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26 Jun 2007 : Column 152

Ms Hewitt: It is already clear that we will need to continue to increase the number of clinical psychologists, psychiatrists and other mental health care professionals, as we have done over the past 10 years. We have already established demonstration sites in Newham and Doncaster, and the early results in Newham show that one in three patients are improving their employment prospects as a result of psychological therapies. That gives us real heart that continuing to build up the service—as we have promised to do and as we will do—will bring enormous benefits to patients, their families and the wider community.

Meg Hillier (Hackney, South and Shoreditch) (Lab/Co-op): In my constituency, we have a high incidence of mental health problems, and we have good organisations, including, among others, the Psychiatric Rehabilitation Association, which provides psychological services. What can my right hon. Friend say about improving access to those services, particularly out of hours, so that people’s whole lives are not disrupted because they have to take time off work to go to quite difficult sessions? Perhaps more sessions could be provided in the evenings and at weekends.

Ms Hewitt: My hon. Friend raises an extremely important point. One of the great advances that the NHS has made in recent years has been the establishment of more than 700 new community mental health teams, whose services are available to patients when they need them. I have talked to mental health staff who meet the users of their services in the community: in a local café or in their own homes. In particular, the crisis resolution team is available at all hours to meet the needs of the patient, rather than expecting the patient to go on suffering until the service is ready to meet their needs.

Tim Loughton (East Worthing and Shoreham) (Con): Why did the clinical director of the Leicestershire Partnership NHS Trust, in the Secretary of State’s constituency, find it necessary earlier this month to write to the GPs in her constituency encouraging them to get their patients to stump up their own money for private treatment for cognitive behavioural therapy? The letter stated:

That is private treatment using NHS facilities and staff. The clinical director was subsequently forced to withdraw that letter in a hurry. What advice would the Secretary of State give her successor on how to reduce the alarming waiting times for talking therapies without sacrificing the guiding principle of the NHS—that treatment should be free at the point of delivery?

Ms Hewitt: As the hon. Gentleman indicated, that letter was withdrawn almost as soon as it was issued. If he were more aware of the situation in Leicester and Leicestershire, he would know very well that there have been some significant difficulties in that trust in recent years. There is now a new chief executive in place, and I have no doubt at all that the trust will move rapidly to improve its services and will certainly not depart from
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the principle that is absolutely central to the national health service—at least as long as there is a Labour Government—that care will be provided on the basis of clinical need and not the ability to pay.

North Yorkshire Trust Deficit

5. Hugh Bayley (City of York) (Lab): What assessment she has made of the impact the North Yorkshire and York primary care trust deficit is having on care for patients in York. [145314]

The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): Although the NHS overall delivered a net surplus of £510 million in 2006-07, we recognise that a number of organisations—North Yorkshire and York PCT among them—continue to face significant financial challenges. Despite financial difficulties, all parts of the NHS are consistently delivering for patients against national priorities.

Hugh Bayley: I am informed by the strategic health authority that the budget of the NHS trust in York will rise by £6 million, despite the deficit in North Yorkshire. York hospital will, however, be closing beds because a greater number of patients are being treated in the new £8 million day unit at the hospital. Will the Minister therefore reassure me and my constituents that the same full range of NHS treatments will be available to patients in York as are available elsewhere in the country?

Mr. Lewis: I congratulate my hon. Friend both on how he has championed the needs of patients in his constituency and the surrounding area and on his frankness about the need for financial discipline and budget control in the NHS—a responsible balance. Of course he is right to demand an appropriate balance of treatment, from social care and community health services to acute NHS provision, to ensure that patients in his constituency receive appropriate, high-quality and responsive health care. I give my hon. Friend that assurance today.

NHS Dentistry

6. Lorely Burt (Solihull) (LD): What recent assessment she has made of the level of access to NHS dentistry. [145315]

7. Tom Brake (Carshalton and Wallington) (LD): What recent assessment she has made of the level of access to NHS dentistry. [145316]

The Minister of State, Department of Health (Ms Rosie Winterton): Since April last year, primary care trusts have commissioned a growing volume of new dental services. Once those services are fully up and running, approximately 500,000 patients will gain access to NHS dentistry.

Lorely Burt: In the past 12 months, the number of adults seen by an NHS dentist has fallen by 63,000. The latest figures show that 45 per cent. of the population have not seen a dentist in the past 24 months—a figure that has remained stable over time. How can the Secretary of State claim that the new
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contract has increased access to NHS dentistry, and when will she implement an urgent review of the system?

Ms Winterton: In the hon. Lady’s constituency, some 14 of the 33 practices in the PCT are accepting new patients. We know that the number of units of dental activity commissioned has increased from 77 million last April to 78 million; some of them are yet to be provided, but they have been commissioned. We know that NHS dentistry is expanding, and that new contract is working. We have a review group to ensure that we continue to discuss the implementation of the contract with the profession and representatives of patients. The hon. Lady is quite wrong to say that the new contract is not making a difference. It is.

Tom Brake: In the past couple of months, I have had 7,000 health survey responses returned to me, and 70 per cent. of respondents said that getting access to an NHS dentist was extremely difficult. Furthermore, according to an orthodontist I met yesterday, the situation will get worse when the contracts expire in 2009. What discussions has the Minister had with PCTs about provision after 2009? At what point would she expect PCTs to inform the dentists of their plans, so that dentists can prepare their own investment plans and budgets for post-2009?

Ms Winterton: I am not saying that the situation has been fully resolved—far from it. What I am saying is that the new dental contract is proving that we can increase access to NHS dentistry. As I said, already approximately 500,000 more people are able to get access to an NHS dentist. One thing is absolutely clear: if an NHS dentist leaves the NHS, we now have the money at local level to recommission NHS dentistry. That is the difference between the old contract and the new one—now, local people have power to recommission at local level.

Mr. Lindsay Hoyle (Chorley) (Lab): My right hon. Friend needs to stop making excuses for the primary care trusts. She has given them the money and they have it, but they are not providing the dentists. We do not have NHS dentists. The waiting lists are growing and there are no vacancies for the people in Chorley. Please get a grip: make the PCTs spend the money and make them provide NHS dentists. They are letting her down.

Ms Winterton: The PCTs are not allowed to spend the money allocated to dentistry on anything else; they cannot switch it to other services. We work closely with the PCTs, through the strategic health authorities, to make sure that if an NHS dentist leaves the NHS, the PCT recommissions at the local level. If my hon. Friend knows of examples in which that is not happening, I am more than happy to meet him to discuss the issue.

Laura Moffatt (Crawley) (Lab): Does my right hon. Friend agree that denturists, the highly skilled people who make dentures, particularly for older people who may not have been able to look after their teeth as well as people can now, are an important facet of dental services? I am deeply grateful to her for the many
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letters that we have exchanged, and she is to see me and one of my constituents, a denturist, about the issue. Will she say whether there might be any changes to the rules to allow people direct access to denturists, or any other changes that might be helpful to many thousands of people?

Ms Winterton: Obviously, the issue of denturists being able to treat patients directly has been discussed. It is difficult, because the regulations insist that proper training be undertaken. If people who had not undertaken that training practised directly on patients, it would be illegal. We have had to consider that carefully. It is important that proper training be available to people performing that health care task.

Sir Paul Beresford (Mole Valley) (Con): I clearly have an interest in the subject. People outside the House in NHS dentistry do not quite recognise the glorious oil painting that the Minister just painted. Will she tell the House what changes she has introduced through the implementation group that she set up at the beginning of the contract—or was that just a sop to keep the dentists quiet?

Ms Winterton: The issues that we are considering, particularly as we come to the end of the first year, have to do with the banding system and units of dental activity. We are looking carefully at whether dentists are able to meet the targets that have been set relating to units of dental activity. The evidence is that the vast majority have been able to meet the requirements of the contract. The group is a way of keeping an open dialogue about any difficulties that occur. I will write to the hon. Gentleman. On a number of occasions, we have been able to issue further guidance to PCTs about some of the issues raised through the review group.

Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab): Milton Keynes primary care trust has used the new system very effectively to open new dental surgeries and completely clear the waiting list. Will the Minister take steps to make sure that that good practice is spread to those PCTs which do not seem to be performing as well as that PCT does?

Ms Winterton: My hon. Friend is absolutely right. There have been good instances of PCTs taking real action to recommission services and really prioritise dentistry. Lincolnshire, which is represented by the hon. Member for Grantham and Stamford (Mr. Davies), has taken real steps forward in recommissioning dentistry, and I am sure that he appreciates the works of the Labour Government.

John Penrose (Weston-super-Mare) (Con): The Minister may not be aware that the incidence of tooth decay among under-fives in my constituency is above the national average. What specific measures is she taking to ensure that some of the resources that she has described this afternoon will be targeted on the dental health of that important group?

Ms Winterton: We have introduced a number of initiatives, such as Brushing for Life, which works through schools. It is about teaching young children how important it is for them to keep brushing their teeth, using fluoride toothpaste. There are a number of public health initiatives that have been very successful.
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Obviously, local authorities and PCTs can now consult on the issue of fluoridation, which can in itself be very helpful in improving dental health.

Mr. Kevan Jones (North Durham) (Lab): Will my right hon. Friend congratulate County Durham PCT on the opening of the new Pelton Lane Ends NHS surgery in my constituency, as it not only offers provision for existing NHS patients but extends NHS provision to those of my constituents who were abandoned by the private sector?

Ms Winterton: My hon. Friend is quite right. At our meeting yesterday it was encouraging to look at the steps that the PCT has taken to deal with an area with poor access to NHS dentistry. The majority of people are on quite low incomes, so they could not purchase private sector dentistry. That is therefore a very good example of the way in which PCTs that prioritise dentistry can provide for many thousands of people care that has been severely lacking for some years.

NHS Trust Deficits

8. Mr. Henry Bellingham (North-West Norfolk) (Con): When she next expects to meet representatives of NHS trusts in East Anglia to discuss deficits. [145317].

The Minister of State, Department of Health (Andy Burnham): I meet the chief executive of the East of England strategic health authority on a quarterly basis to discuss finance and other topics. For 2007-08, all PCTs in East Anglia and the east of England are forecasting financial balance.

Mr. Bellingham: Can the Minister explain why he and his ministerial colleagues allowed the new Norfolk PCT to start operating with a £50 million deficit? Is he aware of the widespread concern in East Anglia that a number of accident and emergency units are under threat, and can he confirm that there will be no linkage between strategic health authority deficits and the closure of A and E units?

Andy Burnham: As I said a moment ago, the health economy of which the hon. Gentleman’s PCT is a part is forecasting financial balance this year. In addition, it will make progress on our 18-week target, effectively bringing an end to waiting and to waiting lists. All PCTs in the country have to plan for their own local services and get services in the right places that are convenient for the population. I wish that the hon. Gentleman and his colleagues would stop trying to perpetuate the myth that financial pressures are causing cuts to services such as A and E, because it is simply not true.

Mr. Bob Blizzard (Waveney) (Lab): The East of England strategic health authority figures show that even though Cambridgeshire PCT has the highest funding allocation per head, it was the biggest overspender in the eastern region. My own PCT has successfully managed down its own modest deficit, but the strategic health authority took some of our money to bail out Cambridgeshire. Will my hon. Friend tell me when we will get it back?

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Andy Burnham: My hon. Friend has just put his finger on the unfairness of a health funding system that allowed overspending to continue, thereby taking money from other parts of the country that needed the resources to improve the health of the population. I pay tribute to his PCT, which moved from an in-year deficit in 2005-06 to a surplus last year. If his PCT has got its house in order, others can do so too.

Norman Lamb (North Norfolk) (LD): As the Minister reflects on how those trusts are struggling to cope with deficits and to deal with a substantial programme of reform at the same time, is he minded to agree with the chief executive of the NHS, who said:

Does he agree that the current structure is hopelessly over-centralised and that independence, as proposed by the Conservatives, will not change that at all? What we need is local, democratic accountability for local health services.

Andy Burnham: If I can decode what the hon. Gentleman said, he wants to retreat to a comfort zone where we tolerate practices that allow overspending to continue. Parts of the reform programme, however, have shone a spotlight on areas where inefficiency has been tolerated for far too long, and the tariff system has made people ask questions of their own operation so that they can achieve more efficiency. Our 18-week target is hammering out unnecessary delays in the patient journey, and making sure that there is better and more productive use of resources. The reform measures that we have put in place therefore do not contradict at all the goal of financial balance. In fact, they help trusts to achieve it.

Complementary and Alternative Medicine

9. David Tredinnick (Bosworth) (Con): What guidance her Department has produced for primary care trusts on the role of complementary and alternative medicine in innovative service redesign. [145318]

The Minister of State, Department of Health (Caroline Flint): The Department has published guidance on practice-based commissioning which enables the delegation of indicative budgets for services including complementary and alternative health therapies. “Our health, our care, our say” states that primary care trusts will be expected to support practices that are innovative and provide services that promote patient choice—for example, complementary medicine.

David Tredinnick: That sounds fine. The trouble is that there is no specific direction that there should be guidance, although 75 per cent. of the population want those services on the health service. What, for instance, does the Minister intend to do now that the scientific survey on Echinacea has been published, which shows that that remedy can cut colds by 50 per cent., as well as the duration of a cold? Is not that the sort of guidance that should be offered through the primary care trust? Will she revisit the subject and see what she can do?

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