, the Minister said that extra money is to go to health action zones. Will he say whether, in future, money will go to authorities such as Birmingham, which are not health action zones but which nevertheless lead the field in that area, to support their good work?
Mr. Hutton: Again, I am happy to join my hon. Friend in supporting the excellent work that is done in Birmingham. The smoke-free Birmingham campaign is an excellent model for other partners to explore. The first year of the new three-year programme of promoting smoking cessation services will be focused on health action zones, but in years two and three we expect the benefits to be spread more widely throughout England. We expect £20 million to be spent in year two and £30 million the year after, throughout the country.
The Secretary of State for Health (Mr. Frank Dobson): The forthcoming guidance to health authorities on the use of HIV and AIDS special allocations will emphasise the need to match funding of prevention initiatives to the local situation and highlights the target groups identified in the current HIV health promotion strategy.
Mr. Brooke: Can the Secretary of State confirm that HIV-AIDS strategy will strengthen targeting work with the three communities that the all-party hearings last summer regarded as most at risk--first, gay and bisexual men, secondly, African people and, thirdly, injecting drug users--if that analysis was correct?
Mr. Dobson: I can confirm to the right hon. Gentleman that we want to target the effort and we want people in the national health service to target in particular those three groups that are most at risk. However, we do not want to concentrate all the effort exclusively on them because we need to ensure that groups that are near the boundary are also properly covered and protected. That is the way that we can stop AIDS spreading among groups of people who are not at present particularly susceptible.
Mr. Neil Gerrard (Walthamstow): Given that there are about 2,500 new infections of HIV a year and that the Public Health Laboratory Service Board still states that HIV is the most important communicable disease in the country, as well as advising health authorities, will my right hon. Friend consider what can be done to strengthen monitoring systems so that we regularly get meaningful and consistent data on how each health authority is spending and using money to target those people who are most at risk?
Mr. Dobson: I do not know whether I am disclosing things that I should not disclose, but I have been spending considerable time with my officials to try to ensure that what my hon. Friend asks for is done.
The Parliamentary Under-Secretary of State for Health (Mr. John Hutton): The NHS research and development programme is funding two relevant studies, "Re-designing postnatal care: a randomised controlled trial of protocol based midwifery-led care", and the "Extension of an established clinical data set to address the effect of structural variables on the process and outcomes of United Kingdom maternity units". In addition, evaluation of the midwifery-led unit at the Royal Bournemouth hospital has been funded by Dorset health authority and evaluation of the Edgware birth centre has been commissioned by Barnet health authority.
Mr. Hutton: I certainly pay tribute to my hon. Friend on his campaign to promote and defend maternity services in his constituency. He may be aware that Warwickshire health authority has been carrying out a survey of women's views of maternity services throughout the county. As a result, the authority will be reconsidering the future configuration of maternity services in Rugby taking into account the views of local women and health professionals.
Mr. Philip Hammond (Runnymede and Weybridge): Midwives do a wonderful job, in which we all want to encourage and support them, but does the hon. Gentleman acknowledge that there is a need for a consultant presence to deal with problem cases? Does he share the concerns of the confidential inquiry into stillbirths and deaths in infancy about the lack of consultant input in such cases? Will he confirm that by 2001, each year, 500 specialists in obstetrics and gynaecology will be chasing only 50 consultant posts, and that as a result, many of them will leave the national health service? Is it not a scandal that those expensively trained, badly needed doctors are being thrown on the scrap heap because the Government will not fund the necessary NHS consultant posts?
Mr. Hutton: I can accept very little of that. The hon. Gentleman usually has something sensible to say, but I am afraid that today he did not. Research evaluating midwifery-led maternity services has been generally positive about their contribution. My right hon. Friend the Secretary of State recently asked a multi-disciplinary working party, including the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and others, to develop criteria for ensuring that small maternity units, including those that provide a midwife-led service, can avoid closure while maintaining patient safety. I reject fundamentally the hon. Gentleman's attack on midwifery. The Government are committed to developing good-quality midwifery and maternity services, and that is what we will do.
Mr. David Drew (Stroud): Will my hon. Friend bear in mind how important midwife-led services are in rural areas, where they add greatly to choice? Will he note the importance of general practitioners, who can make or break such units? Will he encourage the health service to talk to GPs to ensure that they are aware of their benefits?
Mr. Hutton: I agree with my hon. Friend. The Government remain fully committed to the principles of woman-centred maternity services that offer women greater choice, continuity of care and control. We will bear my hon. Friend's comments in mind.
The Parliamentary Under-Secretary of State for Health (Mr. John Hutton): The causation of most breast cancers is complex and has not been established but may involve several dietary, hormonal, environmental and hereditary factors. The influence of diet and nutrition on the incidence of breast cancer was considered by the Committee on Medical Aspects of Food and Nutrition Policy in the 1998 report "Nutritional Aspects of the Development of Cancer", a copy of which is in the Library.
Mr. George: I thank the Minister for that helpful reply. While it is of course necessary to co-ordinate proper screening, detection and treatment of breast cancer, does he agree that understanding the causes is as important--possibly more so--in the long run? Some companies produce arguably carcinogenic agrochemicals while making vast profits out of breast cancer treatments such as Tamoxifen. Does the hon. Gentleman agree that it is important to give proper priority to research and its dissemination, so that perhaps this country will follow others in banning lindane?
Mr. Hutton: I agree with much of what the hon. Gentleman said. He knows that the Government support a wide variety of research programmes examining this area and others. The Committee on Carcinogenicity of Chemicals in Food, Consumer Products and the Environment recently considered the potential association between organochloride insecticides, which I think are the hon. Gentleman's concern, and breast cancer. I expect that it will prepare a draft statement at its June meeting, which should be available for publication early in July.
Miss Melanie Johnson (Welwyn Hatfield): Does my hon. Friend share my concern about the importance of improving and modernising the equipment available for the detection of breast cancer? I believe that £100 million of lottery money will be made available for that. When, and on what projects will it be spent?
Mr. Hutton: I strongly agree with what my hon. Friend says; it is important that new investment goes into improving cancer services. The sum of more than £100 million from the new opportunities fund will make a most significant contribution to doing that. We expect the first resources to be available during the winter.