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Caroline Flint: I am sure the hon. Gentleman agrees that it is very important that clinicians are on the front line in deciding what is required for patient care. Clearly, doctors are accountable for any treatment that they give their patients, both conventional and complementary. The National Institute for Health and Clinical Excellence has produced guidance in certain areasin relation to multiple sclerosis and on supporting care for patients who have cancer. We are working with the foundation established by the Prince of Wales for integrated health to look at ways in which we can encourage voluntary self-regulation in certain areas. We also have some outstanding work on which we hope to report by the end of the year; it concerns bringing aspects of acupuncture and herbal medicine under statutory regulation. No doubt the hon. Gentleman would agree that, like medicine, politics has alternatives. I am so pleased to see that the hon. Member for Grantham and Stamford (Mr. Davies) has chosen an alternative called Labour.
Mr. Andy Reed (Loughborough) (Lab/Co-op): As my hon. Friend knows, the rise in obesity and type 2 diabetes is causing enormous problems, particularly among young children and those growing into adulthood. What is she doing to ensure that part of the health budget is used for physical activity and sport, rather then relying on the Department for Culture, Media and Sport and others to provide those facilities? Will she ensure that GP referral schemes are available throughout the country, and that people are encouraged through marketing to take up physical activity?
Caroline Flint: I thank my hon. Friend for that question. In the framework of health and well-being on which we are consulting, there are a number of examples showing how GPs can be innovative in the referrals that they make, including referrals for physical activity. We have just completed the physical activity care pathway, which is a tool that doctors and others can use in order to determine what levels of physical activity are needed by adults and young people. I hope that in future, in line with value for money and effectiveness, we will see much greater emphasis on preventive care and on ways of encouraging people, young or old, who are suffering from obesity to tackle that problem through exercise, with the support of others, and most importantly, through personal responsibility.
10. Mr. Gordon Marsden (Blackpool, South) (Lab): What assessment she has made of the extra demand for NHS acute and accident and emergency services in seaside and coastal towns from visitors during the peak tourist season. 
The Minister of State, Department of Health (Andy Burnham): It is a matter for the local NHS to ensure that it has arrangements in place to plan for and respond to increases in demand. Where demand comes from outside a primary care trusts areafor example, because of a large tourist populationproviders can recover costs from the patients home primary care trust.
Mr. Marsden: My hon. Friend knows that in a town such as Blackpool, which has almost 10 million visitors a year, the extra pressures are considerablesome 8,000 people seen out of hours, some 4,500 seen on a temporary resident basis, and some 11,500 seen at the walk-in centre. Although I accept my hon. Friends point, that hard work provides testament that the additional pressures on Blackpool and other seaside towns are not fully met by the procedure that he set out. Will the Department examine the funding formula with other appropriate Departments and see whether the pressures of day visitors as well as temporary one and two-week residents are properly catered for? That was funded by the Department of Health
Andy Burnham: I am indeed aware of the pressures that my hon. Friend talks of, as a regular visitor myself to the Sandcastle water park with my son. Indeed, I have nearly had cause myself to visit his local walk-in centre and A and E. I have looked in detail at the issues that he raises, and I believe that he is raising a genuine and fair point. There are changes proposed in relation to payment by results that would effectively de-host, as we put it, A and E services, which would mean that A and E costs could be reclaimed from another PCTthe PCT responsible for the tourist in question. Having looked at the figures, it appears to me that his trust is not succeeding in recovering the money that it spends on treating patients from elsewhere in the country. It appears that he has a valid point, and I shall look further into it.
11. Mr. Philip Hollobone (Kettering) (Con): To ask the Secretary of State for Health, if she will make a statement on her Departments plans to make it a legal requirement for all independent midwives to have professional indemnity insurance. 
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): The Governments policy is to include provision for compulsory indemnity cover as a condition of registration for each profession as the opportunity arises in wider legislative change. No date is set for the implementation of the policy specifically in respect of midwives.
Mr. Hollobone: Given the national shortage of midwives, may I urge the Government to do far more to encourage independent midwives in their profession, including all those in the Kettering constituency who have written to me to highlight the problem?
Mr. Lewis: There is a real issue of professional indemnity, but we do not want to create a situation in which we make life impossible for independent midwives. That is why we are working closely with their representative organisations to try to find a solution. Before professional indemnity was required of midwives, secondary legislation would be required in this House. We are not at that stage yet, and we intend to do absolutely everything we can to work with midwives to see a satisfactory way forward.
Sir Nicholas Winterton (Macclesfield) (Con): The Royal College of Midwives, of which I am an honorary vice-president, has clearly stated that if Maternity Matters, which is a Government policy, is to be fully, properly and effectively implemented, there will need to be 22,000 whole-time equivalent midwives in Englands NHS in the relatively near future. Currently, there are 18,949 midwives. Would not the Ministerthis is a non-party political question to himsupport my hon. Friend the Member for Kettering (Mr. Hollobone) in saying that we need to give encouragement to the independent midwives if this service is to be properly managed and effective, and that they must therefore have some
Mr. Lewis: If we are to make a reality of choice for women throughout the country, which we are committed to do by the end of 2009home birth, midwife-led birth and consultant-led birththere will undoubtedly be a need for more midwives in some parts of the country, possibly including the great place of Macclesfield. It has been made absolutely clear to every local health economy that that is the expectation.
The Minister of State, Department of Health (Andy Burnham): We have no immediate plans for another formal review of out-of-hours services, but we will be emphasising the importance of high quality GP out-of-hours services as part of the network of urgent and emergency care provision in the forthcoming framework document.
We need more access to doctors, we need drop-in centres, we need local health care centres to be more effective, we need NHS Direct to be working.
Andy Burnham: I must remind the hon. Gentleman that the GP out-of-hours service was close to collapse when his party left office. It was simply not sustainable, and the changes that we have already made with the introduction of NHS Direct are a major improvement. Only today, we have announced that six PCTs are taking forward proposals to tender for new primary care services, which is real action to address the quality of GP and primary care services in some of the more deprived communities. What did his party do?
David Taylor (North-West Leicestershire) (Lab/Co-op):
I cannot be alone among MPs in having a continuing trickle of constituents who are concerned about the deficiencies of out-of-hours care. Such cases
are often moving, and occasionally they are tragic. One common feature is the out-of-hours doctor not having direct access to the patients medical details. Will the Minister say whether the Connecting for Health IT programme includes provisions to allow organisations such as Primecare to have remote access to that information, in the interests of the patient and their family?
Andy Burnham: I thank my hon. Friend for his question. He is right to say that the quality of out-of-hours provision needs to improve in some areas. There is a set of national quality requirements against which all PCTs must monitor their out-of-hours service. He is right to raise information transfer, because the report into the tragic death of Penny Campbell highlighted the need to transfer information between clinicians, and we reiterated that point to the wider NHS in response to the coroners report. My hon. Friend is right to say that the Connecting for Health programme has the potential to bring major improvements in patient safety by giving any clinician in the country access to relevant and up-to-date records for the patient before them.
Mr. Andrew Lansley (South Cambridgeshire) (Con): The Minister will recall that the Public Accounts Committee said that the introduction of the new out-of-hours contracts was shambolic. Privately, Ministers say that they inherited that situation from their predecessors, so what advice would they give to their successors on how to improve out-of-hours care?
Andy Burnham: I can confidently say that we have improved out-of-hours care. Indeed, the National Audit Office review of out-of-hours services found that those services are broadly on track and improving. Indeed, satisfaction levels for out-of-hours care show that eight out of 10 patients say that their care is satisfactory. Again, I remind the hon. Gentleman that the out-of-hours service was close to collapse in parts of the country. GPs were not joining the profession, because they were not prepared to take on a 24-hour commitment to providing out-of-hours services. The hon. Gentleman should remember the facts and the history before lecturing us at the Dispatch Box.
Tell that to the people in Cornwall. The Minister might at least have shown some evidence of what needs to be done to improve out-of-hours care. Why, for example, are there so few occasions when GPs have used practice-based commissioning to take
responsibility for commissioning out-of-hours care, even if they are not personally responsible for its delivery?
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): Ministers have regular meetings with Members of Parliament and other stakeholders about spending on health services in London. We also receive a regular flow of correspondence from across the country, including London.
Jeremy Corbyn: The Minister will be aware that there has been a large increase in PCT spending in the borough of Islington in the past 10 years and that the number of doctors has doubled. In the next five years, the boroughs population is likely to rise by 14,000, and there are already enormous demands on overstretched mental health services. What consideration is he giving to the needs of mental health, as funded through the PCT, in future spending rounds and the future allocation of funds for inner-city areas such as mine?
Mr. Lewis: There has already been an average increase of about 19.5 per cent. over the past two years in my hon. Friends local primary care trust. We recognise that population changes and demographic changes, as well as the fact that we want mental health services to be regarded as a priority, will be a central part of the deliberations that inform the comprehensive spending review discussions, which are still under way. Those discussions will be concluded in the autumn, when the level of resource available to my hon. Friends primary care trust and those of other Members will be clear.
The Secretary of State for Environment, Food and Rural Affairs (David Miliband): With permission, Mr. Speaker, I should like to make a statement on the serious flooding that has affected large parts of England in the past 24 hours. As the House will know, the flooding was caused by the most exceptional weather conditions: up to 100 mm of rain in 24 hours in several places. This follows an unusually wet month with up to double the normal average monthly rainfall, which has saturated the ground and caused rivers to rise above their normal levels for the time of year.
Sadly, I have to report the confirmed loss of three lives: a 68-year-old man and a teenage boy died in separate incidents in Sheffield, and a 28-year-old man died in Hull. I am sure that the whole House will want to join the Prime Minister in extending our very deep sympathy to the families and friends of all those who have lost their lives in these tragic incidents.
It is estimated that some 1,000 properties have been flooded in and around Sheffield, Nottingham, Leeds, Hull, Grimsby, Rotherham, Doncaster, Cheltenham, Shropshire and elsewhere. We all know that flooding is every householders nightmare. Within the past two hours, the Minister for Climate Change and the Environment, my hon. Friend the Member for Dudley, South (Ian Pearson), has attended the Gold Command meeting, and he is visiting some of the affected areas in south Yorkshire today. He will see for himself, and will report back to me on, the major impacts that the floods have caused. These are traumatic events, especially for the elderly people involved, and every effort will be made to support them.
This morning, the Environment Agency had in place 25 severe flood warnings, 133 flood warnings and 129 flood watches, mainly concentrated in Yorkshire, the midlands and Lincolnshire. The situation does, of course, remain subject to regular change. River levels are dropping in the upper catchments today, although they will still rise further downstream. Flood defence operations are in place, including, where appropriate, temporary defences.
The House will have seen reports of very real dangers associated with the Ulley reservoir near Rotherham. The emergency services are working to control the situation, utilising high volume pumps that have recently been bought for the fire and rescue service through the good offices of my right hon. Friend the Secretary of State for Communities and Local Government. The situation is potentially serious. Gold Command is monitoring developments very carefully and contingency arrangements are being made. Two hundred and fifty people from the downstream area have been moved from their homes, and the M1 motorway has been closed as a precautionary measure.
The founding principle of the emergency response system is for decisions to be taken locally through an integrated structure, with the police in charge once Gold Command is activated. I am sure that the House will want to pay tribute to the heroic efforts of the many who have responded so magnificently to this event at local level. These include the staff of the fire,
ambulance and police and other rescue services, local authorities, the Environment Agency and the voluntary sector. We know just how hard the fire and rescue service worked in the ultimately vain attempt to rescue the man trapped in the drain in Hull, and saw on television the RAF search and rescue helicopters airlifting people at risk in Sheffield. Otherwise, there has been no requirement for armed forces support. However, armed forces liaison officers were deployed to Gold Commands yesterday afternoon, notably in Humberside and Sheffield, and are ready to provide support if required. Overall, some 1,400 people have been provided with emergency shelters and other temporary accommodation. The community spirit in all the affected areas has, from all the reports that I have received, been outstanding.
It is clearly much too early to make a full assessment of the event. All relevant lessons will be learned once the immediate priorities have been met. However, I have been assured that the Environment Agencys new Floodline Warnings Direct system performed well in issuing warnings to very large numbers of people in areas affected.
Some water flowed over the flood defences as the unprecedented rainfall exceeded what they were designed to deal with, but there had been no reported structural failings of flood defences. The local authorities are responsible for the short and longer-term recovery effort in the affected areas, and I am sure that elected members and officials will rise to that challenge. The relevant Government offices and other agencies will work with the local authorities to support them in that process.
Emergency financial assistance is available to local authorities under the Bellwin scheme to help with non-insurable clear-up costs incurred in taking immediate action to safeguard life and property following a disaster or emergency in their area. Local authorities have one month from the end of an incident to notify the Department for Communities and Local Government that they intend to apply for activation of a Bellwin scheme. If approved, that Department will usually reimburse an authority for 85 per cent. of its eligible costs above a threshold related to the authoritys annual budget.
I am also pleased to note that insurers are playing their part in the recovery, and that the Association of British Insurers has advised that its members have staff in place to ensure that claims are tackled promptly.
Ministers and officials in my Department and elsewhere in Government have kept in close touch with the events around the country without getting in the way of the local delivery effort. I spoke last night at 10.40 pm to the chief executive of Sheffield city council and this morning with the chair of the Environment Agency. It is clearly most efficient that decisions on how to manage the event are taken locally, drawing on local emergency plans. Again, those seem to have operated well.
For many people, the immediate task is one of clean-up. However, it is also vital to prepare for any further wave of extreme weather. Heavy rain later in the week remains a real threat and all the appropriate agencies remain on high alert. I will report any further significant short-term developments to the House.
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