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District Nurses

8. Helen Jones (Warrington, North): What plans he has for involving district nurses in profiling the health needs of their community. [12112]

The Minister of State, Department of Health (Mr. John Hutton): District nurses play an important role in profiling the needs of health communities, through their knowledge of local communities and also through their work with individual patients. They will support primary care trusts as part of their responsibility for preparing health improvement plans from 2002. They are also eligible to serve as members of the professional executive committee of primary care trusts. The process for their selection is determined by local nursing colleagues.

Helen Jones: Does my right hon. Friend accept that, as well as playing a major role in improving people's health—allowing them to be maintained in their own homes, and avoiding unnecessary hospital admissions—district nurses, precisely because they work in the community, often have a better idea of its health needs than people sitting in offices elsewhere? Will he ensure not just that district nurses are eligible for involvement in PCTs, but that PCTs make a real effort to consult them

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when drawing up health improvement programmes and trying to improve primary care? These are the people with a real knowledge of their local communities.

Mr. Hutton: I strongly agree. District nurses do a brilliant job, and will have an increasingly important role to play in the pattern of NHS services that we want to be delivered in future. I certainly want all PCTs to consult fully, and to involve district nurses in the development of their local strategies. We aim to devolve more and more responsibility and power to the front line of the NHS, and I do not think anyone is closer to the front line than district nurses.

Sir Teddy Taylor (Rochford and Southend, East): Would the Minister be willing to consult the district nurses of Southend-on-Sea, where, with their encouragement, the John Grooms establishment for severely disabled people carried out a massive, costly improvement to provide separate residential units? It was then hammered by separate rating demands, which increased its rates by 300 per cent. The arrangement has only just started, although I understand that it has now been applied to another establishment in Wells, and will also be operated elsewhere. Will the Government review the law to ensure that homes providing care facilities do not receive separate rating demands? This is a new situation, and the Minister's help would be greatly appreciated.

Mr. Hutton: I am not aware of the situation in Southend, and I am concerned about what the hon. Gentleman has said. If he is prepared to write to me about these matters, I shall take certainly them up with my colleagues in Government.


9. Liz Blackman (Erewash): When he expects the National Institute for Clinical Excellence to publish its recommendations on the prescribing of atypical anti-psychotic medicines for schizophrenia. [12113]

The Minister of State, Department of Health (Jacqui Smith): We anticipate that the National Institute for Clinical Excellence will publish guidance on atypical anti-psychotic drugs in March 2002, provided that there are no appeals against the draft guidance.

Liz Blackman: I thank my hon. Friend for that reply, and I welcome the fact that NICE is appraising this class of drugs at the moment. I hope that there is no slippage in that programme. Is my hon. Friend aware that, although the traditional anti-psychotic drugs used at present on patients suffering from schizophrenia are useful, they also have some worrying long-term effects? Those effects include irreversible involuntary facial and body movements, which have long-term consequences for patients' employability and care needs.

Jacqui Smith: My hon. Friend makes an important point about the consequences of side effects on the wider lives of people suffering from schizophrenia, and I assure her that the NICE appraisal will look at the side effects of both traditional and atypical anti-psychotic drugs. It is

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important that a wide range of stakeholders—including users, carers, professionals and industry representatives—should be consulted and provide evidence to NICE.

The appraisal will contribute to the on-going development of the clinical guideline on the management of schizophrenia, which is due for publication by the end of 2002. In that way we will be able to ensure that people with schizophrenia receive the very best and most appropriate care on the NHS across the whole range of treatment options, including treatment with drugs.

Michael Fabricant (Lichfield): Will the Minister confirm the general point that drugs licensed in the United Kingdom—including the atypical anti-psychotic drugs and the anti-TNF drugs for rheumatoid arthritis currently under consideration by NICE—can still be prescribed and funded by local health authorities? Will funds be made available to local health authorities to enable them to prescribe the drugs permitted or encouraged by NICE?

Jacqui Smith: We have made it clear that local health authorities should continue with their prescribing activities, but the problem highlighted by the hon. Gentleman is the reason that we have introduced NICE. NICE is a key component in ensuring that there is a common-sense way to end postcode prescribing: without it, the mess of variable access to treatment under different local policies would have continued. Where NICE has laid down guidelines already, rapid progress has been made towards giving people access to treatments on the NHS.

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Mr. Oliver Heald (North-East Hertfordshire): The Minister will be aware of the widespread concern in the House that these modern medicines should be made available to patients, and she will have seen the reports from the Zito trust and heard the representations from the National Schizophrenia Federation, MIND and other bodies. Will the Minister say whether NICE has already reached its provisional findings in relation to those medicines? If so, will she insist that they be published? That would give those of us who want to argue and make further representations a chance to do so?

Finally, will she confirm that, if NICE finds against the medicines on the grounds of affordability, it will still be possible for the Government to consider the matter again, as happened with beta interferon? If that is not going to be possible, will she say why?

Jacqui Smith: As I said earlier, it is right that NICE should undertake the detailed analysis and consultation with stakeholders that is already under way. Provisional appraisal decisions are made available to the consultees, so that there can be continuing input into the decisions being made by NICE. Having set up an independent way of determining both the cost and the clinical effectiveness of drugs, I do not believe that it is right for Ministers to intervene in the approach that NICE is taking, but I can assure the hon. Gentleman that—as I pointed out earlier—the evidence of the effectiveness of NICE is that it has brought into the NHS, for the benefit of NHS patients, many treatments that were previously available only on the basis of a postcode and random prescribing process.

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Points of Order

3.30 pm

Dr. Liam Fox (Woodspring): On a point of order, Mr. Speaker. I have given previous notice of this matter. Under the guidelines published by the Cabinet Office in July 2000, Departments are required to disclose sponsorship amounts of more than £5,000 in the departmental annual reports. This year, the Department of Health disclosed that, from various sponsors, it had received £500,000 for the public consultation on the NHS plan. In response to a parliamentary question this week, the Minister of State, Department of Health, the right hon. Member for Barrow and Furness (Mr. Hutton), said:

Mr. Speaker, those two things cannot be right. On which occasion were we misled?

Mr. Speaker: The hon. Gentleman has put the matter on the record. It is now up to him to pursue it, perhaps through parliamentary questions.

Mr. Andrew Robathan (Blaby): On a point of order, Mr. Speaker. I have given you prior notice of my point of order, which relates to the ability of Members of Parliament to hold the Executive to account—an ability that I believe Members on both sides of the House consider extremely important. This afternoon the parliamentary ombudsman will lay before Parliament a report entitled, "Access to Official Information: Declarations made under the Ministerial Code of Conduct". That relates to a series of questions that I tabled in the summer of 2000, to try to get declarations out of the Government. I asked each Department on how many occasions Ministers had made a declaration of interest according to the ministerial code of conduct. Each

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Department, with the honourable exception of the Department for International Development, stated that they were hiding behind exemption 2 of the code of practice on access to Government information. I asked the ombudsman whether that was reasonable—[Interruption.]

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