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Ann Winterton: The Minister is talking about equality of opportunity in health. Will she say a word about the inequalities in the postcode prescribing of Herceptin? Having had a constituency case in which we fought for a young woman to be given that treatment, it was obvious that people living two miles down the road in another area had it as of right. What equality was there between those two examples?

Caroline Flint: We have clearly said and maintained that individual clinicians should consider with patients whether drugs such as Herceptin are an appropriate
 
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treatment choice, taking into account risks and medical history. We have also said that primary care trusts should not rule out treatments on principle, but should consider individual circumstances when reaching decisions and that they should not refuse to fund Herceptin solely on the ground of cost.

I am pleased to say that we have seen some huge improvements in other areas of cancer treatment in the past seven to eight years that have been of benefit to many people suffering from many different types of cancer.

Mr. Lansley: It would be courteous to my hon. Friend the Member for Congleton (Ann Winterton) to find out precisely what Government policy is. Clearly, primary care trusts in different parts of the country reach different decisions about whether they will fund Herceptin for breast cancer patients on the basis of their judgment of the clinical case rather than that of individual clinicians. Do the Government think that that is the right way to proceed? Do they accept that different decisions should be made in different parts of the country about an issue where a clinical judgment could potentially be made on a national basis?

Caroline Flint: It would be inappropriate to direct PCTs to have a standard position on a drug that is not yet licensed or appraised. The PCTs have the opportunity to make choices about their policy on that particular drug and we have made that clear. As with many such matters, PCTs should deliver what they think is right for their local communities and should take into account clinicians' advice as well as other issues, such as guidance from the National Institute for Health and Clinical Excellence.

Mr. Lansley: It is a simple point. It is perfectly logical for the Government to have said that PCTs must make a decision on an unlicensed drug, but why did the Secretary of State interfere? Why did she say such things if her intention was not to send a message that Herceptin would be available for early stage breast cancer?

Caroline Flint: I think that I am correct in saying that the Secretary of State was pointing out that cost was not the only factor that should be taken into account. Clearly, individual cases have to be suitable and other matters apply.

I want to return to my point about the major reasons for people dying an earlier death than we would hope. For example, circulatory diseases and cancer are responsible for approximately 50 per cent. of avoidable early deaths. Logically, it would be correct to focus on treating those diseases. However, as I said before, we should also target the underlying causes of ill health. Unemployment, the absence of support in early years, housing conditions, homelessness and other contributing factors mean that some individuals are more likely than others in their community or elsewhere in the country to suffer ill health.

Mr. Graham Stuart: The Minister will be aware that poorer people in rural areas are statistically invisible, struggle to access services and are disproportionately affected by closures and cutbacks at community hospitals. If the Minister believes in reducing health
 
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inequalities, will she reverse the ongoing cuts to community hospitals and make the welcome rhetoric of the White Paper a reality?

Caroline Flint: The hon. Gentleman is right to make the point about challenges in rural areas, particularly for those who might not have transport or who have low incomes. That is why health inequalities have to be tackled not only in urban areas but in other communities, and why programmes such as neighbourhood renewal funds are important.

On the hon. Gentleman's point about community hospitals, I cannot comment on his remarks about reversing cuts. One of the challenges is to meet the health needs of families, neighbourhoods and communities that are not getting the much closer and more personal health service that could make a difference and motivate them to consider aspects of their lifestyle that might affect their later years. One way of meeting that challenge is to examine the way in which some services could be provided closer to home.

My right hon. Friend the Secretary of State has said in recent debates that in areas where community hospitals or cottage hospitals have been identified for closure, it is important that the people involved in the planning arrangements take a hard look at the ways in which those hospitals could be refashioned or reorganised to provide services in the different ways suggested in the White Paper. I have taken part in a few Adjournment debates on this subject, and I am aware that some of the services being provided by the community hospitals are not necessarily the ones that most meet the needs of their community. It is important, whether in community hospitals or acute hospitals, to consider what is being provided and whether it meets people's needs. I hope that I have given the hon. Gentleman a full answer to his question.

Mr. David Drew (Stroud) (Lab/Co-op): May I say that my hon. Friend has got this absolutely right? One of the problems with rural areas is the disproportionate effect of funding being spread across the whole area and missing the pockets of real deprivation. This is made clear by the way in which some general practices operate. Will my hon. Friend take it from me that the best way to deal with this is—to use a horrible expression—to drill down and find out what the social and medical problems are in rural areas, and disproportionately to fund the people and places in greatest need? It is not fair that, too often, those people miss out because they do not have a voice. We hear the rhetoric that the funding is going to those people, but the reality is that it is not.

Caroline Flint: My hon. Friend makes an important point. One of the things that we can do at national level, in identifying this problem, is to ensure that the organisations that commission and provide services demonstrate how they are meeting the targets on health inequalities through the services that they provide and through the outcomes of those services. That is one way of incentivising local service providers, commissioners and GPs to understand the nature of the problems
 
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experienced by some of the people in their communities, and to look in different ways at the services needed to help us close the gap created by these inequalities.

Mr. Philip Hollobone (Kettering) (Con): In north Northamptonshire, alcohol misuse is becoming an increasing problem. Is tackling that problem moving up the Minister's list of priorities?

Caroline Flint: It is certainly there, along with a number of other issues, such as obesity and smoking. Alcohol is an interesting subject because there is evidence that its misuse takes place across different social classes. Yes, it is a problem for those in our poorest communities, but also for those who are better off. I am having discussions with the Ministers responsible for these matters in the Department for Culture, Media and Sport and the Home Office, and we are working with Ministers in the Department for Education and Skills on alcohol education in schools. We are also engaged in discussions with producers and retailers in the alcohol industry about what further information they could provide on packaging to inform people about safe levels of drinking. There is lot that we need to do to get people to understand the dangers. They might not think that they are drinking at an unsafe level, but, over time, they could develop real problems. This is an issue for young people, some of whom could have considerable health problems by the time they reach 30, if they do not reflect on the amount that they are drinking.

Several hon. Members rose—

Caroline Flint: I shall give way to my hon. Friend the Member for North-West Leicestershire (David Taylor), then to the hon. Member for Torridge and West Devon (Mr. Cox). Then I would like to make some progress.

David Taylor (North-West Leicestershire) (Lab/Co-op): I am grateful to my hon. Friend the Minister for giving way. One of the proudest achievements of our Government since 1997 is the establishment of the post of Minister with responsibility for public health, and a very successful one we have today, particularly in view of what happened earlier this week.

My hon. Friend has outlined a number of the significant gaps—between urban and rural areas, social classes, age groups, geographical areas and so on—but perhaps one of the most fundamental is a man-woman split. Will she say a little about the inequality that exists there in terms not only of the natural tendency of the male not necessarily to report or monitor his own health, but in some of the most fundamental diseases of all? An awful lot of investment has rightly gone into breast cancer, but less has gone into testicular and prostate cancer, where the outcomes for that extra £5 million, £10 million or £15 million would be even better. This is a difficult one, but what is she doing about it?


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