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I cannot give my hon. Friend the exact number of children using the early intervention teams, but the spending on child and adolescent mental health
servicesCAMHSincreased from £284 million in 2002 to £530 million in 2005. With that increased investment, we have managed to employ more staff. There were about 7,700 in 2003; that figure went up to 9,800 in 2005. The case load has also risen by about 40 per cent. between 2002 and 2005, however. The extra investment is making a difference, but we certainly accept that there is some way to go, particularly in the development of CAMHS services, and the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), is continuing to work on further improving those services and, in some instances, integrating them more effectively with the other services.
Tim Loughton (East Worthing and Shoreham) (Con): Yesterday in Committee Room 16, in front of MPs and Members of the Lords, two teenage girls, Lois and Antonia, gave harrowing accounts of their experiences in acute mental wards. Those were adult, often mixed-sex, wards, which contained people who had committed homicides, in which the girls were subjected to sexual abuse and invasion of privacy, and received little or no age-appropriate treatment from inappropriately qualified staff and no help with their education. On behalf of the hundreds of children placed in those wardsthe number is growingthey begged for the age-appropriate amendments to the Mental Health Bill to be retained. They do not think that the Lords amendments would prove to be a straitjacket, because they would provide for age-appropriate treatment and allow for emergency admission. Why are they wrong?
Ms Winterton: They are wrong because [Interruption.] I am not saying that those girls are not well intentioned, or that we do not want to ensure that the situation improves. At the moment, the number of such bed daysthat is, the number of days when a bed in an adult ward is occupied by under-16s and 16 to 17-year-oldsis dropping. We need to ensure that we have more accurate information about that.
The Lords amendments include the proposal that a child should be seen by a specialist practitionerin this instance, a CAMHS specialist. If they were on an adult ward, that would be difficult to achieve. In that sense, the problem is a real one because the CAMHS specialist would not be assigned to an adult ward. Were it more appropriate for the care of an individual aged 17 to 18 to place them on an adult ward, they would not have access to the specialist. As I have said, however, there are certain problems with the Lords amendments
Mr. Turner: I thank my right hon. Friend for putting into context the large and fully justified pay increases for student nurses since 1997. New nurses need to know, however, that they have an adequate career path once they enter the service. Will she indicate what Agenda for Change means for nurses throughout their careers?
Ms Hewitt: My hon. Friend makes an extremely important point. One of the most important reforms introduced by Agenda for Change was to open up new opportunities for nurses to build their skills and take on new responsibilities. Under the old Whitley scale, a clinical nurse specialist grade 1 could hope to achieve a salary of £26,000barely twice that of a newly qualified nurse. Under the new system of Agenda for Change, by November this year a nurse consultant at the highest level will be able to earn more than £90,600, which is a measure of the change and improvement that we have been able to make.
Mr. Andrew Mackay (Bracknell) (Con): Is the Secretary of State comfortable with the fact that, because of the actions of the Chancellor of the Exchequer, nurses in England are experiencing a staged pay increase, while those in Scotland are having a full pay increase?
Ms Hewitt: I understand the concerns of nurses and other health service staff about the staging of the pay award. When we accepted the independent pay review body recommendations across the public sector, not simply those for the NHS, we decided to stage the implementation for this year as we took account of the wider economic position on inflation and interest rates. That is not only fair to nurses and other public sector staff, but right for the public as a whole.
Norman Lamb (North Norfolk) (LD): I acknowledge the increases in pay over the years, which were clearly needed. Nurses are still, however, one of the lowest- paid groups of professionals in public service. Does the Secretary of State accept that nurses this year are getting a real-terms cut in pay, and that the impact on morale of the phased increase, combined with the fact that many newly qualified nurses have no job at all, is really damaging the profession? Is she proud of that situation as we approach the 10th anniversary of the Labour Government?
Ms Hewitt: I have just explained, as I have on many occasions, why it was necessary to take account of the wider economic circumstances. It would not be in the interests of newly qualified nurses or anybody else were we to see inflation and interest rates return to the levels that they reached under the Conservative Government. We will not take risks with the economic stability and strength that have been achieved, particularly as a result of the policies of my right hon. Friend the Chancellor. The hon. Gentleman mentioned newly qualified nurses and their difficulties in getting jobs. We are making great efforts to ensure that the NHS in each region finds appropriate posts for newly qualified NHS staff to address that precise issue.
Mr. John Baron (Billericay) (Con):
Not only are nurses receiving a real-terms cut but the Department of Health originally argued for a pay rise of only 1.5 per
cent. Given that the independent review body for nursing not only rejected the Governments figures but criticised the Department of Health for failing to provide any evidence as to how its estimate was reached, does the Secretary of State understand how angry and cheated nurses up and down the country feel when the Government seem to be plucking figures out of thin air in order to keep salaries low?
Ms Hewitt: Salaries for nurses and other NHS staff are a great deal higher than they were under the Conservative Government, and a great deal higher than they would have been under the Conservative partys new policy of cutting public spending to make way for tax cuts.
I remind the hon. Gentleman that there are over 80,000 more nurses in the NHS now than there were when we were elected 10 years ago. Not only has their pay increased substantially and not only will it continue to rise substantially this year as a result of the increments under Agenda for Change, but nurses are increasingly enjoying more flexible working conditions and support for child care needsand, of course, much better holidays, maternity and paternity leave and pay than they ever enjoyed under the hon. Gentlemans party.
The Minister of State, Department of Health (Caroline Flint): Asylum seekers, including those who have been victims of human trafficking, are entitled to free NHS treatment for as long as their applications, including any appeals, are being actively considered by the Home Office. Any ongoing treatment will continue free of charge for unsuccessful applicants until their removal from the United Kingdom.
Mr. Steen: Trafficked women inevitably display mental as well as physical damage. Can the Minister guarantee that all victims who have applied for asylum will receive mental health support, some kind of counselling, and psychological carenot just to help them gain security and confidence as required by article 12 of the Council of Europe convention on action against trafficking in human beings, which the Government signed only last month, but to help the criminal authorities pursue traffickers?
People who have been trafficked and who claim asylum can gain access to mental health services, but the Department, along with colleagues in the Home Office, intends to review access to health services for foreign nationals. We hope to report in October this year. As the hon. Gentleman will know, as part of the action plan to which the Government are committed and following the signing of the convention, we are examining ways of preventing trafficking and identifying its victims, as well as considering what services are needed. The POPPY project, which we
have funded, now has funds to provide an outreach service, which will be very important to the many agencies that will play a role in supporting the needs primarily of women, and in some cases of children.
Mrs. Ann Cryer (Keighley) (Lab): I am delighted by my hon. Friends reply. It is comforting to know that trafficked women will be given that level of care, but what provision will there be for people who are in the country on visitors visas?
Caroline Flint: I thank my hon. Friend, who I know takes a huge interest in this issue. I should make clear that my original answer related to those who have been trafficked and are claiming asylum. As for my hon. Friends question about visitors visas, emergency treatment is available to those who present themselves provided that it has priority over establishment of their status or ability to pay. That underpins the way in which we run our health service.
There are issues involving people who should be paying and the reclaiming of funds. I understand that the Minister of State, my right hon. Friend the Member for Doncaster, Central (Ms Winterton) and colleagues across Government are examining a range of issues relating to health service access for foreign nationals, which may include insurance issues.
The Secretary of State for Health (Ms Patricia Hewitt): On 3 April we published Maternity Matters, which sets out how we propose to deliver on our commitment to improve maternity services for women. By the end of 2009, for the first time, mothers-to-be will have a guarantee that the NHS will give them real choice. That will include the opportunity to be supported during births, either at home or in midwifery units, by midwives whom they know and trust to care for them.
Mr. Khan: St Georges hospital in Tooting has an excellent maternity department. Both my children were born there. This summer, the hospital will open a new midwifery-led unit for low-risk women. Does my right hon. Friend agree that such units, which help to create a home away from home for women and their families, should be offered to all who wish to have their babies delivered naturally?
Ms Hewitt: I strongly agree. That kind of midwife-led unit, which can provide superb support for women and their partners and babies, is exactly the kind of development that we want to see repeated in other parts of the country. I congratulate midwives and other staff at St. Georges on that excellent development. The fact that there are 60 more midwives at St. Georges than there were 10 years ago is in part what has helped make that improvement possible.
Greg Mulholland (Leeds, North-West) (LD):
On 17 March we heard the devastating news that the proposed new childrens and maternity hospital in
Leeds would not go ahead, despite having been approved by the then Secretary of State for Health in July 2004. Why has the project been pulled despite leading local specialists having said on 27 March that current services are not fit for purpose and that they are anxious about the continuing safety of children in hospital? When will the people of Leeds get the childrens and maternity hospital that they so badly need?
Ms Hewitt: There is no doubt that the people of Leeds need a new childrens hospital and improved services; that has been recognised for a long time. Following the recent concerns and the possible delay in respect of that new hospital, the Minister of State, my hon. Friend the Member for Leigh (Andy Burnham), recently met the strategic health authority and colleagues from the trust to discuss that and to ensure that issues, particularly to do with cost, can be looked at so that the scheme can get back on track.
Mr. Jeremy Hunt (South-West Surrey) (Con): Will the Secretary of State congratulate my sister-in-law, who happens to be a constituent, on the recent birth of her son, Thomas, at the Royal Surrey county hospital, and does the Secretary of State share my hope that my constituents continue to benefit from its excellent maternity unit for many years to come?
Ms Hewitt: I am happy to congratulate everybody whose children have recently been born at that hospital, or anywhere elseperhaps I can cover all congratulations at this point. As we discussed earlier, proposals will come forward for improvements and changes in services in various parts of the country, and there will be proper and full consultation on those proposals. It is important to ensure that in the constituency of the hon. Member for South-West Surrey (Mr. Hunt) and everywhere else women and their partners have the proper choice of having a baby at home if that is what they want and it is safe, having a baby at a midwife-led unit, or having a baby in a hospital, where there would be a consultant-led unit as well as a midwifery team. We will guarantee that choice.
The Minister of State, Department of Health (Andy Burnham): On the basis of results reported at quarter three, we believe that the NHS is on course to deliver at least a balanced financial position at the end of the 2006-07 and continues to perform well against key service targets.
I thank the Minister for that reply. He might be aware that the Health Service Journal recently published some very out-of-date and inaccurate information about the financial aspects of various trusts, one of which was the Shrewsbury and Telford Hospitals NHS Trust. Please will he issue the latest figures so that publications such as the Health Service Journal have up-to-date figures? Also, does he
agree that Tom Taylor, the chief executive of the Royal Shrewsbury hospital, is doing a great job of turning around the finances of our hospital?
Andy Burnham: I agree that the chief executive is doing an outstanding job. The hon. Gentleman might be aware that the latest figures at quarter three show that the trust was forecasting a £2.3 million deficit for year-end, but I can update that by telling him that the view of the strategic health authority is that the trust continues to make improvements and the expectation is that it will continue to improve in this financial year. The expected improvements relate to both the application of resource-accounting and budgeting and the effect of the national payment by results policy. Therefore, there is good news. The hon. Gentleman is right that his trust is on an improving course, and I hope that we can look forward to having his support in continuing to help it get into financial balance.
Andrew Miller (Ellesmere Port and Neston) (Lab): Will my hon. Friend the Minister congratulate my primary care trust on getting its books back into balance and, pursuant to his response earlier on community hospitals, will he ensure that the next round of investment takes into account fabulous community institutions such as Ellesmere Port hospital, which are especially fabulous for patients such as stroke victims?
Andy Burnham: I certainly pay tribute to my hon. Friends primary care trust and to others around the country, which have done an outstanding job in difficult circumstances in getting the NHS into a position whereby we can predict that overall, it will balance its books this year. It is because we have asked the NHS to take some of those difficult decisions and to tackle overspending that PCTs such as my hon. Friends can support the excellent community services that he rightly draws attention to. It has been a difficult year for many PCTs, but we can now look forward to a year in which we can bring down waiting lists and improve the range of services for patients.
The Minister of State, Department of Health (Ms Rosie Winterton): In April 2006, primary care trusts had commissioned 75 million annual units of dental activity; by January 2007 that had risen to 78.4 million.
Mr. Hands: The chief dental officer leaked to the press on Friday that instruments used to perform root canal treatments will now have to be disposable. The excellent NHS dentist on North End road is concerned about access, pointing out that those regulations could cost £35 per root canal treatment, which is half the total that a PCT typically spends on a whole course of treatment. Given those new regulations and the fact that no extra funding is being provided, is not the Ministers purpose to create an NHS dentistry system that is solely about tooth extraction?
First, I challenge the hon. Gentlemans assertion that this information was leaked; it was sent to all dentists, and there was a ministerial statement about it. Moreover, and as he knows, this was a safety issue relating to Creutzfeldt-Jakob disease. Dentists with a good NHS commitment are given some
£80,000 towards their business expenses and are expected within that to offer proper equipment and treatment and proper staff to carry that treatment out. So such expenses are perfectly well covered by the existing amount given to dentists to help run their businesses.
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