The Secretary of State for Health (Ms Patricia Hewitt): The NHS has always made use of the private sector and will continue to do so to provide services when there are clear benefits for NHS patients through faster access, more choice, better services or better value for money for the taxpayer by helping to improve productivity and innovation All those services, however, will be absolutely consistent with the founding principle of the NHS: treatment based on clinical need and not on ability to pay.
David Taylor: In 1997, we promised to end the internal market and restore the NHS as a public service working co-operatively for patients, as opposed to a commercial business driven by profit and competition. Despite an historic level of investment, however, our county of Leicestershire now faces planned hospital cuts, ward closures and a loss of beds. Does the Secretary of State agree that her marketisation plans are going too far and too fast, and that we risk offering illusory patient choices that will widen inequalities in health and access to health care rather than narrowing them?
Ms Hewitt: I do not accept what my hon. Friend has said. As a result of our investment and reforms, we are already delivering substantially improved services to patientsto my hon. Friend's constituents, and to the public throughout the country. But my hon. Friend and I have been re-elected on the 2005 manifesto in which we promised to continue the programme of investment and reform, and to continue selective use of the independent and private sector where that would help us to secure better services for patients. That is what we are doing, and I hope that my hon. Friend will continue to support it.
Ms Hewitt: I think that "contestability" implies something considerably wider: the challenge that we need in the system so that where parts of the NHS are underperforming, patients will have a wider choice of providers who can help to raise even further the level of innovation that already exists in the NHS. I hope that the hon. Gentleman supports that. As a result of the changes that we have madethe granting of more freedom to foundation trusts, for instance, and the selective use of the private and independent sectorwaiting lists are falling faster, and services are improving faster, than many people thought possible three or four years ago.
Judy Mallaber (Amber Valley)
(Lab): My right hon. Friend's Department is currently market-testing purchasing and supply functions in the NHS, with the laudable aim of seeking additional savings for front-line
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care by expanding central purchasing. Will she assure me that no private sector bid will be accepted without a clear demonstration, to the satisfaction of Members of Parliament, that it can persuade more trusts and hospitals to purchase centrally, that the agency concerned is as efficient as NHS Logistics, which is currently expanding, and that all the safety issues have been taken fully into account?
Ms Hewitt: As my hon. Friend knows, we are considering how we can continue to improve the performance of NHS Logistics. No decision has been made, and no decision would be made to move to a different provider unless there was a compelling case for thatand there would, of course, be the usual consultation.
9. David T.C. Davies (Monmouth) (Con): If she will issue revised guidance on the performance of abortions following publication of the chief medical officer's report on the British Pregnancy Advisory Service. 
The Parliamentary Under-Secretary of State for Health (Caroline Flint): The Department of Health will be issuing best practice guidance for abortion services in spring 2006. The guidance will also take into account the issues raised by the chief medical officer's recommendations, including the legal position on abortion.
David T.C. Davies: The CMO's report makes it clear that the British Pregnancy Advisory Service was actively encouraging vulnerable women to undergo late-term abortions in Spain. Whatever the legality of that, will the Minister join me in expressing abhorrence of the fact that a publicly funded body is engaging in such a practice? Why do Islamic terrorist suspects and convicted criminals apparently have more human rights than unborn children?
Caroline Flint: Dearie dearie me. Never let the truth get in the way of aspersions. The fact is that, according to the evidence seen and legal advice, the BPAS did not break any law or give out a number knowing or believing that the Spanish clinic was performing illegal abortions. The Catalan health department found no evidence that the clinic had acted outside Spanish law. What the chief medical officer did identify is that we need to look more closely at, and review, the support and advice given to women who are seeking a late-term abortion, and that is what we are doing. We are meeting BPAS and others, and once the protocol has been established, the Department of Health and the Healthcare Commission will monitor it.
Chris McCafferty (Calder Valley)
(Lab): I am sure that women throughout Britain will welcome the Minister's saying that BPAS provides legal abortions in this country. Does she agree, however, that a revision of protocols on the performance of abortion is not required, rather what is desperately needed instead is better training for BPAS staff, who counsel women on
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the complexities of late abortions? Will she consider helping to fund such extra training, and will she look carefully at protocols to help staff in that regard?
Caroline Flint: I thank my hon. Friend for raising those issues, many of which are subject to the recommendations on training and support. We will work with BPAS and with primary care trusts to see how we can provide such support. I should make it clear for the record that 88 per cent. of abortions happen under 13 weeks, and 60 per cent. happen under 10 weeks. One reason why we have achieved that result is that we have made this a performance management subject for PCTs to deliver on.
10. Mr. Desmond Swayne (New Forest, West) (Con): What progress has been made to ensure that insulin pump therapy is available to diabetics in accordance with National Institute for Health and Clinical Excellence guidance No. 57. 
The Minister of State, Department of Health (Jane Kennedy): The House will be reassured to learn that a new insulin pumps working group has been set up by the Department of Health and Diabetes UK, in order to develop a strategy to support local services in implementing national guidance on insulin pumps. The findings will be fed into the NICE review of the insulin pumps guidance, which is currently scheduled for February 2006.
Mr. Swayne: Only some of the 2 million diabetics in this country have access to this treatment, while many do not. Does that not illustrate the postcode lottery that persists in our NHS? What recourse does an individual patient have if there is clear evidence that their PCT is not implementing the NICE guidance?
Jane Kennedy: Once NICE has issued guidance, we expect the NHS to take full account of it. The NHS has three months from the date of publication of guidance on technology appraisals to provide funding, so that clinical decisions made by doctors involving NICE-recommended treatments or drugs can be funded. Where there is evidence, however, that PCTs are restricting access to NICE-recommended treatments solely on cost grounds, we look to the strategic health authorities to intervene.
The Parliamentary Under-Secretary of State for Health (Mr. Liam Byrne): Selby and York primary care trust recorded a deficit of £6.6 million in 200405. It is working with its national health service partner organisations to put in place a financial recovery plan.
Is the Minister aware that the projected deficit could reach £47 million by the financial year 200708, and is he concerned that for every two
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GPs there is an administrator looking after them? Is he aware of the implications of the working time directive, the GP contract and the new consultant contract on the budget, and what is he going to do to reduce the deficit?
Mr. Byrne: I am well aware of those points. Having spent a little time looking at the health economy in Selby and York this morning, I hope that the hon. Lady will join me in celebrating the results of the record investment that has gone into her constituency. Cancer mortality is down by 10 per cent. in York and by 22 per cent. in Selby, and mortality from circulatory disease is down by 25 per cent. in York and by 19 per cent. in Selby. Only 449 people now wait more than six months for treatment in her PCT, and we plan to boost investment yet again. She points out that the deficit will grow to north of £40 million if no further action is taken, and I am happy to say that plenty of action is proposed. She will know that the deficit is currently only just over 4 per cent. of the £225 million that the PCT gets each year, and that over the next two or three years
Mr. John Grogan (Selby) (Lab): Can my hon. Friend confirm that the Selby and York PCT will continue its plans to rebuild the Selby War Memorial hospital? In the light of earlier answers, will he also confirm that, when that hospital is rebuilt, the local primary care trust will continue to be able to choose to employ staff directly there and, if it so chooses, to employ district nurses, who serve Selby so well, without central interference?
Mr. Byrne: First, may I congratulate my hon. Friend on his championing of the Selby War Memorial hospital, for which he has been an effective advocate for some time? I have reviewed the position and can confirm that plans for the Selby War Memorial hospital will press ahead and will be published at the PCT board meeting in December. As my right hon. Friend the Secretary of State has said, it will quite rightly be a local decision as to whether NHS staff continue to be employed locally.
Hugh Bayley (City of York) (Lab): Surely the key issue is that services to patients should not be cut as a result of the deficit. Given that the NHS budget for our local area has doubled, can the Minister give an assurance that, if a prompt recovery plan is brought into effect, services to patients will not suffer?
I am grateful to my hon. Friend for that question. We made a big promise to the British people in May: to transform our health services over the next few years from suffering the scandal of the year-and-a-half waiting lists that we inherited to one in which waiting lists are down to just 18 weeks. What is more, we shall put in the resources to deliver and to ensure that those are not just empty promises. One does not have to be a health economist, though my hon. Friend is one, to understand that investing another £80 million in the Selby and York PCT over the next few years amounts to eight times the deficit that is currently being recorded.
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