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House of Commons

Tuesday 14 January 2003

The House met at half-past Eleven o'clock


[Mr. Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—

NHS Dentistry

1. Mr. Simon Thomas (Ceredigion): What recent discussions he has had with the National Assembly for Wales in relation to NHS dentistry. [90189]

The Parliamentary Under-Secretary of State for Health (Mr. David Lammy): Officials from the Department of Health continue to have a regular dialogue with the National Assembly in relation to NHS dentistry.

Mr. Simon Thomas : I am grateful to know that the dialogue is still ongoing. Is the Minister aware that just 31 per cent. of the population in my constituency are registered with an NHS dentist? That is the lowest figure ever, since the NHS dentistry system came in. According to figures released last week, we also have the highest rates of lip and mouth cancer registered in Wales at European level. The Select Committee on Health report on NHS dentistry published in March 2001 identified the scale of charges for NHS dentists as the main obstacle to increased access to NHS dentistry. What is the Department doing to change that scale of charges to encourage more dentists to come into the NHS and to ensure that we pay them not just for the treatment that they provide but for the preventive care that they undertake?

Mr. Lammy: The hon. Gentleman rightly points out that the Welsh Assembly is responsible for dentistry in Wales. The Assembly has rightly set out its reform agenda under XRoutes to Reform". Like us, it is also examining how local commissioning can be taken forward, and our XOptions for Change" document is a vision for that local commissioning.

Huw Irranca-Davies (Ogmore): Without wishing to cast a slur on the whole dentistry profession, I wonder whether the Minister would agree with a colleague of mine, my dentist, who primarily treats NHS patients, that there is a problem with the motivation of many of

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those now coming into dentistry? We need to encourage more of those who have an ethical reason to be there, rather than simply a financial one.

Mr. Lammy: My hon. Friend makes a good point. It is key that dentists should be able to move away from the piecework and methods of payment that we have had in the past. My hon. Friend will know that we intend to put proposals before Parliament to change the structure to ensure local commissioning by primary care trusts. I believe that that will empower dentists to move in the direction that they and the British Dental Association want.

Specialist Stroke Units

2. Mr. Michael Jack (Fylde): If he will make a statement on the role of specialist stroke units at NHS acute hospitals. [90190]

The Minister of State, Department of Health (Jacqui Smith): As the national service framework for older people makes clear, all hospitals that care for people who have had a stroke should have specialist stroke services in place by April 2004. Monitoring of implementation of the national service framework shows that progress is being made with the introduction of those services.

Mr. Jack : I am grateful to the Minister for restating the national service framework target. The Royal College of Physicians estimates that, at present, only 27 per cent. of patients are being treated in specialist stroke units, which, in its judgment, is resulting in 6,000 unnecessary deaths a year. Is the Minister really telling the House that, within one year, 73 per cent. more patients will be treated in specialist stroke units in places such as Blackpool, which has no such specialist unit? What comfort can she give to people there that the money and resources will flow at a speed that will enable her target to be met in one year?

Jacqui Smith: The right hon. Gentleman is right: we do need to make more progress. That is why provision of stroke services is a key priority in the Department's priorities and planning framework issued last October. I am sure that he will be pleased to reflect that the third national sentinel audit showed an increase in the number of hospitals with specific stroke units, notwithstanding the fact that the Government's objectives go beyond stroke units to involve integrated stroke services covering preventive care, rehabilitation and long-term support for stroke patients. The right hon. Gentleman also makes the important point that this progress is dependent on investment. I do not think that it will be the last time that we say this today: I hope that he will explain to his constituents that the progress we have made and that we expect to make is dependent on the investment that this Government are putting in and that his party would take out.

Mr. Harry Barnes (North-East Derbyshire): I am always grateful to you, Mr. Speaker, for the help that you gave me in 1998, when you rushed me into St. Thomas's hospital from Westminster when I had a stroke in the House. Is the Minister aware that the

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diagnosis, treatment and prevention of strokes is cost-effective as well as humane? Is she also aware that magic potions are not what are needed to deal with strokes? It is mainly a matter of careful treatment, sensible eating, exercise and, if you have the stomach for it, a mild aspirin a day. It is, therefore, just sensible organisation that is required. Surely that can be delivered according to the time scale that the Minister is describing. We do not need high-tech to deliver this programme.

Jacqui Smith: My hon. Friend makes an important point, not least from his experience. Although stroke rehabilitation units are important, so is the increasing amount of preventive work in primary care. That is being taken forward through other initiatives; for example, it is linked to the Government's action on preventing heart disease. My hon. Friend referred to the importance of exercise and healthy eating. On Friday, my hon. Friend the Parliamentary Under-Secretary of State for Health, the Member for Salford (Ms Blears), made an important announcement about the Government's five-a-day project to encourage healthier eating.

My hon. Friend is right that stroke services are about prevention and long-term rehabilitation. He is also right that the Government have made that a priority, and we are confident that the sort of improvements that we have announced are being and will be made.

Hospital Waiting Lists and Times

3. Sir Sydney Chapman (Chipping Barnet): If he will make a statement on progress on reducing waiting lists and times in the NHS. [90191]

The Secretary of State for Health (Mr. Alan Milburn): Waiting lists and waiting times are falling. Waiting lists for primary care and hospitals have fallen, and waiting for in-patient and out-patient appointments has reduced. The biggest reduction in waiting times is that for cancer and heart treatment.

Sir Sydney Chapman : Will the Secretary of State confirm that, within five years of coming to power, the Labour Government failed to reduce waiting lists by the promised 100,000, which was only a reduction of less than 10 per cent? Waiting times are more important than waiting lists. The right hon. Gentleman set a benchmark of reducing waiting time to a maximum of six months by 2005. Does he accept that he failed to achieve the benchmark of a maximum waiting time of 15 months by March this year?

Mr. Milburn: With the greatest respect, I think that the hon. Gentleman is confused. We promised at the time of the general election that we would reduce waiting lists by 100,000 and we have achieved that. It might benefit hon. Members if I read out the figures. In March 1997, 283,000 people waited more than six months for a hospital operation. That figure is down to 230,000. In March 1997, almost 6,000 people waited more than 15 months for a hospital operation; the latest figures show that six people are waiting that length of time.

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More than 70,000 people were waiting more than 26 weeks for an out-patient appointment when we came to office; that figure is down to 700. There is a long way to go but waiting times and waiting lists are moving in the right direction for one simple reason: our reforms of the national health service and the resources for which we voted and against which the hon. Gentleman voted.

John Mann (Bassetlaw): The NHS in my constituency is going from strength to strength according to every indicator except one: that for drug treatment services. Will my right hon. Friend examine the returns on waiting lists that the drug action team for Nottinghamshire provides for my constituency and the rest of the county, and work out why I know people on 12-month waiting lists when the team's results imply a maximum wait of 12 weeks? Will my right hon. Friend consider the specific cases, the details of which I can provide to him, and the way in which the waiting lists for drug treatment services are being fiddled?

Mr. Milburn: My hon. Friend raises an important issue. I appreciate that he takes a passionate interest in issues that involve drugs, such as drug-related crime and drugs treatment. I understand that he mentioned some of them in yesterday's debate. Progress has been made, but, as my hon. Friend knows, the performance of drug action teams varies throughout the country. Some are good and some are unfortunately less good.

When effort has been focused, especially on areas with high street crime, waiting times for treatment have changed remarkably. In some cases, people who obviously needed drug treatment were arrested, but told that they would have to wait many months before they received such treatment. Nowadays, people in high street-crime areas receive treatment almost instantaneously. If we can do it in some areas, we must do it in others. That requires a combination of national and local action.

Dr. Evan Harris (Oxford, West and Abingdon): Is the Secretary of State aware of the increasing concern about fiddling waiting list figures? I refer not only to the National Audit Office findings of more cases of fiddling but the scandal at St. George's hospital, where it appears that some figures were fiddled. Will he assure us that he is confident that clinical priorities are not being distorted by his obsession with waiting times and waiting lists, and that we are treating the sickest thickest—I mean the sickest quickest? Will he also assure us that he has confidence in the figures on which he relies to demonstrate the claimed improvements in waiting times?

Mr. Milburn: Obviously the hon. Gentleman spent too long in front of the mirror this morning. He claims that the Government are obsessed with waiting times, but it is the public and patients who are rightly obsessed with them. As he knows fine well, by and large the biggest public concern about the national health service today is not the quality of treatment received once people get into the NHS, but how long they have to wait to get into it. We believe passionately that the right way forward is to get the reforms into the national health service—I know that the hon. Gentleman opposes all of them—and to get the resources in as well, so that we can

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bring down waiting times. Of course, nowadays there is more independent scrutiny of the NHS than there has ever been.

Mr. Kevin Hughes (Doncaster, North): The reforms are certainly working for us in Doncaster. Of those waiting for treatment for less than six months, nationally the figure is 76 per cent., but in Doncaster it is 88 per cent., which is obviously good. Nationally, 76 per cent. of those waiting for GP referrals are seen within 13 weeks, but in Doncaster the figure is 86 per cent., so the reforms are working. Where there is a will, there is a way. Will my right hon. Friend join me in congratulating the doctors, nurses and management in Doncaster, who are doing an excellent job?

Mr. Milburn: My hon. Friend is quite right, and what he says is true not just in Doncaster. I join him in paying tribute to the Herculean effort on the part of staff and management in Doncaster, but although major problems still exist across the national health service—unsurprisingly so, after literally decades of underinvestment—it is very striking that, for the first time since records began, in-patient and out-patient waiting times are falling, and falling together. The same is true in primary care, and also according to virtually every indicator. What gives me particular pleasure—I know that my hon. Friend will feel the same, particularly since he comes from an area that suffers not just from deprivation but from a high incidence of coronary heart disease—is that the biggest falls in treatment have been in precisely those clinical priority areas of cancer and heart disease.

It is worth saying that when we came to office, heart patients were in some cases being asked to wait more than 18 months for hospital operations. By April of this year, we expect such waiting times to have been halved to a maximum of nine months. There is clearly a long way to go, but the only way to keep the waiting times moving in the right direction—downwards—is to keep on with the reforms, and, most importantly, to keep the resources going in. That is what the Government want to do, and what the Opposition oppose.

Dr. Liam Fox (Woodspring): What estimate has been made of the number of casualties that the NHS could deal with if there is war in the Gulf, and the number of staff who could be sent there without significantly affecting current levels of NHS activity and, thereby, waiting times?

Mr. Milburn: We obviously have not made estimates of the number of potential casualties, but as my right hon. Friend the Secretary of State for Defence told this House just a week or so ago, we have put in place contingency plans. That is sensible, particularly in the first instance for the call up of reservists. This will affect many NHS hospitals throughout the country, but I expect that, on average, the impact will be limited to two or three members of staff being called up. Sometimes they will be doctors, sometimes they will be nurses, and sometimes they will be allied health professionals such as therapists. In addition, as the hon. Gentleman will be aware, last week a meeting was held in the Department

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of Health with six of the principal NHS and other hospitals that would be used to deal with casualties in the event of a conflict.

Dr. Fox: Last July, the armed forces said that they had only 195 GPs when 415 were needed, only 23 anaesthetists when 120 were needed, only 11 orthopaedic surgeons when 28 were needed, and only 18 general surgeons when 43 were needed. The whole House will undoubtedly agree that all our troops should have optimal treatment. If we are talking about a deployment of more than 20,000, how will the extra numbers be made up in those areas without having a very significant impact? Of course, that could cause great difficulty to the NHS.

Mr. Milburn: Perhaps uncharacteristically, the hon. Gentleman is being something of a merchant of doom and gloom. The reason why my right hon. Friend the Secretary of State for Defence made that statement in the House—I very much support what he said—was precisely that the national health service has to plan for all contingencies. The House—and, I dare say, Opposition Front Benchers—would be the first to criticise the Government were we not to put in place suitable contingency plans. That is precisely what we have done, in the first instance with reservists. If it is necessary to supplement the statement that my right hon. Friend the Secretary of State for Defence made to the House, we will take any further action that needs to be taken. However, I am surprised that the hon. Gentleman should have taken this tack. It is worth pointing out that the Government who cut the defence medical services in our armed forces were not this Labour Government, but the previous Conservative Government.

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