The Minister of State, Department of Health (Andy Burnham): At quarter 3 of 2006-07, Brent teaching PCT reported a forecast deficit of £17.6 million. The NHS as a whole reported a small surplus, and we expect the final position to show further improvement. We will publish quarter 4 of NHS finance report in June.
Sarah Teather: At the Departments instructions, Brent primary care trust is embarking on a devastating series of cuts, including to health visitors, drug, alcohol and sexual health services, mental health, and services for children with special needs. Will the Minister apologise for the long-term impact those cuts will have on the lives of my constituents; and will he go back and reconsider?
Andy Burnham: May I point out to the hon. Lady that it is a statutory duty of all NHS organisations to break even? I accept that we are dealing with issues that concern services for vulnerable people, which I accept are matters of huge importance to the hon. Ladys constituents, but may I point out that the PCT and the council both serve her constituents and that it cannot be in their best interest to stoke up a row between the PCT and the council. The only solution is to support a sensible agreement to ensure the continuation of services to her constituents. I hope that she will drop her political posturing and work to that end.
Ms Dawn Butler (Brent, South) (Lab):
Does my hon. Friend agree that there has to be dialogue between the local authorities and the PCT to ensure seamless health
care? In the past 12 months, the Lib-Dem/Tory-run council has failed to have any positive meetings with the PCT, failed to provide any social care services to the people of Brent, and failed to respond to any of my letters. Does my hon. Friend agree that all the hon. Member for Brent, East (Sarah Teather) has proved successful at doing is producing leaflets saying Save our NHS, which does nothing for anybody? Does he agree that they should stop
Andy Burnham: I thank my hon. Friend for her comments and her positive approach to this situation. It has to be in the interests of vulnerable people everywhere that councils and PCTs put aside their differences and work together for the benefit of those people. A blinkered approach or one where people are casting blame will not get us anywhere. It is important to get agreement on these important issues and I understand that the Minister for Local Government and the Minister of State, the noble Lord Hunt, will soon meet to discuss how progress can be made on securing such agreement, which will be in the interests of constituents.
2. Bob Russell (Colchester) (LD): If she will make it a requirement for independent sector treatment centres to pay a levy towards the costs incurred by the national health service in training staff. 
The Secretary of State for Health (Ms Patricia Hewitt): The first wave of independent sector treatment centres was designed to provide extra capacity to help cut waiting times for NHS patients. Six of these are now providing training as well. All phase 2 schemes will require training to be made available as part of the contract.
Bob Russell: I am grateful to the Secretary of State for that answer, but it does not detract from the fact that these private health centres are privatisation of the national health service by stealth. Will she not agree that every patient who is forced to go to one of these independent centres will help to undermine the financial stability of local hospital trusts [Interruption]and laughing is not the answer?
Ms Hewitt: The hon. Gentleman is wrong on every count. Independent sector treatment centres are not privatisation by stealth or any other means. Patients are not forced to go to ISTCs and, indeed, we are extending patient choice. From 1 July, patients needing orthopaedic treatment will have a free choice of more than 200 hospital and treatment centres all around the country. I would have hoped that the hon. Gentleman would support that and also support the fact that more than nine out of 10 patients said that their NHS hospital treatment was either good, very good or excellent. We should be proud of that, and I am sorry that the hon. Gentleman is not.
Laura Moffatt (Crawley) (Lab):
Does my right hon. Friend agree that independent treatment centres, alongside fantastic NHS staff, have contributed enormously to the reduction in waiting lists? Our staff are fantastic as
a result of the quality of their education and training. Can my right hon. Friend assure me that in future contracts for the independent sector, we will try to ensure that we train the staff we need so much for our wonderful NHS?
Ms Hewitt: My hon. Friend is absolutely right and I can give her the assurance that in the second wave contract, training opportunities will be required from all the independent sector treatment providers. Indeed, the ISTCs will be expected to appoint directors of clinical and medical training, who will work with the post-graduate deaneries and other parts of the NHS family in order to ensure that the best possible training opportunities are available to doctors and other health care professionals.
Miss Julie Kirkbride (Bromsgrove) (Con): Working on the same principle, would the Secretary of State care to estimate how much it would cost the British taxpayer if we were to refund all the foreign countries that had invested in training their own staff who are now working in the British national health service?
Ms Hewitt: I certainly cannot make that estimate, but the hon. Lady raises an extremely important point. As she probably knows, we were the first country in the world to adopt an ethical recruitment policy in our national health service. That means, for instance, that we do not take nurses from South Africa or other parts of Africa. We try to ensure that, just as medical professionals come to Britain for training from some other countries, we support the poorest countries, particularly in Africa, that desperately need to train and keep their own health care professionals.
Mr. John Redwood (Wokingham) (Con): Will the Secretary of State promise that she is still very much in favour of this experiment? I would like to see these centres in the Reading area, where they would expand capacity and help people in my area who cannot get the treatment that they need at the moment. Will she promise not to rig the system against them in the way that many Labour Members seem to wish to do?
Ms Hewitt: The right hon. Gentleman is simply wrong on that point. It is clearly right that independent sector treatment centres should make training opportunities available; that is one of the lessons that we learned from wave 1. I completely agree with him, however, that the centres have helped to cut waiting times for NHS patients in many parts of the country, and all the treatment that they provide is on the NHS and free at the point of need. That is what matters to patients.
Mr. Peter Lilley (Hitchin and Harpenden) (Con): How does the Secretary of State square what she has just said about having an ethical policy on recruiting from Africa with the fact that the Government have issued work permits for 50,000 nurses and doctors from Africa since 2000? Is it not clear that they are coming to agencies in order to get round the ban on direct recruitment to the NHS?
As I have just said, we have stopped the process of direct recruitment[Hon. Members: Ah!] No, we have stopped the process of direct recruitment
into the NHS of nurses from developing countries in Africa and elsewhere. There is, however, a real problem with some agencies that recruit people from those countries. I am not sure what level of regulation the right hon. Gentleman is suggesting, but that practice is difficult to control. We try to ensure, however, that they sign up to exactly the same principles as we have agreed for the NHS, and that people who come in through that route are not subsequently re-employed in the NHS.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): Since its establishment in 1999, NICE has consolidated its position as the leading source of evidence-based guidance on specific health interventions and on broader care pathways. It has deservedly earned international recognition for its work.
Dr. Palmer: I am grateful to the Minister for his response. I have always supported NICE and I still do. It is perfectly obvious that we need a central assessment point for new medications and treatments. Is he satisfied, however, that there is a sufficient flow of information and discussion between NICE and the companies and patient groups involved in the assessment process? Does he think that that process could be made more transparent?
Mr. Lewis: My hon. Friend is absolutely right to suggest that, in the context of modern science and health care, if NICE did not exist, we would have to create it. We are currently conducting an overall review of the way in which NICE reaches its conclusions; it began in April, and is due to report to the NICE board in November. In 2005, we introduced what is known as a single technology appraisal process, which enables NICE to speed up some of its decision-making processes. In addition, best practice guidance was issued to the NHS in December 2006, stating that if a clinical decision is made that a patient requires a particular form of medication, there is no requirement for the primary care trust to wait for the conclusion of the NICE appraisal to ensure that the patient has access to that treatment. Overall, NICE has been a tremendous success, but we are also in the process of reviewing its function, as is appropriate at this stage.
Sir Nicholas Winterton (Macclesfield) (Con): Is the Minister aware of the use of miniature telescopic eye implants as a cure for age-related macular degeneration? This operation is available in many parts of Europe and in the United States, and one operation has been successfully completed by Brendan Moriarty, an eye surgeon in my constituency. Will the Minister urge NICE to look into this new operation as urgently as possible, as it will help people to retain their sight?
I have a good deal of sympathy with the hon. Gentlemans point. Macular degeneration is a real issue for an increasing number of our constituents. I was not aware of that specific intervention, but I think it right for us to reflect on what the hon. Gentleman has said, and then to decide whether the evidence that
we have is sufficient for us to refer it to NICE as one of its priority considerations. Now that the hon. Gentleman has raised the issue, we will certainly have a look at it.
John Smith (Vale of Glamorgan) (Lab): Why is it that although the chief medical officers recommendations on the prevention of hospital-acquired thrombosis were almost universally welcomed, shortly afterwards the NICE guidelines on the same topic seemed to contradict the original, leaving many health professionals aghast? Will my hon. Friend undertake to look into the matter, and ensure that no confused messages are being received by hospitals about a policy that could prevent 25,000 deaths?
Mr. Lewis: I will certainly look into the matter. It is important that, where possible, there is no ambiguity in the message that we send clinicians and primary care trusts on the front line. I cannot comment at this stage on whether there was a difference of opinion between the chief medical officer and NICE, but I will commit myself to investigating that, and to ensuring that whatever message is appropriate is clearly conveyed.
Mr. Stephen Dorrell (Charnwood) (Con): I agree with the Minister that NICE is one of the successes of the Governments health policy over the past 10 years, but is it not time, as part of the review to which he referred, to look again at the principles according to which Ministers retain control of the agenda of issues that NICE examines? Should not NICE have an opportunity to set aspects of its own agenda?
Mr. Lewis: I think that if we are to conduct a fundamental review now that NICE has existed for some time, one of the issues that ought to be reviewed is the relationship between Ministers and the organisation, as well as the relationship with Department of Health officials. We need to ensure that we get the responsibilities of the respective decision-makers absolutely right. It is important for clinicians and primary care trusts to be clear about the position, but transparency is also important, so that patients know what to expect at a time of technological advances and increasingly complex conditions often associated with people living longer.
Tony Lloyd (Manchester, Central) (Lab): May I refer my hon. Friend to the NICE review of the drug Alimpta, which is used to treat mesothelioma? Specialists fear that the original decision to refuse NICE approval was based on a failure to understand the clinical evidence, and in particular the fact that the drug is efficacious in prolonging both life and quality of life. Those are important considerations for people who will certainly die of mesothelioma.
Mr. Lewis: NICE is actively considering the issue. I understand that, according to the guidance, those who are already receiving the treatment are entitled to continue to receive it, but no final decision has been made. I suggest that my hon. Friend and others make representations to ensure that NICE reaches an appropriate conclusion.
Dr. Evan Harris (Oxford, West and Abingdon) (LD):
NICE does a good job for the Government in rationing health care in a rational way, but is not one of the key requirements of rationing that it should be explicit and transparent? As everyone else now recognises that a
treatment that costs more than £30,000 per quality-adjusted life year will not be approved by NICE, will the Minister confirm that that is also his understanding? Such transparency would help politicians to accept that that is what is happening.
Mr. Lewis: No, I will not confirm that. It seems to me that the appropriate context for such a judgment and such a debate is the review, which seeks to be clear about NICEs function. It also seems to me that we either believe in the need for an organisation such as NICE, in the context of a modern NHS and massive advances in technology and science, or we do not. The use of words like rationing by the Liberal Democrats does not accord well with this debate.
Mr. John Baron (Billericay) (Con): NICE was established to deal with the problem of postcode lotteries, but a key problem is that many new drugs awaiting appraisal are subject to terrible regional variations and lack of funding. A recent freedom of information survey by the Conservatives showed that people in England are going blind because cash-strapped primary care trusts are not funding Macugen, which has been approved in Scotland. Some PCTs have been turning down all requests for Macugen although they come from clinicians, with the average PCT funding only two patients, despite an estimate by AMD Alliance that 100 patients a year in every PCT could benefit. Will the Minister now investigate, as a matter of urgency, why his own guidance to PCTs that funding should not be withheld simply because NICE has not issued guidance is being so readily flouted, before new drugs such as Lucentus suffer the same fate?
Mr. Lewis: We have moved to respond to the concerns that have been expressed as NICEs function has been developed. For example, we introduced the new single technology appraisal process in an attempt to speed up the process. We have also issued best practice guidance to primary care trusts, which makes it clear that where a clinician believes that a licensed drug is an appropriate way of treating a condition, there is no requirement to wait until NICE has concluded its appraisal process. The right way forward is a combination of speeding up the process and being absolutely clear about what we expect from primary care trusts. Members cannot have it both ways. We either devolve responsibility, power and decision making to the local level or we command and control from offices in Westminster and Whitehall. We cannot have a contradictory approach.
The Minister of State, Department of Health (Caroline Flint): One GP sits on the board. His full-time job is director of public health for the south-west but he brings his knowledge and experience to the board. A GP in the National Treatment Agency for Substance Misuse clinical team liaises with the Royal College of General Practitioners and others to support effective delivery of policy and promotion of good practice within the primary care setting.
John Mann: The evidence from Sweden and France, as examined by my primary care trust, is unequivocal. Drug treatment is far more effective if primary care and GPs are put at the centre of it. Is it not time that we move towards having a bigger GP presence on the NTA so that primary care is in the mainstream of drug treatment in this country?
Caroline Flint: I congratulate my hon. Friend on the work he has done in his area to achieve direct access to drug treatment services through GPs in the primary care setting. The Bassetlaw Direct Access drugs service has had tremendous results, with an 83 per cent. retention rate. I agree with my hon. Friend that GPs experiences should be represented. However, we are also trying to make sure that we embed substance misuse as an issue in the medical colleges; on 30 April we published curriculum guidelines on substance misuse. We are also improving the opportunities for GP practices to provide access to drug treatment, particularly in rural and semi-rural areas. However, we will endeavour to do more.
Mr. Henry Bellingham (North-West Norfolk) (Con): Is the Minister aware that the NTA values the contribution that GPs make in working with drug addicts and saving lives? However, how many GPs have been struck off by the General Medical Council for over-prescribing?
Caroline Flint: I will have to get back to the hon. Gentleman on that specific point, but the most recent figuresthose for 2004-05show that the number of GPs participating in shared care schemes for providing treatment to drug users has increased in the last 10 years from 20 per cent. to 32 per cent. Clearly we need to do more, but that is a good sign. We must embed the culture of understanding drug treatment in the earliest days of training. That is why providing the guidance to the medical colleges on 30 April was an investment in the future. I hope that more GPs will see this as one of the health roles that they should play in their communities.
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