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Cystic Fibrosis
2. The Reverend Martin Smyth (Belfast South) (UUP): What assessment he has made of the treatment required for cystic fibrosis. [162776]
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): Current treatment comprises physiotherapy and medication to counter infections, assist nutrition and improve lung function.
Rev. Martin Smyth: I thank the Minister for his answer. Does he agree that in cystic fibrosis week we should remember the society that worked for 40 years to develop understanding of the condition? The defective gene was discovered in 1989, but the society still needs help to care for 7,500 people on the register, with more being added daily. Does he acknowledge its attempt, over the next five years, to reach a target of £15 million to improve therapy, and what are the Government doing to assist?
Dr. Ladyman: The hon. Gentleman is quite right—this is a pernicious disease that is incurable at the moment. We need to go much further to develop new therapies for the disease, and gene therapies obviously give us the best hope of doing so. We recognise that through the genetics White Paper, with £2.5 million specifically intended for cystic fibrosis research. In addition, there is a further £4 million to improve researchers' access to the vectors necessary for research, £1 million to investigate the long-term safety of gene therapies, and £3 million for single gene disorder research, including research on cystic fibrosis. We therefore acknowledge the importance of that research, and are putting the money in to make sure that it happens.
Kevin Brennan (Cardiff, West) (Lab): My hon. Friend is right about the importance of research into single gene disorders such as cystic fibrosis and, indeed, Duchenne muscular dystrophy, on which there was recently an Adjournment debate to which he replied. Can he tell the House when he expects an announcement to be made on how the money in the genetics White Paper for single gene disorder therapy research is likely to be distributed?
Dr. Ladyman: I cannot give my hon. Friend a specific date, but an announcement will be made as expeditiously as possible in the not-too-far-distant future. He mentioned Duchenne muscular dystrophy, so he will be interested to know that as a result of the money that we are putting in and the Government's investment in gene research, more than half of the gene therapy research projects in Europe are now being carried out in this country.
Ann Winterton (Congleton) (Ind Con): I agree with the Minister and welcome the fact that treatment for cystic fibrosis over the past two to three decades has improved dramatically, ensuring longer life and a better quality of life for people afflicted with the disease. We also trust that research on genetic material from adult
stem cells will result in better treatments in future. However, does he accept that early diagnosis is important to cystic fibrosis and other conditions?
Dr. Ladyman: I absolutely accept that early diagnosis is necessary, and we are working to make sure that there is universal screening of the new born to see if they have cystic fibrosis. That provision will be implemented in the next year or two, and we are also making checks widely available during pregnancy to screen for the abnormality. We entirely accept the hon. Lady's points and are rolling out screening as rapidly as possible.
Health Care (Droitwich Spa)
3. Mr. Peter Luff (Mid-Worcestershire) (Con): If he will make a statement on health care provision in Droitwich Spa. [162777]
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): South Worcestershire primary care trust is responsible for commissioning health care in Droitwich Spa to meet national and local priorities for improving health, tackling health inequalities and modernising services. Over the current three-year period, South Worcestershire's allocation will increase in cash terms by £60.6 million or more than 30 per cent. That is a significant level of investment and will deliver real benefits and results for the people of Droitwich Spa.
Mr. Luff : Is the Minister aware that Droitwich Spa is in danger of becoming the Cinderella of the health service in Worcestershire and, probably, the whole of the west midlands? It has no community beds, its hospital has closed, its bus service to Worcestershire Royal hospital is being cut and now, thanks to retrospective funding rules imposed by the Department upon the primary care trust, an innovative programme for a new one-stop shop, the lynch-pin of which was a new health centre, looks to have been abandoned. May I urge the Minister to look again at the application of those funding rules, not just for Droitwich but for seven other important projects in Worcestershire, and to ensure that Droitwich can get the full invitation to the national health service spending ball about which his colleagues speak so frequently?
Dr. Ladyman: I find it pretty incredible that the hon. Gentleman should claim massive cuts on such a scale when a huge extra investment is being made in his area. I entirely accept that decisions are now being made locally about where expenditure is to be made, but the scheme he mentioned in Droitwich Spa has not been abandoned. It is simply one of the eight schemes that will be prioritised locally. The Government have decided that decisions should be made where decisions are best made: by local people in the local area. We will allocate money for those schemes and local people will make the decisions about which ones go ahead.
Mr. Michael Foster (Worcester) (Lab): The decision by South Worcestershire primary care trust temporarily to suspend the work on eight GP premises affects plans for the Newtown road development in my constituency. I understand that the primary care trust is awaiting an
allocation of funding from the Department. I stress how important the development is to my constituents. Can my hon. Friend give a speedy response on the allocation, so that locally we can once again start debating how extra NHS resources are spent, instead of talking about cuts?
Dr. Ladyman: I can give my hon. Friend the assurance he seeks. The decision on the allocation of funds is imminent. It will be made very shortly. Once the money has been allocated, the decisions will be made locally, and I am sure my hon. Friend will make representations to the committee that will make those decisions. I stress again that decisions used to be taken at the centre by Ministers in Whitehall. We decided that the most appropriate place for those decisions to be taken was in localities, so we gave the money to the localities to make those decisions. There has been no abandonment or hold-up.
Sir Michael Spicer (West Worcestershire) (Con): The Minister has not answered the question from my hon. Friend the Member for Mid-Worcestershire (Mr. Luff) about why the Government or the Minister have changed the private finance initiative rules in such a way as seriously to affect capital projects throughout Worcestershire.
Dr. Ladyman: This has nothing to do with PFI schemes; it has to do with the funding of GP premises. I accept that the closure date for projects to be funded from the centre was made retrospectively. That was to stop what would have happened otherwise—a large number of poorly quality-controlled projects being pushed through early to get them under the wire. We took the half-year point as a cut-off point between when decisions would be made at the centre and when they would be made locally. Now the schemes to which the hon. Gentleman refers, including five in his constituency, will be prioritised locally. I very much hope that all five will go ahead, but it will be a matter for local decision-making, which is as it should be.
Senior NHS Management
4. Mr. Archie Norman (Tunbridge Wells) (Con): What plans he has to develop senior management within the NHS. [162778]
The Secretary of State for Health (Dr. John Reid): Although NHS managers represent less than 3 per cent. of the work force, they play a vital role in supporting clinical staff to provide the very best care to patients. They are being offered high quality development programmes to maintain and develop their skills and to help them to carry out their key leadership role to the highest standards.
Mr. Norman : As the Secretary of State knows, I welcome the steps that have been taken—the leadership programme and so on—to develop managers in the NHS, but is he fully aware of the urgency of the situation? Only last month the Commission for Health Improvement called for a new generation of managers in the health service. The average tenure of a chief executive in the health service is reported to be only 700
days, but if the Secretary of State has different figures, perhaps he will let us know. This morning his office reconfirmed to me that it has no idea of the background of existing chief executives or where they came from. Will he tell the House what steps are being taken to assess the existing management pool, and to bring in new management talent and fast-track clinicians into management? Without that happening, would not the Government's policy be all about money and not enough about people?
Dr. Reid: The hon. Gentleman brings a great deal of experience—and, if I may say so without irrevocably damaging his career, a great deal of sense—to most of his contributions. However, I do not think that he was quite accurate on a couple of points there. First, we have a good idea of where the people at executive board level come from—[Interruption.] Well, I can tell him now that 30 per cent. of them come from a clinical background, about 20 per cent. from a managerial background, 18 per cent. from a nursing background and only 14 per cent. from a financial background. That seems to give the lie to the hon. Gentleman's second point.
However, I think that the hon. Gentleman and I agree that, in the midst of what is, by any standards, a huge, almost revolutionary, transformation of the national health service, there is a huge premium on personal quality and on the development of managerial skills. We are trying to achieve that both inside the NHS, through the leadership programmes, and also—I say this unashamedly—by learning from outside.
Throughout the national health service, we are trying to learn best practice from outside management and to recruit externally. The Modernisation Agency is applying, among other things, the theories of lean manufacturing to NHS management. That theory was most famously demonstrated by the transformation of the Toyota group. We are talking about a huge revolutionary transformation and revitalisation of the national health service, and the hon. Gentleman is right to say that it will depend a great deal on the skills of management locally and not just on the skills of Ministers at the centre.
Laura Moffatt (Crawley) (Lab): Does my right hon. Friend agree that another excellent way to encourage existing NHS staff to think about a management role is through the leadership schemes in which the Royal College of Nursing is involved? I was delighted last week to welcome a group of nurses from the Surrey and Sussex Healthcare NHS trust, who were extremely well supported by their existing management and by an executive board member to whom they have direct access. They came to Parliament understanding the processes involved, and they are really developing their skills so as to be able to take on the role of managers in the future.
Dr. Reid: Absolutely. This is not just a matter of the providers being extra-skilled or developing their own responsibilities and skills; it is also about the benefit to patients. This morning, I was given a report by Sir George Alberti, a national director for access to emergency services, about this winter. We have done very well this winter, although I am not in the least
complacent; we could always have some unforeseen circumstances in the future. However, there has been a marvellous increase in the quality of treatment and care, and a decrease in the crisis level, because of the superb contribution of NHS staff, not least the nurses, including nurse practitioners, nurse consultants and nurse specialists who are now doing jobs hitherto denied to them and making a marvellous contribution to the health of the nation. I congratulate them, as I do my hon. Friend the Member for Crawley (Laura Moffatt) belatedly on her 50th birthday yesterday.
Mr. Andrew Lansley (South Cambridgeshire) (Con): I am sure that the Secretary of State will agree that leadership and good management in the NHS are essential to achieving the NHS's objectives. Does he also agree, however, that this is not about the quantity of management so much as the quality? Why, then, did he last week seem to applaud the fact that the number of managers in the NHS was rising at twice the rate of the number of nurses? Indeed, over the past decade, the number of managers has risen at three times the rate of the number of nurses. Is it not the case that the number of managers is increasing at that much higher rate simply to deal with the bureaucratic impositions of the Government, including the 206 external controls that the Treasury admitted last week were being imposed on NHS managers? If the Secretary of State can get rid of those, good managers can be given the opportunity to manage.
Dr. Reid: The hon. Gentleman starts off by saying it is not about quantity, it is about quality. Then he proceeds to peddle myths about quantity. Let me destroy the myths. First, senior management in the national health service, at 32,000 personnel out of 1.3 million, is less than 3 per cent. of total management. That is leaner and fitter than the private health sector. Secondly, since 1997, 224,000 more staff have been in the NHS, 13,000 of whom—5 per cent.—have been managers. Thirdly, in the past 12 months, 59,000 more staff have been in the NHS, of whom 3,000—no more than 5 per cent.—were managers. Will he stop peddling this myth, particularly when 87 of the 165 Conservative MPs are on the Front Bench, so 53 per cent. of them are senior management? They therefore have no right to talk.
Mrs. Anne Campbell (Cambridge) (Lab): May I draw my right hon. Friend's attention to a specific management issue in the NHS? Research by Breakthrough Breast Cancer has shown recently that 98 per cent. of patients referred urgently by their GPs to a breast cancer specialist see one within two weeks, on which I congratulate him. Is he aware, however, that many women are referred as routine cases, which can take much longer—sometimes up to 17 weeks? The specific issue that I want to bring to his attention is that 42 per cent. of GPs do not receive any feedback about the accuracy of their referrals. I hope that he will look into this matter and investigate it.
Dr. Reid: I am not sure that I agree entirely with the figures that my hon. Friend uses, but I agree with the general thrust of her comments. Now that the Opposition have accepted that significant
improvements are happening in the NHS, I hope that we will reach a balanced appraisal of just how far we still have to go. It is the case that 99 per cent. of women whom doctors suspect of having cancer are seen by specialists within a fortnight. Nevertheless, it is estimated that about 30 per cent. are not picked up as suspected cancer cases in the first instance. That troubles me, and it is a matter to which we are giving our attention.
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