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Mr. Howarth: I will not give way to the hon. Lady, because it is 28 minutes past. I do not think that the programme has been a failure.
My hon. Friend the Member for Wellingborough (Mr. Stinchcombe) made an interesting speech about drugs in prisons. Significant resources are going into the Prison Service over the next three years, matched by resources from the service itself. He asked about sniffer dogs. I am pleased to tell him that 70 new dogs are being trained and will be put to use by the end of the financial year.
There is a tremendous amount of anecdotal evidence that because of mandatory drug testing there has been a switch in prisons from cannabis to opiates. We commissioned two independent studies last year, neither of which found any evidence to support that. We are vigilant on the subject. I am proud to say that, as a result of the changes that we have made in the testing, the number of positive tests has reduced from 24.41 per cent. in 1996-97 to 18.5 per cent. in 1998-99 so far. That proves that we are driving down drug use in prisons.
It being half-past Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.
Motion made, and Question put forthwith, pursuant to Standing Order No. 25 (Periodic adjournments),
Ordered,
Ordered,
Motion made, and Question proposed, That this House do now adjourn.--[Mrs. McGuire.]
Mr. Robert Syms (Poole):
I am raising an important subject today--the national health service cleft lip and palate units, which are now in a state of some turmoil because of the review undertaken by the clinical standards advisory group, which reported in February 1998. The process is now moving on. I especially welcome the presence this afternoon of my hon. Friends the Members for Runnymede and Weybridge (Mr. Hammond) and for Bournemouth, East (Mr. Atkinson), who may, I understand, make a brief contribution later.
The root of many of the difficulties is the proposed reduction in the number of centres from 57 to between eight and 15. Originally, the CSAG examined practice and outcomes elsewhere, especially in Scandinavia. In general, there is some logic to its proposals, but I have particular concerns about them as they relate to Poole.
The reduction in the number of centres is too great, and it looks as if the implementation of the proposals will be somewhat dogmatic. The date of 1 April 2000, by which everything is to be in place, is too soon. There is a feeling among my constituents and others that the consultations are not being taken as seriously by the NHS executive and the regional health authorities as they should be.
In the south-west, the proposal is to reduce the number of centres from five to one, based in Bristol, although that centre may work out of two sites, with Odstock in Salisbury as a second site. That is going too far, too fast.
I had a letter from the Minister of State, Department of Health, the hon. Member for Southampton, Itchen (Mr. Denham), in which he said:
The 1997 White Paper, under the heading, "A New Start", said:
One of the problems with the present review is that because that method is only one of two methods, there is a risk that we may lose many of the centres that use it. Tony Markus, the surgeon who heads the Poole unit, is one of the foremost national experts in that method, and has published several papers in journals such as the British Journal of Oral and Maxillofacial Surgery. There is concern among patients that following the review, they may have to go abroad, to France or elsewhere, to get such treatment. That is causing a great deal of concern.
Another important point about the Poole unit is that it has conducted an audit and published its results, whereas other units have not published that essential information. It is therefore difficult to make comparisons using the available data, although the data from Europe permit some comparison to be made. The Freiberg analysis is of particular merit, as it covers both the plastic surgery method and the Professor Delaire method. Evidence from parallel studies over a number of years demonstrate that better results are achieved by the maxillofacial technique.
The cost of centralising a region's operations into one centre does not appear to have been analysed critically other than in the broad-brush terms. The maxillofacial treatment usually requires only between one and three operations, whereas plastic surgery requires many more. Moreover, the changes made by plastic surgery do not grow with the child, so fairly regular operations are needed to compensate for growth. Cost ought to be a factor, especially if the method shows signs of success.
If the proposals are implemented, the practical effect will be that parents in the south west and the Wessex region will not be able to choose to have their children treated by the maxillofacial method, which would not be available at Bristol or Odstock. Parent meetings of the Poole group have been informed by member parents who have suffered treatment at Bristol, Manchester and at other units in the midlands that under no circumstances would they allow their children to be treated by those plastic surgery units again.
There is a great deal of support, among parents and patients who have experienced the benefits of the Poole treatment, for maintaining the unit. There is supposed to be freedom of choice under the national health service charter, but the proposals, if adopted, will mean that maxillofacial treatment will survive only at units in the north of England, if they too are not axed by the end of the process.
Published evidence in the United States shows that the attitude of parents to family involvement in cleft palate techniques can be a significant help in such cases. I believe that the system used in Poole commands much public support. The support and co-operation of parents with children suffering from such problems are vital, and the method is tried and tested.
Given that no other unit apart from Poole has published audited accounts, and that such accounts from the continent indicate that better results are being obtained by the maxillofacial process, it appears that the proposal could cause standards here to fall significantly. The Dorset hospital trust and the local health authority support the maintenance of the internationally acclaimed unit at Poole. How can the regional authority or the Government seek to override that local support and international recognition?
The local parent support group has made the strongest representations to the regional authority to be permitted representation at the final meeting in Bristol. None of the three letters that it sent has been answered. The only response was to the regional representative of the Cleft Lip and Palate Association in Exeter, who has no knowledge of or connection with the Poole unit, nor any personal knowledge of the techniques used there, which have international support.
It has been intimated that the regional authority wants decisions to be made by July. What criteria will govern those decisions, and what has happened to the three months consultation period that was first suggested? How is the right of choice under the patients charter to be addressed?
Centralisation in Bristol would be bound to remove all local support for the system that is currently available, and poorer families who could not afford the travel and accommodation that the proposals would require would suffer especially severely. This form of treatment needs a multidiscipline approach and support from many people, such as speech therapists. There is a fear that some of that team approach will be lost if Poole relinquishes its ability to undertake surgical interventions.
The road system between Bristol and Poole has not been improved significantly since the second world war, and travel by rail usually means two changes and significant cost. That is a very real problem for my constituents. An earlier attempt to centralise services at Bristol involved the Bristol baby heart unit: that offers a poor precedent.
The problems of reorganisation in Poole are causing much public concern. The local newspaper has run a campaign against the plan, and most of the parents who have witnessed the benefits that the unit has given to their children want it to remain open so that it can provide a service to people all along the south coast.
That this House, at its rising on Tuesday 27th July, do adjourn till Tuesday 19th October.--[Mrs. McGuire.]
Question agreed to.
That, at the sitting on Tuesday 27th July, the Speaker shall not adjourn the House until she shall have notified the Royal Assent to Acts agreed upon by both Houses.--[Mrs. McGuire.]
Ordered,
That Mr. Oliver Letwin be discharged from the Deregulation Committee and Mrs. Teresa Gorman be added to the Committee.--[Mrs. McGuire.]
That Mr. Geoffrey Clifton-Brown be discharged from the Committee of Public Accounts and Mr. David Curry be added to the Committee.--[Mrs. McGuire.]
Ordered,
That Mr. David Ruffley be discharged from the Select Committee on Public Administration and Mr. Nicholas Soames be added to the Committee.--[Mrs. McGuire.]
2 Jul 1999 : Column 612
2.30 pm
"No decisions have yet been made about the pattern of cleft lip and palate services in the south west, and the views and concerns of patients and their families are taken into consideration in the consultation process."
However, there is still a strong feeling that the proposals for the south-west executive have been set in a particularly firm framework, so that even if we make a case for the benefits of maintaining the unit in full, I am not sure whether that will fit in with the Government's framework. A local petition has so far been signed by 12,000 people and I have the support of many of my colleagues in the south-east Dorset conurbation.
"The needs of patients will be put at the centre of the care process",
and said that the Government would
"rebuild public confidence in the NHS as a Public Service, accountable to patients, open to the public and shaped by their views".
Under the heading "Keeping What Works", the White Paper also said:
"If something is working effectively then it should not be discarded purely for the sake of it".
The key point is that Poole as a unit is working effectively, and should not be discarded. The Poole unit is different from other units in the Wessex region, because it uses a different technique pioneered by Professor
Delaire in Nantes, in France. It is a regenerative process in which the face is rebuilt so that the muscle can grow. A child whose face has been rebuilt in that way will need less surgical intervention in future. The process allows more natural growth, and has a good record. It is used widely in Germany, France, Canada and the United Kingdom. Poole has been so successful that it has taught many surgeons from Africa and Russia to use the method in their countries.
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