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18 Mar 2003 : Column 750—continued


9. Mrs. Annette L. Brooke (Mid-Dorset and North Poole): What progress has been made with the establishment of centres of excellence for the treatment of endometriosis. [103201]

The Minister of State, Department of Health (Jacqui Smith): The Government recognise that endometriosis affects the lives of many women and their families. Some specialist clinics treating advanced endometriosis have developed locally in response to need.Officials in my Department have discussed centres of excellence with

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the National Endometriosis Society and other organisations, and will continue working with them to see whether further work is appropriate.

Mrs. Brooke: Does the Minister accept that much more is needed? What encouragement can she give to women and their families who experience long delays in diagnosis and in appropriate treatment once the diagnosis has been made?

Jacqui Smith: The hon. Lady plays an important part in the all-party group on endometriosis. As she points out, it is important that endometriosis should be diagnosed early, allowing treatment with some of the less radical approaches. That is why the pilot scheme for the national electronic library for health and a virtual branch library under that will include a section on women's reproductive health. We shall ensure that endometriosis is covered in that so that general practitioners, the first and very important point at which women can be diagnosed and then referred if necessary, have the necessary information in order to be able to carry out their work.

Junior Doctors

10. Mr. Archie Norman (Tunbridge Wells): What assessment he has made of the impact on medical staffing in acute hospitals of extending the working time directive to junior doctors. [103202]

The Minister of State, Department of Health (Mr. John Hutton): The Department of Health has issued guidance, with the support of the medical royal colleges, that sets out a range of solutions that will enable NHS trusts to meet their statutory obligations under the working time directive. That is being supported through a programme of pilots, a strategic support fund and the increases in staff and resources announced in the NHS plan.

Mr. Norman : Does the Minister recall that the Royal College of Physicians has warned that implementation of the working time directive in August next year will lead to

Can he comment in particular on the fact that his Department's own pilot study suggests that smaller hospitals, those with six specialist registrars or fewer, will really struggle? Can he now give the House a pledge that if there turns out to be a conflict between the working time directive and acute care in acute hospitals, it will be the patients who are put first?

Mr. Hutton: Of course that must be right, and I can certainly confirm that, and of course I am aware of the views of the Royal College of Physicians, which we take seriously. It welcomed the guidance that we issued earlier in the year and we continue to discuss its concerns with it and how we can construct the right solutions. But it is possible, working with the pilots that we have announced for the 19 trusts that are devising the cost-effective solutions to the problems that the working time directive undoubtedly poses, that we can construct

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effective solutions that put the patient first. It is in everyone's interests to do that, and I think that we shall be able to do precisely that. [Interruption.]

Mr. Deputy Speaker (Sir Alan Haselhurst): Order. There is too much conversation going on. These questions are important and we should be able to hear the answers.

Dr. Richard Taylor (Wyre Forest): Is the Minister aware that while we all welcome the reduction in junior doctor's hours, some junior doctors fear that the quality and length of their training and experience may be compromised, along with continuity of care?

Mr. Hutton: Yes, I am aware of that concern. The hon. Gentleman takes a close interests in these matters and I hope that he will have seen my recent announcement about how we intend to reform medical postgraduate training in order to avoid precisely that issue. We need a more structured senior house officer training programme and that is what will come through from the foundation programme that we shall be introducing. That work is being led by the chief medical officer, who I know takes such concerns seriously, and has made it clear, as we have, that the most important thing that we must do in the circumstances is to ensure that we preserve the quality of medical training in Britain, which most people, fairly, reasonably and rightly, regard as among the best in the world.

Rev. Martin Smyth (Belfast, South): When will that programme start and how long will it take before it is working? As additional consultants were appointed to try to relieve the pressures on junior doctors in the past, have we not succeeded?

Mr. Hutton: The reforms I mentioned to postgraduate medical education will start later this year, and I hope that we will be in a position to introduce them more widely from 2004. We are doing that in full consultation with all the devolved Administrations and with the support of the chief medical officers in all four nations of the United Kingdom.

Tim Loughton (East Worthing and Shoreham): The Minister has singularly failed to answer the question asked by my hon. Friend the Member for Tunbridge Wells (Mr. Norman). Does he agree with the Royal College of Physicians that implementation of the European directive by August 2004 will be difficult or even impossible and that the level of out-of-hours medical cover in many hospitals is already worryingly thin, posing a direct and alarming threat to safe levels of patient care? Given that the number of doctors enrolling in the past five years has been worryingly low—about 350, when the Minister estimates that 7,000 to 10,000 are needed to comply with the directive—is he now prepared to put British patients' interests first by delaying implementation, or does he expect doctors to

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deal with even more patients in fewer hours and risk many of our hospitals collapsing, or will patients simply have to wait even longer?

Mr. Hutton: We have heard it all now from the hon. Gentleman.

Tim Loughton: Answer the question.

Mr. Hutton: I did answer his hon. Friend; the problem is that usually he does not like the answers that I give.

We ought to be clear. The idea that we should delay implementation of the working time directive is ridiculous—that is not going to happen. No, I do not agree with the Royal College of Physicians' assessment. We have published guidance setting out how the NHS can reach compliance and how we will do that, and we are backing that with significant additional investment, which will be important. The hon. Gentleman, like the rest of his rag-tag army of clapped-out, failed Front-Bench spokesmen, has absolutely no strategy other than the usual parade of doom and gloom and cutbacks in NHS spending, which will make it impossible to do what he says we should be doing.

NHS Dentists

12. Mr. David Kidney (Stafford): What progress he has made in establishing the commissioning of NHS dentistry by primary care trusts. [103204]

The Parliamentary Under-Secretary of State for Health (Mr. David Lammy): The Health and Social Care (Community Health and Standards) Bill was introduced on Wednesday 12 March. It proposes that each primary care trust be given a duty to secure or provide primary dental services to the extent that it considers it reasonable to do so.

Mr. Kidney : Does my hon. Friend accept that previous initiatives, such as investing in dentistry and locating an NHS dentist through NHS Direct, have run their course and still many adults cannot find a dentist who will accept them as an NHS patient? Does he agree that the day cannot come too quickly when PCTs commission services so that there is a full range of NHS dentistry services available? Will he consider taking interim action to ensure that NHS dental services are boosted now?

Mr. Lammy: I am grateful to my hon. Friend for his remarks. We were right to take short-term and medium-term steps to ensure that people had access to NHS dentistry through dental access centres and the NHS commitment scheme. It is now right to ensure that PCTs can commission for dentistry in their locality to meet local needs, and we have put the Bill before Parliament to do that. My hon. Friend campaigns for his constituents in Stafford, and his local PCT is keen to act in that respect.

Bob Spink (Castle Point): Does the Minister recall the Prime Minister's promise that everyone would have access to an NHS dentist by September 2001? That

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promise was broken: fewer than half the people in this country have such access. Why was the Prime Minister's promise broken?

Mr. Lammy: The hon. Gentleman asked me precisely the same question in January and today I will give him the same reply. The promise was not broken. People have access to a dentist through NHS Direct. Dentist registration numbers are up, as is the number of dentists. He will know that the number of people registered fell to 16 million under the Conservative Government, whereas it is now 23.5 million.

David Taylor (North-West Leicestershire): Is not access to NHS dentistry a particular problem in areas where the population is growing at a more rapid rate than the national average, as is true in some parts of the east midlands? Cannot some of the gaps in provision be filled by a more effective amalgam of action by the Department of Health, the British Dental Association and primary care trusts? Will my hon. Friend look into the particular problem in areas like mine?

Mr. Lammy: My hon. Friend will be pleased that I am in dialogue with the British Dental Association, and we propose dental support teams to target access problems in specific areas. I will ensure that his area is considered, along with many others, to make sure that constituents get access to a dentist.

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