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Heart Disease
9. Fiona Mactaggart (Slough): What priority he will give to areas with high levels of heart disease in allocating new resources for improving cardiac care and surgery. [115156]
The Secretary of State for Health (Mr. Alan Milburn): The national service framework, which I published earlier this month, is a 10-year programme of action, which will mean that everyone can get top-quality coronary heart disease services wherever they live. As a first step, the extra £50 million to increase heart operations is being distributed using a formula that takes account of deaths from heart disease.
Fiona Mactaggart: I thank my right hon. Friend for that reply. Under the Conservative Government, the town that I represent, despite being in the prosperous south-east, became unhealthier. It is one of the top 10 towns in the country for deaths from coronary heart disease among people aged over 65. Unlike the rest of the country, in Slough the rate of increase for deaths from
CHD is continuing. I am glad that the targeted £50 million will be connected to deaths from heart disease. May I take this opportunity to thank my right hon. Friend for that money? That sum, together with the £600 million that he announced earlier, will mean that Slough, where people have been allowed to die for 20 years because of the ignorance of those who were not focusing on the health needs of the community, will no longer have the only district general hospital in the country without a dedicated coronary care unit.
Mr. Milburn: My hon. Friend raises an important point. I think that all right hon. and hon. Members are aware that, by international standards, we have a high incidence of coronary heart disease in the United Kingdom compared with other developed nations. There is also an unfortunate coincidence in that the very parts of the country that often have the highest levels of coronary heart disease often have the lowest levels of cardiac surgery interventions. That is something that we must put right. We must get resources into the right places. That is the right and fair thing to do.
As for cardiac services, we shall be rolling out the new mechanisms described in the national service framework first into the areas where they are needed most, precisely to deal with some of the big health problems and to narrow the health inequalities that my hon. Friend describes.
Mr. Michael Jack (Fylde):
Will the Secretary of State join me in congratulating the cardiac thoracic unit at the Blackpool Victoria hospital on its excellent work in increasing patient throughput and on the quality of the surgery that it has performed? Will he take this opportunity to remove the cloud of doubt that hangs over the future of the unit? It is much needed in Blackpool and Fylde, and the doubt must be removed. Will the right hon. Gentleman ensure that, in his distribution of moneys, the North West Lancashire health authority has sufficient funds to ensure that patient throughput can again rise at Blackpool?
Mr. Milburn:
As I understand it, the issue about the unit to which the right hon. Gentleman refers is out for consultation. It is a matter that will need to go through the appropriate mechanisms, and it will be determined locally. If it is referred to me, I shall examine it carefully.
Mr. Dennis Turner (Wolverhampton, South-East):
I understand that my right hon. Friend is currently considering demand projections for a fourth cardiac unit in the west midlands. In Wolverhampton, we have not only the highest number of deaths from cardiac disease in the west midlands but the lowest level of access to surgery in the west midlands. Will my right hon. Friend give sympathetic consideration to a new cardiac unit being sited in Wolverhampton?
Mr. Milburn:
I am not aware of the particular local circumstances. If my hon. Friend cares to write to me, I shall examine carefully the issues that he has raised. It is important that all right hon. and hon. Members understand that we have severe capacity problems with our cardiac services and units. As a result of decades of neglect of cardiac services, we have only 170 cardiac surgeons in the NHS in England. We are expanding the
Progress is dependent on the number of surgeons that we have, and it will take time to train them. However, no one should doubt our commitment to increase the number of cardiac surgeons available and to increase the number of heart operations that we are able to carry out. Equally, and in some ways even more significantly, we are committed to nipping some of these problems in the bud. We must get the right emphasis on treatment and on prevention.
Dr. Evan Harris (Oxford, West and Abingdon):
Can the Secretary of State reassure the House that he is aware that it takes more than surgeons, welcome though they will be, to perform cardiac surgery? Will he guarantee funding for intensive-care and high-dependency beds and the anaesthetists who will be needed to increase the number of operations being done?
Mr. Milburn:
It is not only those members of staff who are necessary, important though they are. We also need cardiac nurses and other back-up staff, who will be extremely important. The hon. Gentleman is aware that if we are to expand the capacity of major services to deal with our country's biggest killers--coronary heart disease and cancer--we require an expansion in the number of staff, including doctors, nurses and therapists. That of course requires an increase in the number of available beds, but as I have said to the hon. Gentleman before, it is pretty easy to get beds; it is harder to get trained staff, and I am afraid that it takes time.
10. Mr. Andrew Robathan (Blaby):
When the National Institute for Clinical Excellence will examine the drug infliximab. [115157]
The Minister of State, Department of Health (Mr. John Denham)
rose--
Mr. Owen Paterson (North Shropshire):
What about Gisela? Give her a go.
Madam Speaker:
Order. That is disgraceful, juvenile behaviour. I call the Minister.
Mr. Denham:
We are considering a number of possible topics for appraisal by NICE during the year 2000-01, and an announcement will be made as soon as possible.
Mr. Robathan:
Crohn's disease is an extremely unpleasant condition, which is not terribly common but common enough for those who suffer from it. Infliximab, which was licensed last August, appears to be a very effective treatment for many cases. Does the Minister remember the remarks of his right hon. Friend the Secretary of State--then a Minister of State--on 30 June 1998? He said:
As of now, no one will be denied the drugs that they need. That is a guarantee.--[Official Report, 30 June 1998; Vol. 315, c. 143.]
28 Mar 2000 : Column 215
Could he explain to Crohn's disease sufferers in my constituency and throughout the country why they are being denied infliximab and why, when they ask for it, they are told that it has not yet been evaluated by NICE? That seems to them to be rationing by proxy, and they would like to be given the drugs that they need and which their consultants believe they need.
Mr. Denham:
In preparation for this question, I have endeavoured to establish whether any parts of the country are experiencing problems in the prescribing of that drug for Crohn's disease, and I am assured that in the great majority of health authorities, including Leicestershire, treatment with infliximab is now being funded in appropriate cases. If doubt about that remains, the hon. Gentleman may want to contact me. He will of course welcome the additional £11.3 million of resources that my right hon. Friend the Secretary of State has allocated to Leicestershire today--at least I hope that he will welcome it--because that will undoubtedly enable the health authority to meet a variety of patient needs, including increased drug costs.
Private Finance Initiative
11. Dr. Lynne Jones (Birmingham, Selly Oak): What assessment he has made of the effectiveness of private finance for health capital projects. [115158]
The Minister of State, Department of Health (Mr. John Hutton): The private finance initiative option for every national health service capital investment project must demonstrate that, overall, it is better value for money when compared to the publicly funded alternative, the public sector comparator. Under this Government, 18 major hospital PFI schemes worth nearly £1.4 billion have been approved and are currently under construction. That is the biggest capital investment in the history of the national health service.
Dr. Jones: My hon. Friend will be aware that approval in principle has been given for a new hospital to replace the Selly Oak and Queen Elizabeth hospitals in south Birmingham. Although there is considerable public support for the new hospital, there is anxiety that the additional cost of private finance could lead to the provision of fewer beds and a reduced service.
I note my hon. Friend's reply, but the Select Committees on Health and on the Treasury have exposed the lack of rigour and transparency in the assessment of value for money of private finance schemes. Will my hon. Friend assure my constituents that those problems will not arise in the case of our hospital, and that if, after a fair evaluation, it is found that the public sector comparator offers best value, adequate public capital will be made available so that our hospital can go ahead?
Mr. Hutton:
We have not yet received the outline business case on the investment in Birmingham to which my hon. Friend referred. However, I hope that I can allay some of her fears about the issues that she has raised. In total, the first wave of major PFI schemes will provide slightly more beds than would have been the case if they had been built under the conventional public capital method.
May I also remind my hon. Friend that the Government commissioned Arthur Andersen to examine PFI projects? That report, published in January this year, showed that, on average, PFI projects were delivering savings of 17 per cent. over traditional forms of procurement. The evidence of value for money certainly exists, and I am sure that my hon. Friend will join me in welcoming the recent finding of the Select Committee on the Treasury that
Mr. Hutton:
If changes in services are proposed in the hon. and learned Gentleman's constituency or anywhere else, there must be proper public consultation. If issues are raised in the course of that consultation--for example, if a community health council opposed the service reconfigurations that were being proposed--it would be for Ministers eventually to decide the outcome of that process. We are not there yet, but there will be plenty of opportunity for the hon. and learned Gentleman to raise those concerns with me and my right hon. Friend the Secretary of State in future months.
Mr. Andrew Reed (Loughborough):
Does my hon. Friend accept that the public sector route has a vital role to play in rebuilding our national health service, and that we should not rely on private finance initiatives alone? On that basis, may I thank him and the rest of the team for financing the £9.5 million Loughborough hospital, which will start work this summer and is financed solely by the public sector? Will my hon. Friend visit that site, along with the Opposition spokesperson, the hon. Member for Woodspring (Dr. Fox), who visited it recently, to see Labour delivering its health promises?
Mr. Hutton:
That is probably an invitation that I shall not be able to turn down, so I look forward to visiting my hon. Friend's constituency. Ultimately, what is important is what works, and what delivers the new investments and the new capital projects for the NHS on time and on budget. The PFI has an outstandingly good record on delivering those projects on time and on budget, but of course my hon. Friend is right to say that a significant amount of investment is still taking place through the traditional public sector capital route, and that will continue to be the case.
Mr. David Davis (Haltemprice and Howden):
I am glad to hear the Minister speak of the 17 per cent. advantage that an average PFI project has. As he has just commented, such projects are also significantly faster than the public sector route. Given that one of his problems with the extra money that he has will be capacity increase,
Mr. Hutton:
We want an expanded role for the private finance initiative. However, what matters not just for the right hon. Gentleman's constituents who are patients of the national health service, but for his constituents who are taxpayers as well, is that whatever route we take and whichever way we deliver new capital investment projects for the NHS, the system provides value for money. The PFI has shown its worth, and we are making sure that it will continue to play that role in future.
Mr. John Smith (Vale of Glamorgan):
I, too, welcome my hon. Friend's comments on the effective use of PFI. What counts is what works. Does he suspect, as I do, that civil servants are sometimes reluctant to consider other uses of private finance initiatives, not just for capital projects but for the shared use of facilities and other imaginative proposals that could allow us to retain vital health services in smaller hospitals, which have sometimes been under-utilised? I am sure that there are plenty of good ideas out there, but I sometimes sense a reluctance to push ahead with them.
Mr. Hutton:
I reassure my hon. Friend that we are in the market for new ideas. We are examining all sorts of ways of encouraging the closer partnerships to which he has drawn attention. I am particularly interested in making sure that, in relation to social services, for example, we encourage greater use of the PFI as a route to getting some of the important reinvestment that we need. There is a clear difference, is there not, between the Government, who have delivered that capital investment through the PFI route, and the Opposition, who spent almost 20 years talking about it, but never built a single hospital?
the promotion of PFI projects has clearly led to a considerable and welcome increase in investment in our hospitals.
Mr. Edward Garnier (Harborough):
The Minister may know that it was private finance alone that built the breast cancer unit at the Glenfield hospital in Leicestershire, and that it was the Secretary of State for Health's predecessor who opened the unit last November. It is now threatened with closure. When will the Minister, on behalf of the entire ministerial team, be able to make a pronouncement about the future of the unit? I appreciate that the magic word "consultation" is being bandied about, but the people of Leicestershire and of the Trent region need to know the Government's attitude towards the future of that hospital.
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