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House of Commons

Tuesday 9 January 2007

The House met at half-past Two o’clock


[Mr. Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—

Waiting Times

1. Mr. Andrew Robathan (Blaby) (Con): How many people in Leicestershire waited for more than six months from GP referral to operating theatre for elective operations in the last period for which figures are available. [113225]

The Secretary of State for Health (Ms Patricia Hewitt): At the end of November 2006, seven Leicester patients had been waiting for more than six months for in-patient treatment following the decision to admit. That compares with 3,437 in March 1997.

Mr. Robathan: It is interesting to note that on 16 November, the Secretary of State said:

Will she look into the case of Mr. Ferriman, who lives in Braunstone town, about 100 yards from her constituency? His GP referred him for a hip replacement in April last year, and he has been given an appointment for an operation in April this year. Does the Secretary of State think that that counts as less than six months?

Ms Hewitt: If the hon. Gentleman sends me the details, I will of course examine the case and write to him, but I am surprised and disappointed that he did not take the opportunity to congratulate the NHS on bringing waiting times down to their lowest level since records began. I am really not prepared to take lectures on waiting times from the hon. Gentleman, who voted against the increased investment that we are making in the NHS.

Mr. Andy Reed (Loughborough) (Lab/Co-op): I welcome the reductions in waiting times, and if there are cases in which individuals have struggled I am sure that my right hon. Friend will look into them; but will she also acknowledge that one of the consequences of increased throughput is the potential for superbugs? Is she aware of the campaign launched by the Loughborough Echo, aimed particularly at clostridium
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difficile and its consequences for my constituents? Will she try to ensure that it appears on death certificates in future, to make not just patients but hospital staff more aware of the problem?

Ms Hewitt: We all share my hon. Friend’s concern about the increase in clostridium difficile—which is a particularly problematic hospital-acquired infection—in some hospitals, including hospitals in Leicester. That makes it all the more important for us not just to continue to shorten waiting times for operations but to ensure that patients are treated in the community, closer to their homes, when that is appropriate and clinically safe.

Mr. Stephen Dorrell (Charnwood) (Con): I join the Secretary of State in welcoming the reduction in six-month waiting times in Leicestershire, but may I remind her of information given by the Minister of State, Department of Health, the hon. Member for Leigh (Andy Burnham), in a written answer on 8 November 2006? He reported that in the NHS as a whole, 87 per cent. of patients had been treated within six months in the year to last April. May I also remind the Secretary of State that in 1990, 17 years ago, the equivalent figure was 86 per cent.? Does she think that an increase of one percentage point over 17 years is a good return for the huge increase in investment that she mentioned earlier?

Ms Hewitt: I am glad that the right hon. Gentleman began by congratulating the NHS, and I welcome his recognition that waiting times for elderly people needing hip replacements, for instance, were longer than 18 months when he was Secretary of State for Health. But of course we need to do more, which is exactly why we have promised that by the end of 2008 the maximum wait from GP referral to operating theatre will be just 18 weeks, but that for most people the wait will be much shorter. I hope that the Conservative party will support the NHS in making the further changes needed to achieve that dramatic improvement in care, and will congratulate the NHS as it achieves them.

Keith Vaz (Leicester, East) (Lab): I thank my right hon. Friend for increasing the budget of the primary care trust over the past 10 years. It doubled to £173 million last year. Does she, however, share my concern and that of my constituents, who, when they try to obtain appointments with GPs for referral purposes, are met with administrative delays and difficulties? Is she planning any guidance for local GPs on the way in which their front-line staff should deal with the public, so that when people ring to ask for an appointment they are given one and are therefore referred as quickly as possible?

Ms Hewitt: My right hon. Friend is right. Because some general practices—although, I think, only a minority—do not have proper appointment systems, it can be very difficult for people to obtain appointments when they need them, whether on the same day or in advance if that is what they require. However, I hope that my right hon. Friend welcomes the fact that thanks to the target we have set, people no longer wait for weeks on end to obtain appointments. I believe that
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the patient survey which will begin this month, and which will be linked to GPs’ pay, will ensure that the minority of GPs who are not yet offering convenient appointments will do so in future.

Mental Health

2. Kerry McCarthy (Bristol, East) (Lab): What assessment she has made of the effect of the introduction of supervised community treatment on the care of patients with mental health problems. [113226]

The Minister of State, Department of Health (Ms Rosie Winterton): We are introducing supervised community treatment for patients who have been detained in hospital under the Mental Health Act 1983. That is an important change, which brings legislation into line with modern service delivery and follows the example of modern practice in other countries around the world.

Kerry McCarthy: I am sure my right hon. Friend is aware of the fear expressed by some in the mental health world that people could continue to be given supervised community treatment for lengthy periods without the introduction of adequate safeguards. Can she assure me that that will not happen?

Ms Winterton: My hon. Friend is right that such concerns have been expressed, but I hope that I can reassure her that patients receiving supervised community treatment will be entitled to a comprehensive package of safeguards that are just the same as those for patients detained in hospital. The need for SCT will be subject to regular review in exactly the same way, and patients will have the right to apply for discharge to a tribunal and the hospital managers of their responsible hospital.

Sandra Gidley (Romsey) (LD): The Minister mentioned countries around the world, so presumably the Department of Health has access to information that proves that supervised community treatments are successful around the world. When will that information be released for general consumption?

Ms Winterton: A number of studies have been carried out into SCT. As I have said, it is available in countries around the world—including Scotland, now—to bring them in line with modern service provision. One of the published studies is from New Zealand; it shows that SCT not only worked for carers and patients’ families, but that patients also liked it because it meant that they could return home instead of having to be detained in hospital. The Department is also carrying out some research; it is currently being peer-reviewed, and it will be published fairly shortly.

Meg Hillier (Hackney, South and Shoreditch) (Lab/Co-op): Hackney, South and Shoreditch has a higher than average incidence of mental health issues, and I have received a lot of correspondence from people about community treatment orders; psychiatrists have raised the issue of holding people against their will in the community. Although I think that community treatment can be better than hospital treatment, how can my right hon. Friend reassure those
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with concerns that people will not be held against their will but will receive the treatment that they need and that their lives and their community will be made better?

Ms Winterton: First, it is important to emphasise that clinicians will decide whether supervised community treatment is appropriate for individual patients. We all know that there are instances of patients being released from hospital who then go into the community and who, perhaps, do not take their medication or stay in touch with health services, and whose condition deteriorates to such an extent that they become a danger to themselves or to other people. That is an example of where SCT could apply. It is important to remember that that often puts patients back into the care of their families, instead of their having to remain in hospital. That will be good for patients and for public safety.

Tim Loughton (East Worthing and Shoreham) (Con): The Minister acknowledges that community treatment orders are a contentious provision in the Mental Health Bill, so will she now confirm that her Department commissioned a report entitled “International experiences of using community treatment orders”, which was delivered to her last autumn, and which concluded, from a survey of 50 countries, that CTOs have been found to have no clear effect on patient outcomes or risk reduction, and that these psychiatric ASBOs have been described as discriminatory by many patient groups, not least those representing BME—black and minority ethnic—patients who have suffered disproportionately? Why has she failed to publish this report, after my parliamentary questions and my freedom of information request, given its relevance to the Mental Health Bill which is currently under scrutiny in Parliament?

Ms Winterton: As I have said, the report is being peer-reviewed, and it will be published. Frankly, the Opposition must decide whether they will support a Bill that will introduce supervised community treatment so that high-risk patients get the treatment that they need to keep them well after they are discharged from hospital, and that will lead to people who have potentially serious and dangerous personality disorders getting the treatment that they need. That is the issue.

The hon. Gentleman has called these measures the Government’s latest attack on civil liberties. He needs to think very carefully about the civil liberties of people who go in and out of hospital three or four times a year because we cannot get treatment to them, and the civil liberties of patients, victims and their families who have suffered because we do not have the powers to treat people in the community.

Health Inequalities

3. Linda Gilroy (Plymouth, Sutton) (Lab/Co-op): If she will make a statement on the steps she is taking to address health inequalities in Plymouth. [113227]

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The Minister of State, Department of Health (Caroline Flint): Recent figures show that Plymouth is reducing inequalities in coronary heart disease and cancer, although there is more to do on life expectancy and infant mortality. There is active co-operation between the primary care trust, the local authority and other partners to tackle health inequalities in Plymouth.

Linda Gilroy: I thank the Minister for her recognition of the good work done by people in public health in Plymouth, but does she recognise that in order to continue to deliver in that way, they need confidence to plan ahead? What guidance can she offer primary care trusts to continue to prioritise spending to address health inequalities?

Caroline Flint: I am very pleased to inform the House that in this financial year Plymouth PCT replaced previous health action zone funding with a recurrent allocation of £933,000. In addition, Plymouth secured £966,000 of neighbourhood renewal fund money to tackle health inequalities. That is a total of £1.899 million of funding—twice the amount originally allocated in the choosing health fund. Stretch targets have also been set for the number of healthy schools within the area and also for the reduction of smoking and pregnancy in Plymouth. I congratulate those involved in all those endeavours.

Alison Seabeck (Plymouth, Devonport) (Lab): Does my hon. Friend agree that tackling obesity—commonly found, as in Plymouth, in areas of the greatest health inequality—is also helping to deal with the alarming growth in diabetes? That being the case, does she acknowledge the importance of the research being carried out across the country, but particularly in Plymouth by the Early Bird project? It is looking—uniquely—in the long term at obesity and diabetes across social backgrounds, and it needs further funding.

Caroline Flint: We are acutely aware of the link between obesity and the development of type 2 diabetes. That explains our work in healthy start, which I am pleased to say was trailed to good effect in the south-west and went national last November. It is a way of encouraging better eating habits from the cradle onwards. There is also the healthy schools initiative. Of course we support research, but there is a point at which we know what the reality is and we have to get on with dealing with it.


4. Mr. David S. Borrow (South Ribble) (Lab): What action her Department is taking to improve HIV/AIDS prevention and education programmes. [113228]

The Minister of State, Department of Health (Caroline Flint): The Department is continuing to target HIV health promotion towards the most “at risk” groups in England—namely, gay men and people from African communities. In 2006-07, we made an extra £1 million available to strengthen our HIV work for those groups.

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Mr. Borrow: Does my hon. Friend agree that work needs to be more targeted at younger gay men? It is important to emphasise that contracting HIV does not mean simply taking a pill a day, when everything is okay. Drug treatment for HIV is very unpleasant and is not 100 per cent. effective, so we need to get that message through to younger gay men.

Caroline Flint: My hon. Friend makes an important point. There has been a large drop in diagnoses of AIDS and a 70 per cent. drop in AIDS deaths, but it would be ridiculous to suggest anything other than that HIV is something that has to be dealt with every day of a person’s life in respect of the mix of drugs and treatments necessary. My hon. Friend makes an interesting point about the younger age group, many of whom are too young to remember the 1980s campaign and may have a false sense of safety about their future health. I would welcome my hon. Friend, along with the Terrence Higgins Trust, coming to the Department to discuss those issues.

Mr. Nigel Evans (Ribble Valley) (Con): Can I come as well? [Interruption.] Why not? The Minister will know that the incidence of HIV/AIDS has quadrupled since 2000 and part of the problem is the Government’s complacency about it. They announced a substantial advertising campaign last year, but it was many months late and in the end it was pegged back to a £4 million campaign. Would it not be far better if the Government now embarked on a substantial advertising campaign to prevent needless thousands of people contracting HIV/AIDS in the future?

Caroline Flint: I believe that the last Conservative Government had a review in 1995-96. It looked into the value of mass campaigns in respect of HIV/AIDS. After that review, it was argued that the approach should be targeted more at the particularly vulnerable groups most at risk of contracting HIV. That is the position that we adopted and we carry out that targeted work with the Terrence Higgins Trust and the African HIV policy network. Our recent campaign was about getting across a strong message that is appropriate for tackling chlamydia, gonorrhoea and other sexually transmitted infections as well as HIV. The message is: if you are having sex, always make sure that you use a condom.

Michael Fabricant (Lichfield) (Con): Is it not also the case that of the 7,450 new cases of HIV/AIDS in the UK only—of course, it is still far too many—2,356 arose through homosexual sex? Do not many of the cases of AIDS in the UK come from legal and illegal immigrants who enter the country already infected with AIDS? What steps is the Minister taking to liaise with the Home Office to ensure that infection from that source does not spread throughout the UK?

Caroline Flint: We want to work with all communities that are vulnerable to HIV/AIDS, and that is why we support the Terrence Higgins Trust and the African HIV Policy Network. HIV diagnoses have been increasing since 1999 for several reasons. First, test uptake has increased. For example, among gay men it has risen from 45 per cent. in 1997 to 80 per cent. in 2005, and among heterosexuals it has risen from 25 per
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cent. to 82 per cent. over the same period. More testing is important, and among those tested are people who may have been living with HIV for some time but in whom it is being diagnosed for the first time.

We are not complacent about any of those areas. We have taken other action, including, for example, the testing of pregnant women. Some 95 per cent. of pregnant women with HIV are diagnosed and that has been enormously successful in preventing mother to child transmission.

We are in discussion with the Home Office on several issues, but it is important not to stigmatise people and to do the best we can. We should also remember that we are a very low prevalence country, with lower rates than places such as Spain, France and Portugal, and we should be proud of our record in that area.

NHS Finances

5. Mr. Adam Holloway (Gravesham) (Con): If she will make a statement on NHS financial performance in 2006-07. [113229]

11. Tom Brake (Carshalton and Wallington) (LD): If she will make a statement on NHS financial performance. [113235]

13. Ann Winterton (Congleton) (Con): If she will make a statement on NHS financial performance in 2006-07. [113237]

The Secretary of State for Health (Ms Patricia Hewitt): The NHS as a whole is on course to deliver net financial balance by the end of this financial year, It continues to cut waiting times and perform well against key service targets. Our quarter three financial report will be published next month.

Mr. Holloway: In 2006 and with much fanfare a shiny new hospital was opened in Gravesend. Given the projected year-end deficit for the south-east, what assurance can the Secretary of State give that the hospital is safe and that services will not continue to go elsewhere from it?

Ms Hewitt: The new hospital to which the hon. Gentleman refers is just one of 70 new or rebuilt hospitals already under way, with many others to come. I hope that he will recognise that the enormous investment that we are making, including in the new heart centre that has just opened at Darent Valley hospital, illustrates the fact that we are investing record sums of money in the NHS—investment that his party opposed. We are not cutting services: we are improving them.

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