The Minister of State, Department of Health (Andy Burnham): Provision of complementary and alternative therapies on the NHS is a matter for primary care trusts and local NHS service providers. The Government believe that decisions on individual clinical interventions, whether conventional, complementary or alternative, are for local determination.
Norman Baker: I hear the Minister and sympathise with his philosophical position. However, therapies such as acupuncture and Alexander technique are proven to be effective and cost-effective, but access on the NHS is difficult, with hurdles all over the place. What steps will he take to ensure that such therapies, which are proven to work, are available on the NHS to people who want to use them? Will he ensure that comparisons between conventional medicine and alternative therapies are made on the basis of sound science rather than of prejudice?
Andy Burnham: The hon. Gentleman knows that we have provided more information about the available complementary therapies. Recent figures show that around 50 per cent. of GPs are making such therapies available to patients and evidence shows that people are getting access to those services. Of course, they should always be based on the evidence available and a balance must be struck. However, locally, the matter is for clinical decision and it would be wrong to mandate such treatment or to rule it out from the top down. It is for doctors to decide.
David Taylor (North-West Leicestershire) (Lab/Co-op): The Minister is absolutely correct in saying that, when NHS budgets are under such severe pressure, patients, clinicians and taxpayers are best served only by treatments whose efficacy can be shown to be based on solid evidence. Is it not the case that too many homeopathic and other treatments are not subject to the rigorous testing that is routine for pharmaceutical products? As a result, they can produce known adverse effects, or show no demonstrable or discernable benefits whatever. Is not that a bit of a con?
Andy Burnham: I agree that such treatments or therapies should be prescribed or made available to patients on the advice of a clinician, and that that judgment should be made in the best interest of the patient. When there is doubt about the evidence base for a treatment, people should err on the side of caution.
Mr. Nicholas Soames (Mid-Sussex) (Con): There is a great deal of controversy in the health service about the benefits or otherwise of alternative therapies, but, given that some people feel strongly that they have substantial benefits, should not the Government give primary care trusts some form of guidance on this issue? Perhaps it could take the form of a code of best practice to advise on how best to provide treatments to which many people attach the greatest possible importance.
Andy Burnham: The hon. Gentleman makes a reasonable point. There are obviously strong views at either end of this argument. Some people are passionately in favour of the availability of complementary medicines, but some senior clinicians recently wrote in the newspapers that they were very much opposed to them. It seems to me that the right ground in this case is the middle ground
Andy Burnham: The middle ground, not the third way. We should encourage people to use local clinical discretion. Although we have made more information on this subject available, not least through the Foundation for Integrated Health, we need local decision making.
The Secretary of State for Health (Ms Patricia Hewitt): Allocations to the West Gloucestershire, Cheltenham and Tewkesbury, and Cotswold and Vale primary care trusts totalled more than £561 million in 2005-06an increase of about 30 per cent. over the past three years.
Mr. Drew: I thank my right hon. Friend for her response, and I apologise for the typo in the question. It should of course say Avon, Gloucestershire and Wiltshire strategic health authority, but that somehow got lost in translation. It would, however, be much easier if we were just dealing with Gloucestershire. The letter that the Minister of State, my hon. Friend the Member for Don Valley (Caroline Flint), sent to the hon. Member for Tewkesbury (Mr. Robertson), whom I see in his place, concluded by saying:
However, we would expect the new organisations to inherit the liabilities and obligations of predecessor organisations.
If that is the case, would it not be appropriate to have complete transparency within a strategic health authority such as Avon, Gloucestershire and Wiltshire, so that we can understand exactly where the deficits have come from? There is a great deal of unfairness involved in offloading deficits on to areas that have not created them, and the people involved believe that they are quite within their rights to feel let down.
Ms Hewitt: My hon. Friend is absolutely right about the need for transparency, but there was no such transparency in the past. Underspending areas, often in much poorer parts of the country, were constantly bailing out overspending areas of the NHS, which were often in the better off and healthier parts of the country. We are creating the transparency that my hon. Friend mentioned, as well as asking each strategic health authority to ensure that its area returns to balance. Where an organisation is overspending, and particularly if it is going to take more than a year to get back into balance, other organisations will have to hold back on the improvements that they want to make. However, that all needs to be open, transparent and understood. In particular, the organisations that are overspending need to take decisionsdifficult though some of them will beto ensure that they give their patients the best possible care within the substantially increased budgets that we are continuing to give them.
Mr. Laurence Robertson (Tewkesbury) (Con): In the letter to which the hon. Member for Stroud (Mr. Drew) referred, which followed a two-hour Adjournment debate that I had last week, the Minister of State, the hon. Member for Don Valley (Caroline Flint), attempted to explain the position with regard to the recovery of the financial position. There is a great deal of confusion surrounding this issue, however. The question to which we are trying to get an answer is: do trusts have to achieve a month-by-month balance towards the end of this year, or do they have to have a full-year balance, including the historic deficits? If the Secretary of State could answer that one question, it would clear up an awful lot of confusion. The answer will determine the degree and the level of the cuts that the primary care trusts will inflict on everyone.
The national framework that we have set out is quite clear. We will return the NHS as a whole to financial balance by the end of March next year. Within that, we would like all overspending organisations to achieve a
monthly balance between income and expenditure, again by the end of March next year. Some will not be able to do so, but overspending in one organisation will have to be matched by underspending in another.
The proposals for Gloucestershire and the wider region have not yet been finalised. Not only is local consultation taking place on the proposals that are being made, but discussions are continuing between the strategic health authority and my Department so that we can be satisfied that the proposals will achieve the best possible patient care and return the region to balance as quickly as makes sense. I know that the hon. Gentleman and other Members representing the area will continue to participate in those discussions.
Mr. Andrew Lansley (South Cambridgeshire) (Con): Does the Secretary of State realise that primary care trusts in Gloucestershire are currently planning not only to recover deficits and restore balance this year, but to do so after having their budgets top-sliced so that Gloucestershire is contributing to deficits in Avon and Wiltshire as well? That could have substantial consequences for services in Gloucestershire. As the hon. Member for Stroud (Mr. Drew) is aware, the closure of Stroud maternity unit is being contemplated. Will the Secretary of State tell us whether she intends the PCTs to go beyond restoring financial balance and initiate a cut such as that closure?
Ms Hewitt: I have made it very clear that we expect each of the regions to establish financial balance. Within that, there must be discretion for specific areas and organisations. I have spelt that out, and we repeated it most recently in the report on the financial situation that I published alongside the chief executives report.
What the hon. Gentleman has said reflects the fact that not only has there been overspending in Gloucestershire, despite substantial increases in the budgets, but there are even larger problems in Avon and Wiltshiremany of them deep-seated problems that have been continuing for years. For far too long, those organisations have expected other parts of the NHS to bail them out.
None of the proposals has been finalised. The plan for Stroud maternity unit needs to be considered on the basis of what will give women the best and safest maternity services within the budget that is available to that health community. I hope that instead of continuing to pretend that an unlimited sum is available and difficult decisions never have to be made, the hon. Gentleman will support the NHS in every part of the country, helping to ensure that it can provide the best possible services for patients and the best value
The Secretary of State is trying to resolve the situation in a single year. The point is that Gloucestershire is prepared to try to resolve its financial deficits; what it objects to is having to contribute this year, on top of that, to the resolution of deficits in other places some of which have been around for years, and will be around for years.
I return to the question. We have asked the Secretary of State repeatedly to avoid short-term, financially driven cuts that will be to the long-term detriment of the service. In her manifesto, she said
By 2009 all women will have choice over where and how they have their baby.
Thousands of women in Stroud and related areas want to be able to choose to have their antenatal care or delivery at Stroud maternity unit. Will the Secretary of State promise that in 2009 they will be able to exercise that choice?
Ms Hewitt: Those are decisions that need to be made locally and on the basis that the best and safest care is provided to all patients, within the available budget. As I understand the current proposals, Gloucestershire SHA will contribute some £6.5 million to the regional reserves, with somewhat more being drawn down in that county to compensate for the overspending in its health service. In the maternity services, continuing support will be given to providing home births for those women who choose them and for whom they are safe, although midwife-led care must also be available as part of the broader service. Those difficult decisions will be made locally, in the context of the Governments very generous national settlement.
The Secretary of State for Health (Ms Patricia Hewitt): In the White Paper that we published in January, entitled Our Health, Our Care, Our Say, we set out proposals for making further improvements to end-of-life care, so that many more people are able to choose where they are cared for at the end of their lives, and where they die.
Helen Jones: I am grateful to my right hon. Friend for that answer. There is no doubt that there is good practice in the hospice movement and in some parts of the NHS, and that there are good palliative care consultants, but will she say what steps she is taking to ensure that the lessons learned, and the expertise developed, in those settings are shared with other parts of the NHS? In particular, how is that experience being used to help those dealing with patients who wish to spend their final days and weeks in their own homes?
Ms Hewitt: My hon. Friend is absolutely right. Part of what we are doing is to establish everywhere end-of-life care networks that draw on the expertise available in some parts of the NHS and in the Marie Curie cancer care programme. We will continue to develop the training programme that has ensured that many more community-based staff are trained in palliative care. We must ensure that more palliative care and hospice services are available, both in the community and in peoples homes. In that way, the majority of people who would prefer to die at home or in a hospice will no longer be forced to die in hospital, which is where most people die at present. That is another example of the shift of care from hospitals into the community, which is the best care that we can offer patients.
Bob Spink (Castle Point) (Con): I thank the Secretary of State for the help that the Government have given recently to plug the short-term funding gap for childrens hospices. Will she say something about how we can get together with the Association of Childrens Hospices to develop a fair, sustainable and long-term funding policy for hospices?
Ms Hewitt: The hon. Gentleman raises an extremely important point, and I am delighted that we have been able to make that funding available over the next three years, beginning in this financial year. It will ensure that the childrens hospices will be able to continue their excellent work. My hon. Friend the Under-Secretary will continue to work with the childrens hospice movement to ensure that the right services are provided for terminally ill children, whether that be in a hospice or in their own home.
Mr. Robert Flello (Stoke-on-Trent, South) (Lab): I also thank my right hon. Friend for the £27 million that has been announced for childrens hospices, but end-of-life care is not just about making the end of life as caring as possible. It should also be about exploring all possibilities to prolong quality of life. Will she agree to meet me as soon as possible to discuss the case of my constituent, Kath Withington, who has been denied the Tarceva drug, even though her consultant and GP recommended it? People who may be in their last months or weeks should have access to all the treatments that might prolong their lives.
Ms Hewitt: I am always happy to meet my hon. Friend but, on the more general point, it must be right that we ensure that NICE evaluates drugs, and that the drugs it recommends are available right across the NHS. However, we must not try to substitute ministerial decisions for NICEs recommendations. We played our part in establishing NICE, and in speeding up the evaluation of the growing number of new drugs now available.
Mrs. Nadine Dorries (Mid-Bedfordshire) (Con): The Secretary of State speaks of palliative care being provided in the community. Much of it is provided in small community hospitals, such as Steppingley hospital in my constituency but, unfortunately, many such hospitals are under threat of closure or have already closed due to NHS deficits. Is not the best way to give good, compassionate, end-of-life care in the community to make sure that the beds and nurses are there to provide it?
The greatest need is for palliative care to be available in peoples own homes, because that is where the largest number of people would choose to die if they were given the choice, as I believe they should be. In the case of community hospitals, yes, there are parts of the country where the local NHS is looking at the number of community hospitals and at whether they can be better organised. In the White Paper, we made it clear that they should not be making short-term decisions, because of current financial problems, which may have to be reversed in future years; they should look instead at how to make the best possible use of existing, and
new, community facilities to ensure that they are getting the best care for patients, much of which can now be delivered outside hospitalsnot only in community hospitals, but also in patients own homes.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): Since March 2005, Health Ministers have received two letters in respect of the management of Kensington and Chelsea primary care trusts deficit, both of which came from my hon. Friend. In addition, the chief executive of Kensington and Chelsea primary care trust met Sir Nigel Crisp, the former chief executive of the NHS, on 16 December 2005.
Ms Buck: My hon. Friend is aware that Kensington and Chelsea PCT has an ambitious programme for recovering a deficit that is rootedin this casein past financial mismanagement under previous managers. My concern is that in addition to the underlying deficit the PCT is subject to the top-slicing that applies to all London PCTs. In the interests of transparency, and because that additional pressure is causing difficulty for social and mental health services, will my hon. Friend explain how much has been generated by top-slicing in London, where that fund is being held and when PCTs and others will have the opportunity to learn how that resource will be ploughed back to help authorities struggling with their deficit?
Mr. Lewis: The strategic health authority was asked to come up with an appropriate plan for London, to deal with the overall situation, and it was felt right that Kensington and Chelsea contribute 3 per cent. of its budget to help tackle the deficit. My hon. Friend is right to say that the consequences of the contributions made by that PCT and others should be open and transparent. The SHA should make absolutely clear how much money it has received from the process, how it intends to spend the resources and the consequences for patient care throughout London. I urge her to engage in dialogue with the SHA about how that information can be put into the public domain as soon as possible.