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The Parliamentary Under-Secretary of State for Health (Mr. Liam Byrne): Children with cerebral palsy can access the same range of NHS services as all other children. We recognise, of course, that children with cerebral palsy are likely to need access to those services more often.
Ms Keeble: I thank the Minister for that answer, but may I bring to his attention the case of the Cox family and their son, Aidan, who has cerebral palsy, and the outstanding work that they have done to raise funds for his care? What I and my constituents want to know is why there is such a gap in the provision of services for such children. Why will the NHS not take notice of parental preferences for carein this case, for Aidanand why will it not fund more proactive care, which this couple want for their son, to give him a real chance in life?
Mr. Byrne: I am grateful to my hon. Friend for discussing the case with me personally in the last two or three days. Children with cerebral palsy are, of course, first and foremost children, so it is for local clinicians together with the parents to take decisions about the right course of treatment. Quite complex packages will often be required and it is important for parents to make their own preferences clear to the clinicians in that process. PCTs are then free to fund whatever treatment they think is appropriate, provided that they do so on the basis of available evidence and are convinced of the effectiveness of the treatment proposed.
Mark Pritchard (The Wrekin) (Con): Is the Minister aware of the financial crisis in the Shropshire health economycurrently standing at a £35 million deficitthat will have a direct impact on children's services in my constituency and particularly at the Princess Royal hospital? Will the Minister give an undertaking today to allow an urgent cash injection to pay off that deficit
The Secretary of State for Health (Ms Patricia Hewitt): The independent external panel is advising me on proposals made by strategic health authorities for restructuring both those authorities and some primary care trusts. Where proposals meet the criteria that we set out at the end of July, they will go out to a full statutory three-month consultation. No decisions will be made on the reconfiguration of PCTs until the end of that consultation.
Charlotte Atkins: I am grateful to my right hon. Friend for that answer. Having met the leaders of my strategic health authority last week, it is clear that they intend to force through their unacceptable proposals for a massive Staffordshire-wide PCT and also a merged west midlands ambulance service. Will the expert external panel ensure that suitable and acceptable alternatives are put out to consultation so that my constituents can have their say on other alternatives to those proposed by the SHA?
Ms Hewitt: In response, let me stress that it is not up to the strategic health authority to force through any specific option. My hon. Friend has been assiduous in bringing this particular problem to my attention and we will shortly be writing to each strategic health authority in response to proposals and my noble Friend Lord Warner, the Minister with responsibility for delivery in the NHS, will be writing to all hon. Members to let them know our response to those SHA proposals in their particular area.
Dr. Richard Taylor (Wyre Forest) (Ind): With the proposed reduction in primary care trusts and strategic health authorities, many senior executives will face redundancy. Who will then be accountable for the specific changes that they will have instituted?
Ms Hewitt: Where an existing PCT has come forward with proposals for a new community hospital or improved services, for example, those proposals will be taken over, as the hon. Gentleman would expect, by the successor PCT where there is a change in reconfiguration. The board of the new PCT will remain accountable for those proposals, for the sound management of the PCT budget and for the delivery of the best possible NHS services to its community.
Mr. Brian Jenkins (Tamworth)
(Lab): Will my right hon. Friend issue instructions to the external panel on this issue? Many of us support having a review to save management and associated costs, so that the money can be passed to the front line. But given that the average number of patients in a west midlands PCT is 230,000, we regard with great difficulty the proposed figure of 730,000 patients for a shire county area. Such a PCT will not be local, and because we will need area managers, the funding savings that we are looking for will not be made.
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Ms Hewitt: I understand very well my hon. Friend's concern, and as we stressed at the end of July in "Commissioning a patient-led NHS", the issue here is to balance the need to retain a real understanding of the different needs of different local communities, while ensuring that PCTs have the strength and expertise to challenge, and to hold to account, acute hospitals. Those are exactly the kind of issues that the external panel is taking into account, but let me stress that it is an advisory panel, not a decision-making one. Ministers will decide which of the proposals brought to us by the strategic health authorities go out for consultation.
Damian Green (Ashford) (Con): I am delighted to hear that Ministers will take the final decision on such matters. When the Secretary of State takes that decision on the proposed Kent reconfiguration, will she note that the current proposals put the Ashford primary care trust into a west Kent configuration; and will she have a map with her, so that she can see that Ashford is actually in east Kent? The clue can be found in her own Department. The largest hospital in the East Kent Hospitals NHS Trust is in Ashford, so if she insists on proceeding with this unnecessary and disruptive reconfiguration, can she at least ensure that the Kent reconfiguration puts the right PCTs in the right part of the county?
The Parliamentary Under-Secretary of State for Health (Caroline Flint): The Department has recently released a number of research programmes on health inequalities, including "Tackling Health Inequalities: Status Report on the Programme for Action"; two reports commissioned for the UK presidency of the EU; and a further report, commissioned from the National Institute for Health and Clinical Excellence, on behavioural change, which is linked to the health trainer programmes currently covering disadvantaged communities. Moreover, a public health research and development consortium will address health inequalities as a key theme. All this research continues to inform how best to strengthen our ability to deliver on health inequalities.
I thank the Minister for her response. Does she realise that according to the "Tackling Health Inequalities" report, the relative life-expectancy gap between the average local authority in England and the fifth of local authorities with the lowest life expectancy has actually widened for both males and females? For males, the gap has widened by nearly 2 per cent.; even more worryingly, for females it has widened by 5 per cent. Will she acknowledge that this shows a worrying trend of increasing health inequality, and does she agree that any further market-based reforms would make the situation worse, not better?
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Caroline Flint: The short answer is no. This Government should be credited for identifying the existence of health inequalities in the first place, and we have set into play a number of activities, resourced and supported from the centre, to tackle them. The hon. Gentleman is right: the status report produced over the summerwe commissioned it so that we could actively monitor the situationdid show that the relative gap for life expectancy, and for infant mortality, had increased. However, it also demonstrated that infant mortality rates had fallen in routine and manual groups and in the total population. It further showed that life expectancy had increased for men and women in England, and in the PCTs with the worst health and deprivation indicators. We have also reduced the gap in cancer and circulatory disease mortality, and we are reducing child poverty and improving housing quality. We are moving in the right direction.
Mr. Kevin Barron (Rother Valley) (Lab): Does my hon. Friend agree that one of the most effective ways to reduce health inequalities is to have a comprehensive ban on smoking in all enclosed public places?
Caroline Flint : I am pleased to say that our proposals will cover 99 per cent. of employees and that the prevalence of smoking among adults is lower in England than anywhere else in the UK. That is due in no small part to the measures that we have taken to tackle the diseases linked to smoking and to provide free NHS smoking-cessation services, especially in our most deprived communities.
Mr. Owen Paterson (North Shropshire) (Con): Would the Minister like to come to Whitchurch, where there is consternation today after the publication of a pre-consultation study suggesting the closure of the local hospital as a way to reduce health costs in Shropshire? The county's acute trusts face a deficit of £34 million, but how will health inequalities be improved by closing primary care facilities, which are cheap, and pushing patients into expensive district general hospitals?
Mr. Speaker: Order. May I say to you, Mr. Stuart, that you shout a remark across the Floor of the House every time that a Minister speaks? I know that you are a new Member, but the worst thing that you can do is defy the Chair. You are beginning to go down that road.
One of the best things that we can do for the future of health services is to ensure that we devote as much attention to prevention and public health as we do to treatment. The health service is there to promote health as well as to provide treatment and our consultation exercise, "Your Health, Your Care, Your Say" is helping in that respect. Hospitals are part of the process, as are the services available in the communityand especially in our most deprived communities.
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Mrs. Louise Ellman (Liverpool, Riverside) (Lab/Co-op): Does my hon. Friend agree that allowing smoking in pubs that do not serve food and stopping it in pubs that do will increase health inequalities in places such as Liverpool?
Caroline Flint: The issues involved in smoking and health inequalities are complex. My hon. Friend will recognise the work done by the Department to tackle smoking in the home, where 95 per cent. of deaths caused by smoking occur. For example, we have aimed campaigns at parents dealing with matters such as smoking in front of children and other family members. Our proposals on restricting smoking are in tune with public opinion. Even in the drink-only establishments, they will provide protection from smoke for bar staff and other non-smokers. As I said, they are part and parcel of a comprehensive package designed to help people to give up smoking and to provide more choice for people who want to work and socialise in a smoke-free atmosphere.
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