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Coronary Care

8. Mr. David Crausby (Bolton, North-East): What plans he has to improve heart services. [3771]

The Secretary of State for Health (Mr. Alan Milburn): Improving heart services is a priority for the national health service. Our 10-year blueprint for reform includes speeding up waiting times for heart operations and expanding primary care services to try to prevent coronary heart disease in the first place.

Mr. Crausby: I thank my right hon. Friend for that reply. The national service framework for coronary heart disease mentions smoking and tobacco advertising. Can we be reassured that, by banning tobacco advertising, the Government are determined to help people to stop smoking?

Mr. Milburn: Yes, that is our manifesto commitment. As my hon. Friend is aware, the manifesto is for a Parliament and not only for a year. We remain committed to that measure and will try to find the appropriate time for it, although he will be aware of the special pressures on the legislative programme now. None the less, we will try to do so as soon as we are able. We also remain absolutely committed to tackling the health impact of tobacco consumption. That is why we have moved our position from one of simply exhorting people to give up smoking to providing help so that they can do so.

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Probably one of the most important things that we have done, and it is one of the most important public health measures to be introduced in recent decades, is to make nicotine replacement therapy and Zyban available on prescription. The results have been very welcome indeed. We estimate that about 65,000 smokers have been helped to give up thanks to the additional assistance that we have been able to make available to them. That will have a long as well as a short-term impact on both coronary heart disease and cancer.

Dr. Evan Harris (Oxford, West and Abingdon): The right hon. Gentleman will be aware that those working in primary care, who are struggling to implement the NSF, want smoking cessation clinics and they want to increase the prescription of cholesterol-lowering drugs, but no earmarked funds are available. Many general practitioners have told me that they have to cut another service to provide for those. Does he also recognise the problem that exists in respect of elective heart surgery? On the one hand he says that the top priority is to ensure that no patient waits more than 18 months—it is soon to be 15—but on the other he says that clinical priorities should determine the order in which patients are treated. Patients who used to be operated on within four weeks for unstable angina or for a bypass often have to wait months because the 18-month waiters jump the queue as a managerial rather than a clinical priority.

Mr. Milburn: That was a long shopping list, but not as long as normal from the hon. Gentleman. On those two issues, I can offer him a double reassurance. On prescribing statins, for lowering cholesterol levels to prevent against further heart attacks, and aspirin and beta blockers, there is real progress. I can report to him that in the last year alone the number of prescriptions for statins has increased by well over one third—by 37 per cent. That is real progress. We all know that although it is often the glamorous side of cardiac care that attracts most attention, actually the biggest impact that we can make is probably in primary care, so that is a welcome move in the right direction.

As for the other issues about which the hon. Gentleman is concerned, let me be candid with him: people wait far too long for a heart operation in this country. That is undoubtedly true and he knows the reasons. There has been a history of neglect and underinvestment, particularly in our cardiac services. It is that that we are trying to put right. There is extra, earmarked money going in. I put an extra £50 million in to ensure more heart operations, and I am pleased to be able to tell him that the NHS has made very, very good progress indeed. We were originally due to complete a further 3,000 heart operations by March next year; in fact, that target has been achieved ahead of schedule. That is bringing life-saving surgery to many thousands of people, and I hope that before too long we can make even faster progress to ensure precisely that the cases with the highest clinical need are dealt with most quickly.

Helen Jackson (Sheffield, Hillsborough): I thank my right hon. Friend for making the right decision as regards the continuation of the transplant unit at the Northern general hospital in Sheffield. Will he accept that this has been a hugely popular decision? We recognise that advice had been given to the Secretary of State to the contrary,

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and we are always happy to offer congratulations when Ministers use their own judgment—and that of the public in Yorkshire and round about—and make the right decision.

Mr. Milburn: The Under-Secretary of State, my hon. Friend the Member for Salford (Ms Blears), has just whispered to me that I must be losing my touch because I have made a popular decision. I am glad to accept the congratulations of my hon. Friend the Member for Sheffield, Hillsborough (Helen Jackson). It was the right decision to take. We want to expand heart services to the public and we want to undertake more transplants rather than fewer; and of course there is a big effort being made across the country to increase the number of organ donations. In those circumstances, it seemed pretty odd to me to be reducing cardiothoracic transplant services, not only in Sheffield but in Birmingham and Manchester too. I am pleased to be able to say that the right decision has been taken, that those services can now look forward to a good future and that, hopefully, we can help to bring some good to many people.

Cottage Hospitals

9. Mr. David Cameron (Witney): What plans he has to safeguard and expand cottage and community hospitals. [3772]

The Minister of State, Department of Health (Mr. John Hutton): Community and cottage hospitals play an important role within the national health service. They provide an essential service to patients, especially in the recuperative phases of recovery from illness or accident, and will help us to meet the target of introducing an additional 5,000 intermediate care beds by 2004.

Mr. Cameron: I thank the right hon. Gentleman for that answer. He may recall that the Burford hospital in my constituency was closed during the last Parliament. Is he aware that a local body called the Phoenix project has raised money to buy the building and provide a range of services and clinics to promote healthy living, which is exactly in line with Government policy? Will he encourage the local primary care trust to get on and sell the building to the Phoenix trust so that that can go ahead? I know that he may not have all the details but time is running out; it is urgent and I should really welcome his intervention in this matter. We want to save our local health centre.

Mr. Hutton: I congratulate the hon. Gentleman on raising that point and of course I am more than happy to look into the issues that he has raised.

Lawrie Quinn (Scarborough and Whitby): I welcome the introduction of the new primary care trust for my area of North Yorkshire. For the first time in probably a decade or more, the Whitby community hospital feels that it has a future—that it has a role to play in undertaking proper health care for people in the Whitby and North York moors area of my county. Will the Minister take every opportunity to make sure that the people who live in the remoter, rural parts of the county of North Yorkshire get

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better access to community hospitals such as the Whitby community hospital and that the full intentions of the primary care trust idea can be brought to the forefront?

Mr. Hutton: I am grateful to my hon. Friend—I have had the pleasure of visiting Scarborough with him and seeing some of the improvements in the NHS in relation to the care of the elderly that have taken place there; they are very long overdue. Older people are the largest users of health care services in this country, and it is very important for us to continue to improve the range of care services available to them. My hon. Friend raises a particularly important issue about access to those services in rural communities, but that is precisely the reason why we set up primary care trusts: they can assess those needs and ensure that the necessary arrangements are put in place so that older people can gain access to the wider range of health care services that we are committed to establishing.

Mr. Oliver Heald (North-East Hertfordshire): Does the Minister agree that cottage and community hospitals are more vital than ever as places of convalescence, given the huge increase in the number of elderly people—680,000 this year—who are in hospital beds because they have nowhere else to go? This morning, the Prime Minister spoke of the problem of bed blocking, but is it not a fact that 50,000 care beds have been lost in the past five years due to Government policy? Will the Minister now apologise for the misery and distress caused to so many elderly people? Will he tell us when that trend will end, so that we can see a picture for the future in which the number of care beds does not decline year after year?

Mr. Hutton: I welcome the hon. Gentleman to his new responsibilities and hope that in future he will do his homework a little more thoroughly than he has done today. He complains about the lack of beds in the NHS, so I shall remind him who cut the number of beds in the NHS.

Mr. Heald: You did.

Mr. Hutton: No, the Conservative party did. Under the Conservative Government, 60,000 beds were lost in the NHS, and the hon. Gentleman is quite wrong—[Interruption.]

Mr. Speaker: Order. The hon. Gentleman should not shout at anyone, but especially not at the Minister.

Mr. Hutton: I apologise to the hon. Gentleman and his hon. Friends if I have excited them. They do not like the truth, and the truth is that 50,000 beds have not been lost in the care homes sector. The hon. Gentleman is quite wrong about that. Of course, we have recently announced a substantial additional investment in the NHS and local authorities to ensure that the provision of care for older people is right. I am afraid that it ill behoves the hon. Gentleman, given his new responsibilities, to lecture the Government about a lack of funding, given that he would not even match our social services funding during the previous Parliament.

Mrs. Gwyneth Dunwoody (Crewe and Nantwich): Is my right hon. Friend aware that bed blocking is the direct

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result of the closure of community and cottage hospitals and, indeed, that it is nonsense to suggest moving people to private sector hospitals, such as those run by Westminster Care, which was exposed at the weekend as doing a very bad job, while we allow the closure of NHS beds and the movement of NHS staff to the private sector? I hope that he will resist that very actively and clearly in the future.

Mr. Hutton: We need to ensure that a range of provision is available for older people, and I can tell my hon. Friend that there are almost 2,500 additional NHS intermediate care beds in England over and above the figure that existed in 1999. What is really important in this context is that older people, as well as other patients in the NHS, get access to the best available care. If we can use and commission appropriate care services at the highest level in the private sector, we fully intend to do so.

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