The Minister of State, Department of Health(Ms Rosie Winterton): May I apologise to you,Mr. Speaker, and the House for the fact that my right hon. Friend the Secretary of State for Health cannot be here this afternoon because of a family illness? She was able to speak to the Opposition spokesmen personally yesterday to explain her absence and I am grateful to them for their understanding.
Mrs. Hodgson: I welcome the fantastic progress in reducing cancer waiting times through the dedication and commitment of health service professionals and the extra investment in the NHS. However, is the Minister aware that cancer waiting times after first treatment remain a problem for all cancers, including prostate and bowel cancer, that the waiting times for endoscopy and colonoscopy have been a problem in the past and that, if the bowel cancer screening programme is to be successful, it is important that sufficient resources are put in place?
Ms Winterton: I am grateful to my hon. Friend for her remarks about the dedication and commitment of
the staff who do such work and about extra investment, with which I absolutely agree. The problems that are due to follow-up treatments often involve radiotherapy. We have done a lot to improve radiotherapy provision. Of course, if it is a first treatment, it counts in the waiting times anyway, but there are unacceptably long waits for the second stage of treatment in certain parts of the country, so we have been increasing the number of radiotherapy staff, both in post and in training. We have been making better use of existing staff and new investment in radiotherapy treatment facilities. For example, the number of linear accelerators has increased by about 50 per cent. There is some way to go, but I can assure my hon. Friend that we take this very seriously. We are doing what we can to improve the situation, but that is against a background of increased improvements over a number of years.
Michael Gove (Surrey Heath) (Con): The Minister will be aware of the direct threat to the upper gastro-intestinal cancer unit at Frimley Park hospital in my constituency, not least because I have written to her Department three times to request a meeting on behalf of Surrey, Berkshire and Hampshire MPs, and three times I have been told no. In the last letter that I received from the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint), I was told that a review of that decision would not be pre-empted, but I discovered the day after the letter was sent that interviews were taking place and decisions being made that explicitly pre-empted that review. Why cannot we have a meeting to ensure that that vital service, which contributes so much to health in the south-east, does not face imminent dismantling?
Ms Winterton: We must be absolutely clear about the process that takes place when we consider changing some of the cancer facilities. This is a classic example where cancer networks must look at some of the improving outcomes guidance, which shows that putting some of the cancers together in specialist centres actually saves lives. There is very clear evidence for that, and in a sense to ask for political interference would be wrong in a process that should be looked at very closely by those involved in the networks, which include clinicians, patient groups and representatives of the NHS. It is important that the review proposals are looked at very closely by the networks involved, and that process takes place for very good clinical reasons.
Jessica Morden (Newport, East) (Lab): I, too, welcome the decrease in waiting times for cancer care, but may I ask my hon. Friend for her assurance that cancers with lower profiles, such as myeloma, are not forgotten when we allocate resources?
Ms Winterton: My hon. Friend is right to say that it is important that some of the high-profile cancers are not given more attention than some of the less well known ones. That is why we constantly review things. That can be done through the clinical cancer networks and through the guidance that is issued by the Department in conjunction with the profession to make sure that the very best care is available for patients who suffer in some of those circumstances.
The Minister of State, Department of Health (Andy Burnham): The national programme is an essential part of creating a safer and more modern and efficient national health service. It is delivering integrated IT systems that are critical to the effective functioning of the national health service in ever-increasing numbers right across the countrynot least in the hon. Gentlemans constituency.
Tim Farron: The Secretary of State has told us that the connecting for health computer project will now cost £6.2 billion, but the chief operating officer of the project predicts costs in excess of £15 billion. Meanwhile, Westmoreland general hospitals coronary care unit in my constituency faces an uncertain future because of deficits that pale in comparison to those overspends. Will the Minister commit today to a full, independent, technical and financial audit of the project to ensure that public money is spent on the publics priorities?
Andy Burnham: The hon. Gentleman is right to say that this is indeed a major investment in the national health service. However, in contrast to NHS projects of the past, payment will be made only when the project is delivered. When the project is delivered, it will go further in improving patient care in the NHS. It will deliver more benefits to patients. I have looked at the hon. Gentlemans websites, where I read:
Local MP Tim Farron is leading national calls for an independent review.
If he is to be the self-appointed leader of the national debate on this important issue, may I appeal for less simplistic analysis and more attention to detail? The project will improve patient care and it will not help to make exaggerated and nonsensical claims about it.
Mr. Lindsay Hoyle (Chorley) (Lab): Part of that information technology has been NHS Direct. Chorley was the pioneer of NHS Direct, but we found out today that the Chorley centre is about to close, along with Bolton and Preston. Who is in charge of the Departmentthe Ministers or the chief executive? There is something wrong when people in Preston and Bolton who are being made redundant may be allowed to go to a new site, yet the people of Chorley have not been given the same assurance. Why not?
Andy Burnham: I hope that Conservative Members are cheering the success of NHS Direct, which is dealing with a huge volume of calls this year6.8 million. However, I recognise the concerns that my hon. Friend has raised and I understand why he is expressing them, given the news that has been put out today. NHS Direct has to take decisions to make sure that it can offer a sustainable service, given that it is handling an increasing volume of calls and dealing
with in excess of 9 million internet inquiries every year. My message to him is that there will be provision in the north-west. There is a possibility that a new servicea new NHS centrewill be located in the region of his constituency. I am happy to meet him and other colleagues who are affected by the changes to discuss those issues.
David Tredinnick (Bosworth) (Con): I am surprised that the Minister did not mention the launch yesterday of another NHS information service at the Royal London Homeopathic hospitalthe Complementary and Alternative Medicine Specialist Library. I have no doubt that he will have been fully briefed about that. That new service, which is extremely important and is backed by the Government, has one problem: many of the therapies provided by that one-stop shop are not yet available on the NHS. What is he going to do about that and what is he going to do about the alternative therapies that are available on the health service, such as homeopathy, which Nye Bevan used, but which is not widely understood or known about in parts of the country?
Andy Burnham: I am well aware of the hon. Gentlemans long-standing interest in these matters. Without a shadow of a doubt, he must have a glass raised to him at the Holland and Barrett annual shareholders meeting each year. I am not trivialising his interest and he raises an important matter, so I will examine it in respect of the IT systems and the other issues that he raises and write to him.
Margaret Moran (Luton, South) (Lab): Is the Minister aware that many Labour Members believe that the national programme will be transformatory for the health service, especially due to electronic prescribing and care service records? Will he ensure that IT systems are compatible and, in that context, investigate the Luton and Dunstable hospital and the Royal Free hospital? Electronic records have to be taxied between those two hospitals because of the mismatch of electronic data links. Will he ensure that there is compatibility so that we have a better patient service?
Andy Burnham: My hon. Friend makes an extremely important point, and perhaps the hon. Member for Westmorland and Lonsdale (Tim Farron) would do well to listen to it. The programme is being procured at a national level exactly to ensure that we get value for money with the systems and so that the systems are compatible. A key benefit of the new system will be that a patients record will be instantly available to a clinician wherever that patient presents in the NHS. I am sure that my hon. Friend will agree that that will be an enormous step forward that will end some of the paper chase that goes on in the NHS. It is a clear expression of why the system will deliver improvements to patient care and value for money.
The Minister got right to the point about the IT system when he said that it was about delivery. The
NHS needs an electronic patient record, but can he explain why it is more than two years late? The NHS also needs electronic prescriptions. According to the Governments targets, some 600,000 prescriptions should be transferred electronically each day, but the figure is in fact only about 13,000. The opportunity to make electronic bookings should mean that there are some 250,000 such bookings a month, but in fact there are only 20,000 a week. Can the Minister explain why the delivery about which he talks has so far failed lamentably on the Governments own targets?
Andy Burnham: I am grateful for both the hon. Gentlemans welcome and his broad recognition that modernising the national health service in such a way is the right thing to do. Rather than claiming that there has been no delivery, I can tell him that more than 1 million prescription messages have been issued via the new system and that 325,000 hospital appointments have been booked electronically. A key aspect of the way in which the programme is working is that the NHS pays only when the service has been delivered. The NHS has thus learned from past IT procurement and is doing the right thing by paying only when benefit is released to the service. I hope that the hon. Gentleman and his colleagues will support that approach.
The Minister of State, Department of Health (Caroline Flint): Investment of £1 billion in pay reform, including for nurses pay, has delivered a high earnings growth of 2.8 per cent. between October 2004 and October 2005. We have agreed a 2.5 per cent. pay uplift for 2006-07, which will again deliver strong earnings growth this year. This is a good deal for nurses. A newly qualified nurse will earn £19,166, which is a 55 per cent. rise since 1997. I believe that that compares favourably with a newly qualified primary school teacher earning £19,161.
Mr. Mudie: I am delighted that there has been a55 per cent. increase since 1997 and that the salary is just more than £19,000. A specialist nurse gets £23,000, so will the Minister outline whether Agenda for Change will give newly qualified nurses the opportunity to go on to that higher salary band?
Caroline Flint: My hon. Friend raises an important point. Agenda for Change is about completely transforming the way in which the pay bands operate to ensure that there is equal pay for equal value and, importantly, to give nurses the opportunity to progress up the scale. A senior specialist nurse can earn up to £31,000 and the salary for a nurse consultant rises up to £60,000. Part of Agenda for Change is job evaluation so that the skills and knowledge of individuals are examined and people can acquire skills and knowledge in order to move up the pay band.
Daniel Kawczynski (Shrewsbury and Atcham) (Con): Macmillan nurses at the Royal Shrewsbury hospital earn £5,000 less although they are on the same pay grade as similar nurses in Wolverhampton, which is just 15 miles away. We are concerned that, within such small regional areas, there is such a large difference in pay, with a possibility of poaching. What can the Minister do to reassure me on that?
Caroline Flint: I think that the hon. Gentleman raised that point in the Opposition day debate last week. He should understand that, for the first time, there is a pay band that covers both nurses and non-medical staff. Key to that is the job evaluation. He should be asking at local level about the skills and knowledge that are required of Macmillan nurses in one trust as opposed to another. We do not have regional pay scales, but the purpose of Agenda for Change was to have that job evaluation. Key to his point is the need to see what is expected of Macmillan nurses in one area and whether that is different from another area, and to take up the issue locally. That is important in defining what pay nurses of different types get in the area.
Mr. David Anderson (Blaydon) (Lab): What we just heard was good news, but is it good news if people looking for jobs do not have access to the benefits of Agenda for Change? Has the Minister had any discussions with the unions or the employers about the possibility of setting up a national redeployment, training and relocation scheme? Hopefully, that would address the point raised by my hon. Friend the Member for Chorley (Mr. Hoyle) and mean that no one who wants to stay in the NHS has to leave it.
Caroline Flint: I thank my hon. Friend for that question. He is absolutely right. I am pleased to say that NHS Jobs, which acts as a billboard for vacancies in the health servicea couple of hundred jobs for nurses are on the board currentlywill provide exactly what he says, which is a redeployment service for those who may find themselves without a job as changes take place in hospitals. I reassure him that, where trusts talk about job changes or losses, there might be some compulsory redundancies, but that would be a last resort and kept to a minimum. It will mostly be a case of freezing posts and making less use of agency and temporary staff. I am pleased to say that NHS Jobs will look at redeployment opportunities.
The Minister of State, Department of Health(Ms Rosie Winterton): Planned expenditure for mental health services in 2006-07 is still being negotiated as strategic health authorities finalise their local delivery
plans. In 2005-06, 11 out of 84 mental health trusts reduced planned expenditure by £16 million overall, while the complete expenditure increased by £368 million.
James Brokenshire: I thank the Minister for her response. At the last Health questions, she assured me that mental health services were one of her Departments top three priorities, notwithstanding existing NHS deficits. If that is the case, why is mental health not included on the list of the six key national NHS priorities specified in the Departments operational framework and setting out the key principles for financial management for health trusts for this current year? Does she appreciate that the effect of that is that spending on mental health services by health trusts is likely to be frozen or cut this year as a consequence?
Ms Winterton: We should be clear about the improvements that have taken place in spending on mental health servicesan increase of something like £1.6 billion over the past five years. Also, if we consider what happened last year, again, 11 out of 84 trusts reduced planned expenditure. They were going to spend £384 million more than they spent the year before, but in fact they spent £368 million. That means that overall expenditure on mental health has increased. It is clear, through the targets that have been set and the local delivery plans, that the actions we have adopted contributed towards that increase in mental health spending. Mental health under the previous Administration was a Cinderella service, suffering from years of underinvestment, unlike the situation under this Government.
Mr. Benyon: Berkshire Healthcare Trust faces cuts of £10.2 million in mental health care provision. One area particularly affected by those cuts is early intervention services which, as the Minister knows, are a key Government target in the national strategic framework for mental health. Will she carry out an assessment of the human costs of such cuts?
Ms Winterton: The hon. Gentleman is right that early intervention teams are important, which is why we introduced them. One of the many changes made under the Government to the delivery of mental health care is the greatly increased emphasis on care in the community. In Berkshire, I believe that the spending figure is about £200,000 less than was going to be spent, so it is not quite the same as what he suggested. I will look into his point, but I understand that the figure is about 0.1 per cent., because the overall budget is £77 million. There have been improvements in his area, and I hope that he welcomes them. I accept the point that he made about early intervention, and I will look at what cuts are proposed for early intervention teams, as I would be concerned about them.
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