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The Parliamentary Under-Secretary of State for Health (Mr. Liam Byrne): Patients from Leighton Buzzard and Linslade referred by their GP for urology have a choice of seven providers; Bedford hospital, Buckinghamshire hospital, East and North Hertfordshire NHS trust, Hinchingbrooke health care, Luton and Dunstable hospital, Milton Keynes general hospital and Cambridge university hospitals NHS foundation trust.
Andrew Selous: That is all very well, but residents of Leighton Buzzard and Linslade who depend on public transport often have great difficulty in getting to Wycombe hospital, to where much elective surgery that used to be performed at Stoke Mandeville has been moved. The combined population of Leighton Buzzard and Linslade is greater than that of Liechtenstein, and the Deputy Prime Minister plans to double the number of houses in the area. Given the Government's change of heart in respect of community hospitals, can that area be an early recipient of one?
I confess that it is some time since I compared the population of parts of the hon. Gentleman's constituency with that of Liechtenstein. However, the White Paper published yesterday set out proposals for moving care much closer to where patients
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live. We are also making sure that his constituents have a choice of seven providers, and I know that five of them are within a 30-mile radius of his constituency. We will back the reforms with substantial investment; a total of £75 million will go into his PCT over the next two years. I am sure that that will be very welcome for his constituents.
Mr. Paul Goodman (Wycombe) (Con): A petition signed by 40,000 people in the High Wycombe area who oppose the destabilising changes to which my hon. Friend the Member for South-West Bedfordshire (Andrew Selous) has just referred was taken to Downing street this morning. Given that, can the Minister say how many letters he has received from people in my area who support the changes?
Mr. Byrne: I will happily write to the hon. Gentleman with the precise answer to that question, as I did not furnish myself with the information before I came to the House today. However, the Government will expect his PCT to pay full attention to the White Paper published yesterday and to ensure that any proposals that they make are in line with the plans that we set out.
The Minister of State, Department of Health (Jane Kennedy): The National Institute for Health and Clinical Excellence is consulting on draft guidance on the use of drugs for the treatment of Alzheimer's disease. The consultation ends on 13 February.
Paddy Tipping: Does my right hon. Friend accept that the early prescribing of Alzheimer's drugs can lead to savings in both community and residential care, and is she confident that the methodology that NICE uses adequately reflects the cost of that care?
Jane Kennedy: NICE has taken account of the costs of full-time care in its current draft guidance on drugs for the treatment of Alzheimer's disease. It has looked at a range of costs, as opposed to a single figure that critics had previously claimed was too low. I stress that the consultation is still underway and NICE will listen to all the representations that it receives.
Jeremy Wright (Rugby and Kenilworth) (Con): The Minister will know that her Department has asked some very perceptive questions along the lines of the remarks by the hon. Member for Sherwood (Paddy Tipping). What are the Government doing to ensure that NICE gives satisfactory responses to those questions?
NICE has given satisfactory responses and is consulting on its proposed guidance to the health service. We trust NICE to carry forward its assessments and appraisals in a manner that is internationally respected. Indeed, only yesterday the South African Department of Health requested that all of the clinical guidance that NICE provides for our health service be
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sent to it so that the guidance can be used in South Africa to provide the services that the national institute recommends.
Liz Blackman (Erewash) (Lab): Professionals working in mental health for the elderly tell me that patients who score just above the moderate range for receiving drugs according to NICE's recommendations present very differently, with some needing significant support. Will my right hon. Friend consider that further, so that when firm recommendations are made we can be sure that the drugs will be targeted at all those who can benefit?
Jane Kennedy: I am aware of a range of academic views on the benefits of QALYS in reaching an assessment of clinical and cost effectiveness. I acknowledge that there is no perfect methodology, but we need to recognise that NICE is an international leader in its field and it is generally agreed that it produces guidance of the highest quality. I reiterate that we trust NICE to reach a judgment on this issue in the light of available evidence, which includes any evidence on those patients who will benefit the most.
Dr. Doug Naysmith (Bristol, North-West) (Lab/Co-op): My right hon. Friend is obviously aware, as we have just heard, that there is still some concern about the use of acetylcholine inhibitors in treating Alzheimer's disease in moderate disease only, but not in the early stages of the disease. There is also similar concern about erythropoietin, in that it is not to be prescribed on the NHS for treating the anaemias that often affect cancer patients. I agree with everything that my right hon. Friend says about NICEit does a rigorous job and is internationally respectedbut taking both of those examples together, it is clear that sometimes it looks only at survival rates and cure and does not pay enough attention to quality of life for patients and carers. Does my right hon. Friend agree that NICE could be asked to take more account of such factors than it does at present?
Jane Kennedy: If I thought that what my hon. Friend says is true, I would be seriously concerned. However, when NICE develops guidance on the clinical and cost effectiveness of health technologies such as the Alzheimer's drugs, it takes into account all the factors that he mentions, including quality of life, effect on carerswhen appropriateand savings both to the NHS and personal and social services. It is important that we view the NICE consultation on the subject in the context of all the other services that are available to people who suffer from Alzheimer's, and their carers and families. We are not talking only about a medicine, but a range of support, including psychiatric support and support for carers in a multiplicity of ways. We need to encourage the provision of such support.
The Minister of State, Department of Health (Ms Rosie Winterton): Waiting times for cancer patients have fallen dramatically in recent years. In 1997, 63 per cent. of people with suspected cancer were seen by a specialist within two weeks of urgent referral by their GP. Today the figure is more than 99 per cent. As at September 2005, 94.4 per cent. of patients were treated within one month of being diagnosed and 80.5 per cent. of patients were treated within 62 days of urgent referral by their GP.
Mrs. Hodgson: I agree that that is good news, but will my hon. Friend study early-day motion 1518 on the plight of two of my constituents, Mr. Fergus and Mr. Wilson, who are suffering financial and physical hardship due to the unfairness of the current system of withholding licensed cancer drugs pending NICE approval? Will my hon. Friend assure me that the postcode lottery in prescribing that denies them and many others equity will be addressed?
Ms Winterton: I shall certainly look at the early-day motion to which my hon. Friend referred. NICE has a clear role in appraising drugs, pulling together all the evidence to consider their cost-effectiveness and whether they will be effective in treatment. On 3 November, my right hon. Friend the Secretary of State announced a single technology appraisal process so that NICE can produce guidance on important drugs to a faster timetable. I assure my hon. Friend that we have made it clear to the NHS that it should not refuse to fund specific drugs or treatment simply because they have not yet been appraised by NICE. We shall update that guidance shortly.
Susan Kramer (Richmond Park) (LD): I hope that the Minister is aware that a number of people who turn out to have cancer or severe heart disease have to go privately to get a diagnostic scan; not to jump queues, but because many GPs have set the medical indicators so high that they do not catch early-stage cancer. Is the Minister willing to try to identify the number of people who have to take the private route to get life-saving treatment?
Ms Winterton: The hon. Lady is right to say that there is certainly more that we need to do to ensure that GPs can detect cancer in the early stages and we are doing further work to make sure that the situation improves, as well of course as looking into how we can improve the position with regard to scans, for example. There has been considerable investment, but we accept that there is more to do and we are doing it.
Mr. Andrew Lansley (South Cambridgeshire) (Con): The Minister must know that the specialist cancer services at the Barts hospital site in the Barts and the London NHS trust underpin cancer services across the east of London. The independent report on the Barts hospital redevelopment, published today, states:
In the light of that, will the Minister say, contrary to the Secretary of State's assertions on the "Today" programme last week, that the Department of Health has no reservations on the clinical case for the Barts and the London redevelopment?
Ms Winterton: We have now received the report from the strategic health authority and Ministers will consider the full findings of the review, but I can assure the hon. Gentleman that we are committed to delivering improvements to NHS services in that part of London and that as soon as Ministers have considered the full findings of the review, we will work quickly with the local NHS to finalise consideration of the business case for the Barts and the Royal London private finance initiative scheme.
Mr. Lansley: In responses to my questions, Ministers have told me that there have been 14 meetings since 22 September between the Department and the Barts and the London NHS trust. They must arrive at the point, today, where they make a decision, otherwise there will be rising penalties; £17.5 million a month will be added to the cost of the redevelopment as a result of the delays. We are more than a month beyond when a decision should have been taken. Will the Minister accept that the House will not stand by while Ministers delay a project and make it less affordable and less value for money due to their delays rather than its inherent costs?
Ms Winterton: May I just make it absolutely clear that we are now looking at the ninth draft of the final business case? It is essential that we have the right balance of services in north-east and wider London before, quite frankly, we make a commitment that will last for 42 years for cancer and cardiac services. It is right that we look carefully at the reports that we have before us and make a decision with all the evidence that is available to us.
Meg Hillier (Hackney, South and Shoreditch) (Lab/Co-op): My colleagues in east London completely agree that we should get good value for money and good provision of services in east London. In that respect, the Government are right to look at this issue, but why has the review taken place now at the twelfth hour?
Ms Winterton: Obviously, we must be absolutely certain before we commit what are, quite frankly, very large amounts of money to a scheme that it is properly thought out and will deliver the benefits to patients that we wish to see. I am sure that my hon. Friend would not want such a scheme to be set up if it had not been properly thought out and reviewed by Ministers to ensure that it delivered for patients, certainly in that area of London.
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