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The Minister of State, Department of Health (Mr. John Hutton): Funding to provide security for GP premises is included in allocations to primary care trusts. I allocated an extra £108 million of additional capital to PCTs last year for 200405 and 200506, which enabled PCTs, when necessary, to fund further security improvements to GP surgeries.
Will my right hon. Friend use the Dispatch Box and, I hope, the good offices of the Opposition
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parties, to condemn unequivocally any assaults or attacks on people in the front line of our national health service, such as doctors, midwives, nurses and other people in doctors' practices who are doing a superb job, particularly in deprived areas such as my constituency where a tiny minority of people choose to vent their anger on NHS staff? Will he state now that he totally condemns that activity and provide adequate financial support for PCTs as they try to support our front-line health staff?
Mr. Hutton: Of course. I certainly condemn attacks on NHS staff as, I am sure, do all right hon. and hon. Members. It is impossible to imagine anything more antisocial than attacking NHS staff or vandalising or destroying NHS premises. I am aware of two GP surgeries in Nottingham that have recently benefited from significant additional investment to improve the security of their premises. That is right and proper and is the responsibility of PCTs.
My hon. Friend may be aware that the Healthcare Commission published its annual staff survey today and has produced some important figures showing, for the first time, a fall in the overall number of attacks and assaults being reported by NHS staff. I am sure that all right hon. and hon. Members welcome that progress.
Miss Anne McIntosh (Vale of York) (Con): Will the Minister join me in condemning any assault or attack on any member of NHS staff, whether a doctor, a nurse or ambulance staff? Is it not the case, as my hon. Friend the Member for Hexham (Mr. Atkinson) said, that it is now impossible in rural areas to see a GP on Saturday morning or to have a GP visit on Saturday morning? Surely that will lead to more protests and perhaps assaults on NHS staff because of sheer frustration?
I do not accept her description of out-of-hours services in her part of the country. Primary care trusts have a legal responsibility to provide out-of-hours services and they must contract with providers who meet the national minimum quality standards, which require GPs to be available to staff out-of-hours rotas and to make home visits when necessary. If the hon. Lady has evidence that that is not the case, she should bring it to me.
Mr. Bill Olner (Nuneaton) (Lab): The figure of £108 million that the Minister announced for primary care trusts to help doctors to combat vandalism in their surgeries is welcome. Can he tell us how much our primary care trusts will receive and how it will be distributed? I am concerned that that very good message does not always get through.
Mr. Paul Burstow (Sutton and Cheam) (LD): I echo the condemnation by the hon. Member for Nottingham, North (Mr. Allen) of assaults on NHS staff. Given the publication today of the Healthcare Commission's survey, which shows a reduction in the number of assaults being reported but that more than one in four NHS staff are the victims of both violence and abuse, and given that the costs of damage to property and injury to staff amount to £678 million a year, is it not time for the Government to consider legislation to ensure that those who are harmed and assaulted in our NHS are given the additional protection and certainty of stiffer penalties against those who assault them? That would send a clear message that we have no tolerance for such actions.
Mr. Hutton: I am glad that the hon. Gentleman welcomes the progress that has been made, even though he did so rather grudgingly. The penalties in the criminal justice system are a matter for my right hon. Friend the Home Secretary. My responsibilities and those of my ministerial colleagues are to ensure that whenever assaults take place, we do everything that we can to ensure that all the available evidence is in place so that the prosecuting authorities can prosecute. That is the most important contribution that the NHS can make, and we are encouraging it to do so.
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): The national service framework for older people sets out service models, actions and milestones for the NHS and social care to follow in the provision of services for older people with dementia. The Green Paper on adult social care, published yesterday, sets out our further proposals for improving services for all adults who need care.
Mr. Bacon: The future of Cygnet house, a care facility for the elderly with dementia in my constituency, is under threat from a review by the Norfolk and Waveney mental health trust. At its consultation meeting on 21 February, the trust met an overwhelming response from local people to the effect that Cygnet house must be kept open in some form and not go the way of Dennyholme, an excellent facility in Diss, which was tragically closed. Does the Minister accept that if public consultation means anything, it means listening to what local people actually say?
Of course the hon. Gentleman is right and the consultation must take full account of local people's views and give them appropriate weight. It is the responsibility of the primary care trust and the other officials working for the NHS in the area to ensure proper provision for all people with dementia. Increasingly, we are able to help many people with dementia to remain independent and in their own homes, and I have no doubt that that is what most of them want to happen for as long as possible. That has to be balanced with the need to provide residential and
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nursing care, and other types of long-stay care for those who cannot stay in their own homes. That is the difficult balance for his local trust to strike in reaching its decision.
Mr. David Hinchliffe (Wakefield) (Lab): I understand from the Library that in nearly 18 years here I have asked 3,684 questions. Unfortunately, I have not received as many answers. One question that I have asked successive Governments on many occasionsand it is very relevant to dementiais to define the boundary between means-tested social care and free NHS nursing care. In implementing the excellent Green Paper, will my hon. Friend look seriously at getting rid of that nonsensical boundary which unfairly discriminates in particular against people with dementia?
Dr. Ladyman: There is a possibilityno more than thatthat this may be my hon. Friend's last opportunity to ask a Health question. If it is, I may say how much the Government have appreciated the work that he has done over the years. I am sure that his constituents and everybody in the House will join me in wishing him well.
As my hon. Friend knowsbecause a day or two ago, his Health Committee quizzed me thoroughly on the issuewe are conducting a review of the way in which the eligibility criteria for NHS continuing care work. We will produce a national framework, and one of the aims will be to ensure that we have clear, objective means to discern where top band nursing care leaves off and where NHS continuing care comes in. We have to end up with a system in which everybody feels that they will be treated the same, no matter where they live. The NHS does not discriminate against people with dementia, who are as eligible for free NHS continuing care as anybody else, if they meet the necessary criteria.
Hywel Williams (Caernarfon) (PC): Bilingual older people with dementia can lose ability in their second language, which is often English. What provision is the Minister planning for people in that predicament who are assessed for NHS services in their second language?
Dr. Ladyman: Of course, the Welsh Assembly has responsibility for such matters in Wales, but I can tell the hon. Gentleman that we are making extensive efforts to ensure that people in England whose first language is not English have wider access to translation services, to which NHS Direct now provides access. That is part of the NHS offering that we must continue to work on and improve, and the hon. Gentleman is absolutely right: people cannot be assessed fairly if they cannot explain their needs. Yesterday's Green Paper on adult social care spoke of the need to start introducing self-assessment, but people who cannot use their own language in this context cannot communicate what they have decided that they need.
Mr. Eric Illsley (Barnsley, Central)
(Lab): Will my hon. Friend reject the recent guidelines from the National Institute for Clinical Excellence, which recommend the withdrawal, purely on cost grounds, of drugs to treat dementia? There has been a great deal of opposition to that suggestion.
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Dr. Ladyman: As my hon. Friend knows, NICE is independent of Government. It attempts to produce objective guidance, based on available evidence. The guidance to which he refers is open for consultation, and the Government are as free as anyone else to make their views known. We will do that, and this afternoon my right hon. Friend the Secretary of State will meet representatives from the Alzheimer's Society. We will respond to NICE later today, and copies of that response will be available in the Library and on the internet. We will make it clear that the institute should consider the wider cost implications of withdrawing those drugs, including the implications for families and carers.
Mr. Simon Burns (West Chelmsford) (Con): Is the Minister aware of the great concern among physicians, charities and carers that, if the preliminary NICE decision on Alzheimer's drugs is confirmed, it will have a disastrous effect on patients, and on their families and carers? Does he realise that withdrawing those drugs will create a perception that patients are being abandoned by the Government, and that an even greater burden will be placed on carers and the care services?
Dr. Ladyman: Of course I recognise those concerns. I want to put it on record that, when the NICE guidelines were first published, I spent two days ringing experts and lobby groups. I spoke to them about their response to the report and about what the Government were going to do, and I reassured them that we would make our position clear through the consultation. Many experts told me that they considered the decision to be flawed, either because it did not take into account sufficient evidence in respect of efficacy, or because the mechanism behind the review was flawed. Both those considerations will need to be taken into account when NICE determines the final content of the guidelines.
We should not speculate now about what that final guidance will contain, or about what we shall have to do as a result. However, I make it clear that, if the ultimate decision is that the drugs in question are ineffective and that there is no point in using them, we expect PCTs to deploy money that is not spent on those drugs on effective treatments for people with dementia and Alzheimer's.
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