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NHS Services (Rural Areas)
5. Mr. David Heath (Somerton and Frome) (LD): What plans he has to improve access to NHS services for those in rural areas. [162779]
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson): The Government are committed to ensuring that everyone has fast and convenient access to NHS services, wherever they live, at all times, and on an equitable basis.
Mr. Heath: Does the hon. Lady understand that many people in rural areas, particularly in the west country, feel that they are uniquely disadvantaged in terms of access to NHS services, whether in primary care, including dentistry and chiropody; acute services, with large distances between accident and emergency units; domiciliary care; and even services that are intrinsic to the community such as maternity services, with small baby units often under threat? Within the generality of improvements to the NHS, which I recognise and applaud, can the Minister now look at specific service delivery for rural areas so that people in rural areas have access to NHS services on an equitable basis with cities?
Miss Johnson: I am grateful to the hon. Gentleman for his acknowledgement of the progress that we are making. We also have 78 new rural one-stop primary care centres in place, providing easy access to health services, and we will have 100 rural one-stop centres by December this year. He mentioned that there is a question about dental access in his area, as he regards it. There are only 2,524 people per dentist in the Somerset and Dorset strategic health authority area, which is relatively well served—it is below the national average of 2,660 people per dentist. A good local service is therefore being provided in his area, which is reflected, for example, in the reduction in numbers of patients waiting for an in-patient appointment within the East Somerset NHS trust, with only 83 people waiting more than six months.
Jon Trickett (Hemsworth) (Lab): Should not health need be the key determinant of where resources go? In the rural communities I represent—former coalfield communities—rates of cancer, cardiovascular and respiratory problems and many other illnesses are startlingly high. When the time comes, will my hon. Friend pay particular attention to the formula whereby basic sums are allocated across the nation, and ensure that enough goes to coalfield areas such as Wakefield where there are a lot of health problems?
Miss Johnson: We are well aware of the health inequalities that persist, and are determined to tackle them. The formula for the distribution of funds to primary care trusts already reflects the existence of deprivation and health inequalities, but we will look at it again over the next few months. I can reassure my hon. Friend that the issue is very much on our agenda.
Dr. Richard Taylor (Wyre Forest) (Ind): Given the importance of local hospitals to people in rural areas, will the Minister tell us what progress has been made in the attempts to postpone implementation of the European working time directive?
Miss Johnson: We have had many discussions with colleagues about that important subject, which the hon. Gentleman is right to raise. Those discussions are continuing, and much effort has been devoted to finding a way of maintaining the services that we wish to maintain.
Hugh Bayley (City of York) (Lab): Does my hon. Friend accept that there is a shortage of NHS dentists in many rural areas? Is she aware that officials in her Department reporting to the Minister of State, my hon. Friend the Member for Doncaster, Central (Ms Winterton), are working on proposals to increase the number of dentists in training? Would the Department welcome an application from Hull York medical school to open a school of dentistry? Its brand of training focuses on training in the community, especially in rural areas. That might prove helpful.
Miss Johnson: I know of my hon. Friend's long-standing interest in dentistry. I am pleased to be able to tell him that we are currently considering where future opportunities might arise. My hon. Friend the Minister of State, who is listening carefully, assures me that she will bear in mind what my hon. Friend has said when investigating the possibilities offered by the York area.
Dr. Andrew Murrison (Westbury) (Con): I am sure the Minister agrees that community hospitals are particularly important in providing access to health care in rural areas. She did not seem to have much of a clue about the implications of the European working time directive for such hospitals, but will she reflect on the impact of the new general practitioner contract? GPs are currently declining clinical assistantships in community hospitals, which is endangering the future viability of a vital health service resource in many areas including my constituency.
Miss Johnson: Of course community facilities are important. Primary care trusts have recognised that. Having carried out surveys to establish what their local communities want, many PCTs are now providing many more services of the type provided by community hospitals, such as orthopaedic services and mental health services on an outreach basis. That is because we have devolved funding to local areas, which enables PCTs to buy health care that reflects the needs of their own populations.
Eye Treatments
6. Mr. Henry Bellingham (North-West Norfolk) (Con): When he next expects to meet representatives of patients' organisations to discuss eye treatment procedures. [162780]
The Minister of State, Department of Health (Mr. John Hutton): My fellow Minister of State, my hon. Friend the Member for Doncaster, Central (Rosie Winterton), met representatives of the Royal National Institute of the Blind and the Macular Disease Society in December to discuss photodynamic therapy. Ministers will continue to meet patient organisations regularly.
Mr. Bellingham : The Minister will know that a quarter of a million people in the United Kingdom suffer from age-related macular degeneration and are going blind. That includes many people in my constituency. The good news is that treatment is now possible through photodynamic therapy, but the bad news is that the Government deny the treatment on the ground of a shortage of trained professionals. Why does the RNIB say that the Government are wrong in their assumption? Why do most national health service centres continue to treat patients who are prepared to pay for private treatment?
Mr. Hutton: The hon. Gentleman is wrong on almost every count. It was not possible to implement the National Institute for Clinical Excellence guidelines within the normal three months' deadline precisely because we needed more staff and training. Indeed, the national institute recognised that when it recommended that we should take longer to implement the new service. We made it clear to the NHS that if the capacity is there, it should use it. That is precisely what is happening.
I am sure that the hon. Gentleman will be pleased to know that 95 per cent. of primary care trusts are funding photodynamic therapy in line with the NICE recommendations, including for some of his constituents.
Andy Burnham (Leigh) (Lab): I recently visited the Christopher eye hospital in Wigan, where patients who once waited months, if not years, for cataract operations under a previous Administration now wait just weeks. I am pleased that the hospital has been accepted as a regional centre for photodynamic therapy. It could begin to provide that treatment tomorrow, if necessary, but patients from Wigan continue to travel to Liverpool to receive it. Will the Minister look into whether negotiations could be held between our local primary care trusts so that the service is up and running in the next couple of weeks?
Mr. Hutton: I am happy to look into that. I am grateful to my hon. Friend for highlighting a significant achievement of the NHS in the past few years, which the hon. Member for South Suffolk (Mr. Yeo) was gracious enough to acknowledge yesterday. There have been 113,000 more cataract operations performed this year than in 1996–97 and we are confident that we shall get maximum waiting times for those operations down to three months by the end of the year. That is a significant step forward for the NHS.
Mr. John Baron (Billericay) (Con): Further to the question of my hon. Friend the Member for North-West Norfolk (Mr. Bellingham), the Minister will know about various independent claims, such as that of the RNIB, that, on average, more than 100 people go blind each week because of the Government's decision to extend the NICE guidance deadline on AMD because they believed that there was insufficient capacity to provide treatment. Yet up to 50 NHS centres throughout the country are equipped to treat patients, as the Prime Minister recently acknowledged in a letter to the Leader of the Opposition, and some primary care trusts, such as South-West Oxfordshire, clearly stated that the problem was not capacity but shortage of money. That is why so few extra patients have been treated since the NICE guidance was issued. Given that NICE confirmed at the press conference on 24 September that implementation would take place in three months, will the Government stop hiding behind NICE, realise that the cost of blindness far exceeds that of treatment and tell the PCTs to bring the deadline forward?
Mr. Hutton: Let us get one thing clear: we want to implement the guidelines as quickly as possible for the obvious reasons that the hon. Gentleman has stated. The advice that I have received is that AMD never results in complete sight loss, and I am therefore not sure on what basis the hon. Gentleman claims that people will go completely blind. I stress to Conservative Members, who raise the matter repeatedly, that we are making additional resources available to fund NICE guidelines.
I ask the hon. Gentleman and all Conservative Members who have made strong arguments about the subject to reflect on the fact that, in the 18 years that they had stewardship of the NHS, not a single initiative dealt with postcode prescribing and the subsequent unfairness in terms of access to medication. We have established mechanisms to tackle that, and we have invested resources. It is also worth remembering that when we had the opportunity to vote on establishing NICE, the hon. Gentleman and all Conservative Members voted against it.
Mr. Speaker: Order. I ask the House for co-operation. We have reached Question 6 and are about to go on to Question 7. We need shorter questions and shorter answers. I need hon. Members' co-operation.
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