The Minister of State, Department of Health (Andy Burnham): It is for Leicester City primary care trust to determine its plans for LIFT schemes by developing its strategic service development plan. I am pleased to confirm that it has already opened three new buildings to patients, with another two under construction, and five more in the planning stages.
Keith Vaz: I welcome the Governments huge investment in our health service in Leicester, but what explanation can I give to my constituent, Mr. Mark Golding, whom I met on Saturday and who is suffering from a double hernia? He has waited four months for an operation, even though his surgeon told him that he would have to wait only three months. I do not propose that the Minister or the Secretary of State should conduct hernia operations themselves; in fact, we are grateful to them for not doing so, but how can we convince our constituents that we are making a huge investment when they still have to wait for operationsin my constituents case, in agony?
I am pleased that my right hon. Friend is absolving me from personal responsibility. The only kind of doctor that I have ever been is a spin doctor, as he knows, and I would not trust anyones care to me. I know that he raised his constituents case at business questions last week, and I am informed that the waiting time targets have not been breached, as the case is being treated as routine, rather than urgent. If his information is different from that, I recommend that
he bring it to the attention of his primary care trust. More broadly, on LIFT, in his constituency investment has been made in the Humberstone health centre and the Charnwood health and social care centre, and I believe that there are plans for a Belgrave health and social care centre. That is a huge investment in the primary care infrastructure in his constituency, and it will bring benefits not only to patients such as the gentleman whom he mentioned, but far more broadly.
David Tredinnick (Bosworth) (Con): Will the local improvement finance trust schemes have any bearing on the pathway project for the future of Leicester hospitals, and what should I tell my constituents now that the east and north wards in Hinckley and District hospital have been shut? Does the Minister think that the LIFT schemes will stretch across the county from Leicester and touch Hinckley?
Andy Burnham: The service at Hinckley is, of course, a matter for local decision, but there is an interrelationship between the facilities that are being developed through LIFT in the city of Leicester and the hospitals trust, because LIFT allows for the development of services much closer to the patients home. Services that were traditionally provided in a hospital setting may now be delivered in local communities, because of the high quality of the facilities being built in the constituency of my right hon. Friend the Member for Leicester, East (Keith Vaz) and elsewhere. Getting the infrastructure right, so that there is a secondary service, surrounded by high-quality facilities in the community, is a matter for local decision making.
David Taylor (North-West Leicestershire) (Lab/Co-op): The Minister is an honest, shrewd and talented man. How convinced is he that handing over long-term, exclusive contracts to the private sector, so that it owns, manages and finances public infrastructure and services, represents good value for patients and taxpayers, given that there is a growing body of evidence that points in precisely the opposite direction?
Andy Burnham: I am grateful for my hon. Friends generous comments at the beginning of his question, and I hope that I can assure him that there is a process locally, whereby each scheme is tested and signed off by the district valuer. Before the scheme proceeds, it needs to be clear that it represents good value for money in the long term. LIFT schemes are a different way of funding primary care facilities; they deliver facilities that could not have been delivered under the old ways of funding, because they bring together a broader range of partners, who invest in something far better than GPs or primary care practitioners operating alone could ever have built. There are persuasive and compelling arguments in favour of the LIFT model, because LIFT schemes are transforming health care in some of the most deprived communities, including inner-city communities, of the country.
Alan Simpson (Nottingham, South) (Lab):
Will the Minister ask for an audit of LIFT schemes in the Leicester area and elsewhere to assess the number of projects that have been able to incorporate energy-generating systems, rainwater harvesting or recycling measures in their design? Given that they make a fundamental
contribution to climate change measures, it is disappointing that we have experienced so much difficulty in getting those schemes accepted as part of the design brief, so it would be useful for the House to know how successful we have been.
Andy Burnham: My hon. Friend makes an important point. It is fair to say that some LIFT schemes have made a considerable step forward in incorporating energy efficiency measures into their design, but others could have done better. That is an honest response to his question. The health service must make sure that the people who make decisions on procurement have energy efficiency and environmental issues at the top of their concerns as well as the provision of the highest-quality facilities offering modern health care services. My hon. Friend is therefore right to push us on that point. I will take an interest in the way in which LIFT schemes that are under development pay attention to energy efficiency, and I will write to him on the subject.
The Secretary of State for Health (Ms Patricia Hewitt): The estimated expenditure on the turnaround programme to 31 March 2007 is £10 million in central costs and £36 million locally. This is about 3 per cent. of the forecast in-year savings from the programme.
Mr. Lancaster: Since the Secretary of States visit to Milton Keynes last summer, the Fraser day hospital has closed, along with a 23-bed surgical assessment unit, and there have been cuts to mental health services, oral health services, language therapy services, podiatry services and counselling servicesthe list goes onso does she consider the turnaround programme in Milton Keynes a success?
Ms Hewitt: I am surprised that the hon. Gentleman did not mention the fact that in the past three years the budget for the national health service in Milton Keynes has increased by more than £47 million. In the current two years, it will receive a further £55.6 million increase. I congratulate the staff of Milton Keynes primary care trust and others working in the local NHS who have made difficult decisions this year to reduce their deficit, although they will need longer than this year to do so. I suggest that the hon. Gentleman speak to his hon. Friend the Member for South Cambridgeshire (Mr. Lansley), who said in the House yesterday that primary care trusts
receive a given amount of public expenditure resources.
They should live within the overall resource envelope.
has a responsibility not to spend more than the resources that are voted to it through the House.[ Official Report, 12 March 2007; Vol. 458, c. 41.]
Mr. Kevin Barron (Rother Valley) (Lab): My right hon. Friend will know that in its report on NHS deficits the Select Committee on Health said that the fact that the turnaround programme had to be introduced was
a sad reflection on the quality of much management in the NHS over many years.
Ms Hewitt: I congratulate my right hon. Friend on the Health Committee report that was debated yesterday. The scale of achievement by NHS managers and front-line staff, supported by turnaround teams, is indicated by the in-year position of organisations that had a deficit last year. That deficit has been reduced by £600 million, almost all of whichnearly £500 millioncan be attributed to the turnaround organisations, which have supplemented the excellent management in many parts of the NHS. It is up to local organisations to decide when they cease to make use of them.
Mr. Simon Burns (West Chelmsford) (Con): Following the turnaround teams work in mid-Essex, how will the closure of all three intermediate care wards at St. Johns hospital alleviate the problem of delayed discharges at Broomfield hospital?
Ms Hewitt: The decisions to which the hon. Gentleman refers are, of course, for the local NHS to make. Delayed discharges are a serious problem, and the local primary care trust must satisfy itself that alternative arrangements are in place, including intermediate care in patients own homes, to ensure that it does not recur and become worse, as it did when his party was in power.
Paddy Tipping (Sherwood) (Lab): Turnaround teams are important, because they resolve the problem in the current financial year so that there are not even bigger projected problems in the next financial year, 2007-08. Is it not right that individual trusts live within their means so that other partners and NHS trusts are not disadvantaged?
Ms Hewitt: My hon. Friend is right. It was unfair and unacceptable that in the past a minority of overspending trusts were bailed out, sometimes year after year, when other parts of the NHSmental health organisations or, more often, underspending trusts in parts of the country, especially the midlands and the northhad even worse health problems. That was not fair and it gave the overspenders no incentive to sort themselves out. I am glad to say that with the fair, transparent and responsible financial system that we have put in place, we are stopping that unfairness at last.
Mr. Stephen O'Brien (Eddisbury) (Con):
In figures dragged from them last June, Ministers said that the declared central costs of the turnaround programme would be £5 million. Successive freedom of information requests showed that those costs have more than doubled to £11 million, and more recently we managed to extract the information that the local cost of the programme is more than £24 million. The central £11 million plus the £24 million means that the financial incompetence of the Secretary of State has so far cost £35 million, and rising. As the growth deficit of the NHS is forecast to
increase this year, will the right hon. Lady tell us what the turnaround teams have delivered, what the final cost of the programme will be, and above all, at what cost to front-line patient care?
Ms Hewitt: Spending on the turnaround teams has been higher than we originally estimated because we found that more organisations had been overspendingsome of them for yearsand needed to go into the turnaround programme. The investment in the turnaround programme is a very small proportion of the savings that are now being made. The hon. Gentleman might wish to acknowledge that, as we indicated in the most recent financial report, eight out of 10 hospital trusts and seven out of 10 primary care trusts report an improvement on their in-year position. There has been an enormous improvement in the in-year position, and thanks to the difficult decisions that NHS managers and staff have made, the NHS has got a grip on its finances while continuing to improve waiting times, cancer treatment and other key services. By returning to balance at the end of this month, the NHS will be in a far stronger position for the next financial year and able to make further improvements for patients, particularly in cutting waiting times even faster.
The Minister of State, Department of Health (Caroline Flint): The Department of Health is currently investing some £170 million a year in cancer research. We have the highest level of patient participation in cancer trials of any country in the world. Through the National Cancer Research Network we are providing the research infrastructure for 20 studies on brain tumours, seven of which are focused on adults and 13 on children.
John Bercow: Given that no fewer than 16,000 people a year are diagnosed with brain tumours, that they are the biggest single disease killing children and that more than half of those suffering aggressive brain cancers die within 12 months, is it not a scandal that the General Medical Council treats brain tumour research as a Cinderella sector and that, as a consequence, life-saving medical breakthroughs are delayed or denied?
I pay tribute to the hon. Gentleman, who is Chair of the all-party parliamentary group on brain tumours. He is also here today, I think, to promote March as brain tumour awareness month. I know from his constituent, Sue Farrington Smith, who was one of the founders of the charity Alis Dream, that the hon. Gentleman has been very involved and shown his commitment in a number of ways. I understand the point that he makes. That is one of the reasons we have tried to increase the funding for cancer research across the board. Significantly, more than 60 per cent. of our total spend on non-site-specific research develops our understanding and ability to treat many different cancers. We have established, as he knows, the National Cancer Research Institute, primarily to identify the gaps and opportunities for future research. That is why I am pleased about the 20 projects that are under way, but
clearly this is an area that needs looking at. My right hon. Friend the Secretary of State announced in November that she has asked Professor Mike Richards to develop a cancer reform strategy to build on the 2000 cancer plan and to consider how we can improve cancer services, especially for the less common cancers, of which brain tumour is one, although I appreciate the hon. Gentlemans point about the mortality rate of those who develop brain tumours.
Mr. Lindsay Hoyle (Chorley) (Lab): Does my hon. Friend share my worry that the big problem is early detection? People go to GPs and get passed on for other treatments, when what is needed is early diagnostics to show that they have a brain tumour, of whatever type. Does she agree that we need to give that support and extra funding to GPs?
Caroline Flint: I thank my hon. Friend for raising that point, which was raised with the Minister of State, my right hon. Friend the Member for Doncaster, Central (Ms Winterton), by the hon. Member for Rugby and Kenilworth (Jeremy Wright) in an Adjournment debate last year. In summary, it is necessary to consider early diagnosis. That is why the National Institute for Health and Clinical Excellence updated its referral guidelines for suspected cancers in June 2005. The guidelines are aimed exactly at the people my hon. Friend mentionsprimary care health professionalsin order not only to identify patients who are most likely to have cancer but to see how we can identify the early signs and symptoms of cancers in children and young people. In addition, the NICE guidance on improving outcomes is a useful tool for trying, through the cancer networks, to get not only better diagnosis but better care and treatment plans for individuals who are affected by cancer of whatever form, including brain tumours.
Susan Kramer (Richmond Park) (LD): The Minister will be aware that there is a new drug with great potential to deal with brain tumoursTemodal, which, it is hoped, will have NICE approval in June. She will also be aware, however, that approval has been delayed by 12 months because of a statistical error in the first draft of the NICE report. What would she say to my constituent, a 41-year-old father of two, who is dying of a brain tumour that, it is widely accepted, will respond dramatically to Temodal but who cannot receive it because Richmond primary care trust has a policy of not funding drugs that have not yet received NICE approval, despite the fact that everyone knows that that is a matter of only months away? What advice would she give
PCTs have the authority to approve drugs even if they have not received NICE approval. It is always extremely difficult for families who are going through cancer or other diseases, but we have a process to try independently to come to the right conclusions about different drugs and treatments. It is difficult to plan for these things when people are experiencing such diseases and cancers as we sit here today. However, I hope that the hon. Lady will agree that in establishing NICE we have tried to provide the best independent mechanism for thoroughness as well as the opportunity
for appeal, which is why the drug went back to NICE to ensure that NICE can make reasoned and properly thought through recommendations for the NHS. I understand that it is due to report in June this year.
Jeremy Wright (Rugby and Kenilworth) (Con): The Minister has already mentioned the Adjournment debate that was held on 28 March last year, to which the right hon. Member for Doncaster, Central responded. In the course of that response, she was kind enough to indicate that she would be prepared to visit the childrens brain tumour research centre in Nottingham. Has there been a ministerial visit, and if so what was derived from it? If there has not yet been a visit, may I encourage her or one of her colleagues to go as soon as possible to speak to Professor David Walker and his colleagues about the valuable work that they do and how the Government might help?
Caroline Flint: I thank the hon. Gentleman for that contribution. My right hon. Friend says that she is not aware of an invite, but of course she is always open to such invitations. We are mindful of the opportunities that we have to improve our knowledge and awareness of how the NHS can provide better services. I am pleased to say that in the past 30 years survival rates have improved for children. However, this is clearly a difficult area that poses different challenges to, say, leukaemia, but requires our attention. That is why we have tried to direct NICE to look for gaps and opportunities to further our knowledge while providing the best diagnosis, treatment and rehabilitation services.
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