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The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): There are 3,807 chiropodists employed in the NHS, which is a 15.9 per cent. increase since 1997. It is for local primary care trusts to determine local priorities for access to chiropody.
Dame Marion Roe: I am grateful to the Minister for that reply, but will he give the House his estimate of the number of patients with foot problems who have been deemed to be low risk and thus discharged from NHS care and forced to look in the voluntary and private sectors to find the specialist chiropody services that they need? What plans does he have to draw up guidelines on the management and treatment of foot problems to lay down a patient's minimum entitlement to NHS care and remove the current postcode lottery of entitlement to foot care?
Once upon a time there was such guidance on who should have access to chiropody services, but it was scrapped in 1994 under the previous Government. We have simply moved to a situation in which local primary care trusts are responsible for ensuring that everyone in their areas has access to the foot care that they need. Most PCTs are concentrating specialist problems on specialist chiropodists and thus leaving other organisations, such as those in the voluntary sector, to deal with less specialist needs, but each PCT has the responsibility to ensure that everyone in its area has access to the appropriate foot care.
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Miss Anne Begg (Aberdeen, South) (Lab): A number of senior citizens go to private chiropodists for their care. Has my hon. Friend assessed how many of those chiropodists will fail to register with the new Health Professions Council? One chiropodist in my constituency said that the process is very bureaucratic and expensive. My constituent would like to see automatic registration for anyone who has three years' experience. He thinks that the number of practising chiropodists will fall because they will no longer be able to practise under that title. That might cause a crisis and, obviously, difficulties for those who are receiving treatment under the NHS as well.
Dr. Ladyman: I understand the issue that my hon. Friend raises. These are matters, first, for the Health Professions Council. More importantly, they are negotiated closely with the professional bodies representing chiropodists and podiatrists. We try to meet their registration needs. Although individual chiropodists may have views about the democratic nature of the requirements for registration, I can assure my hon. Friend that the professional bodies that represent podiatrists are having their views closely adhered to by those who have to implement these arrangements.
Dr. Ladyman: I can certainly do that. The figures are roughly similar to the number of new starts in each year since we came to power. The total number of procedures carried out each year is roughly the same. There is a slight decrease, and that entirely reflects the fact that more specialist podiatrists are concentrating on specialist processes that take longer than the old, simple foot care procedures that are now being undertaken by people who are not specialists. That is good value for money. The assertions of Opposition Members that there is a massive removal of people from NHS podiatry services is simply not true. Like the Opposition's announcements yesterday from the shadow Chancellor of the Exchequer, their figures just do not add up.
The Secretary of State for Health (Dr. John Reid):
The new Gloucestershire Royal hospital became operational two months ago. A final phase of works of this £32 million investment is due for completion this year.
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Mr. Dhanda: I thank my right hon. Friend for his response. He is aware that the new hospital is a £32 million redevelopment project and consists of 17,000 sq m, something that we are understandably proud of in Gloucester. It has enabled me to become the first local Member in Gloucester in a generation to preside over hospital ward openings rather than closures. Would my hon. Friend take up an invitation from me to see the hospital for himself? I think that it would be the right thing to do. It would pay testament to a Labour Government and their priorities if a Labour Secretary of State opened the new hospital. Will he consider coming to Gloucester to do that?
Dr. Reid: I would be delighted to visit once again my hon. Friend's constituency, as I did in June last year. Before I get any other requests, it will not be possible for me to open all the hospitals commissioned by the Government. There are not enough weeks in the year as we have now commissioned 132 new hospital projectsthe biggest building programme ever in the history of the NHS. That is one of the reasons why we are slashing waiting lists and waiting times and providing better quality care than ever before. We have a long way to go, but my hon. Friend's constituency exhibits, I think, the transformation that is now taking place in the NHS.
Mr. Laurence Robertson (Tewkesbury) (Con): If the Secretary of State visits Gloucester Royal hospital, will he also visit Cheltenham hospital, which is facing the closure of the children's ward in terms of 24-hour clinical care? I do not rise to make a political point, but I think that it is worth mentioning that closure in view of the previous question. The primary care trust is pushing the transfer of the ward to Gloucester on a clinical basis, and recently there have been clinical questions raised about that transfer. I do not expect an immediate answer from the Secretary of State, but will he look into that matter? Will he satisfy himself that it would be in the wider interests of all the children in Gloucestershire for that move to take place, and will he endeavour to write to me about it?
Dr. Reid: May I make two general remarks to the hon. Gentleman? First, it would have been a little fairer if he had announced that, quite apart from any changes in his constituency, there is an unprecedented increase in the finance going into the national health service there. Secondly, on the decision and the proposed changes, the constant refrain, quite correctly, from the Opposition and their Front-Bench team is that we should stop micro-managing the NHS and let local people make local decisionsexcept when Conservative MPs do not agree with those decisions, when they ask us to intervene in every case.
I will take a look at this case, but my general predisposition is that, as far as possible, front-line staff should be allowed to get on with making those decisions in consultation with local people, which is why we now allocate 80 per cent. of the money going into the NHS to front-line staff. I should have thought that the hon. Gentleman and his colleagues, who are always asking for that, would support it when it is put into practice.
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The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson): On 15 March 2004, the Government published the alcohol harm reduction strategy for England. The Department of Health and the Home Office are the joint owners of that strategy. The White Paper, "Choosing Health", which was published on 16 November 2004, highlighted additional commitments that build on the strategy.
Sandra Gidley (Romsey) (LD): We are all aware that the Government have sexed down the alcohol reduction strategy, but could she explain a serious omission, as there is no mention of older people, among whom there is a growing problem of alcohol misuse? Is that yet another example of NHS ageism, or is it because older people do not present such a high profile problem on a Saturday evening at club and pub chucking-out time?
Miss Johnson: What we are doing, both through the alcohol harm reduction strategy and the White Paper, is to concentrate on finding out how much more treatment needs to be provided, and an audit is under way. We are also making interventions in primary and hospital settings to work out how we can better target people of all ages with alcohol problems who are using those services. Much of the improvement across the board in health services has helped elderly people as much as, if not more than, the rest of the population.
David Winnick (Walsall, North) (Lab): Is my hon. Friend aware that a recent report showed that one in four emergency hospital admissions for men is alcohol related? Alcohol plays a part in about half the number of serious road crashes and half of domestic violence incidents. In view of all that, does she agree that the Department of Health should be concerned about plans significantly to extend pub opening hours, which could lead to some pubs being open both day and night for 20 or 24 hours?
I am sure that my hon. Friend has seen an article in one of today's newspaper suggesting that we suppressed a report about the number of accident and emergency attendances that are alcohol related. In fact, it is completely untrue. [Interruption.] I am coming on to the related point that my hon. Friend made. Page 36 of the alcohol harm reduction strategy identifies the problem with reference to research commissioned by the strategy unit, and page 149 of the White Paper puts the same information into the public domain. I can reassure my hon. Friend that we are well aware of the problems in A and E departments resulting from alcohol, which is why we are looking at targeted interventions. We are working with the chief medical officer and the chief nursing officer on the curriculum, guidance and training for health service professionals so that we can deal better with people who come to the NHS the worse for alcohol.
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Mr. Simon Burns (West Chelmsford) (Con): May I press the Minister to pick up on the question from the hon. Member for Walsall, North (David Winnick), which she singularly failed to answer? Given the problems facing the health service because of alcohol-fuelled abuses and, in addition, attacks on NHS staff, particularly in accident and emergency departments, will the Minister share with the House the information or advice that the Department of Health gave the Home Office when it was considering relaxing the laws on licensing to allow 24-hour drinking? Does the Minister agree with her right hon. Friend the former Home Secretary who, it now transpires, did not agree with that legislation, even though his Department was responsible for it?
Miss Johnson: I agree with the Government. We are all aware that there are problems arising from binge drinking. That is why we are the first Government to set out a harm reduction strategy, and the first Government to produce a comprehensive White Paper[Interruption.]
We are the first Government to produce a White Paper that examines the problems arising from alcohol. My right hon. and hon. Friends in the Home Office have been tackling the disorder consequences of binge drinking with measures such as fixed-penalty fines, additional fixed-penalty fines, enforcement campaigns and new laws to close down premises if under-age sales occur. That is on top of the measures that we are taking in the health service. We all accept that more work is needed to clamp down on binge drinking. The problem is already with us and it has a long history. We have instituted the measures that will tackle the problem.
Ms Julia Drown (South Swindon) (Lab): I am grateful to my hon. Friend for meeting me and one of the leading consultants from the Great Western hospital who deals with the results of alcohol misuse and sees patients dying on our wards each day because of alcohol misuse.
Does my hon. Friend support the measures that doctors are pushing foralcohol warnings on bottles so that people know how much alcohol they are consuming; alcohol specialist nurses in our acute hospitals so that they can tackle people at the point at which they are potentially willing to change their mind, following an acute admission; and more education in schools about the damage that alcohol can cause to a person, their whole family and their friends?
We support a range of measures that my hon. Friend is probably aware of, including a new sensible drinking message based on research into how we change behaviour, targeting the interventions that I mentioned a moment ago in primary and hospital settings, and better advice and training for professionals. We also recognise that we need to do more about education on alcohol. All these topics form the basis of the alcohol harm reduction strategy that I mentioned.
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