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Alan Johnson: Well, hon. Members should not believe everything that they read in the Financial Times. All that I can say to my hon. Friend is that every single ISTC proposal has to be cleared, not just by my Department but by Her Majesty’s Treasury, on the basis of whether it is cost-effective, and whether it
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provides capacity that does not exist. The whole point is to get more MRI scanners and more cardiothoracic centres, and to bear down on the issues so that we attain that precious objective of patients waiting only 18 weeks from referral to treatment. We cannot put that on hold, and that is why the Financial Times story is inaccurate, but we can ensure that at every stage we get value for money and add to capacity. That is the whole point of using the independent sector.

Mr. Geoffrey Clifton-Brown (Cotswold) (Con): Following on from that question, may I ask the Secretary of State what the Government’s general view on the second wave of independent sector treatment centre contracts is? In particular, will he say when he is likely to sign a contract for Cirencester hospital, which I gather is on his desk or his Minister’s desk? I am sure he would agree that prolonged uncertainty does nothing for the morale of the staff and the clinicians in that hospital.

Alan Johnson: I have not had a chance to look at that, but now that the hon. Gentleman has raised it, I will look specifically at his scheme.

Mr. Andy Reed (Loughborough) (Lab/Co-op): I welcome the Secretary of State’s statement and the fact that he is in listening mode. I will bring him many of the local issues that I wish to discuss, such as GP referrals and GP out of hours services at walk-in centres. It is important that the review is not just hospital led. Does my right hon. Friend agree that public health, especially challenging lifestyles, will be the most important thing that we do? Obesity is reckoned to cost the country £8 billion a year. Will he work across Departments, as he has done in his other roles, to ensure physical activity, sport and so on play a crucial role in developing and delivering many of the lifestyle changes that are needed to reduce health inequalities?

Alan Johnson: My hon. Friend is right. I can give him the assurance that public health will be a central part of what we are examining. We are some way off our public service agreement target on obesity. As I mentioned in my statement, these are the new problems that we are dealing with. Lifestyle changes have brought about a whole set of new problems that did not exist back in 1948. Malnutrition, rather than obesity, was the problem then. We need to tackle that and face up to the challenges presented by demographic and lifestyle changes. That is one of the basic reasons for the review.

Mr. Michael Jack (Fylde) (Con): This morning the National Audit Office published a strong and critical report on the diagnosis and treatment of dementia in the United Kingdom, comparing us unfavourably with the rest of Europe. Given that the second of the review’s objectives is dealing with long-term debilitating illnesses, may I ask the Secretary of State whether, in the first three months, he will be able to use the review to come up with a strategy to respond to the NAO’s criticisms?

Alan Johnson: I am not sure whether I can set a time scale, but that was an extremely important report. We
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need to study it carefully and work with the Alzheimer’s Society to see how we can resolve the problems. The review is crucial. The right hon. Gentleman will have a chance to see the terms of reference in the House of Commons Library, but as I mentioned, Professor Darzi will look particularly at the new challenges of an ageing population.

Jim Cousins (Newcastle upon Tyne, Central) (Lab): I welcome my right hon. Friend’s desire to go deeper than the professors. In Newcastle, at the university of Northumbria we have an expanded group of physiotherapy graduates with no jobs to go to, and a huge need to raise the quality of physical activity and deal with avoidable pain and discomfort. The north-east health authority, which is responsible for planning and training, has a surplus of £60 million. Will my right hon. Friend knock heads together and get that sorted out?

Alan Johnson: I will look at that problem. It needs local partnerships to tackle those issues in their locality. Once again I say that that is why we need a bottom-up national health service, rather than a top-down one. I am willing to discuss with my hon. Friend the specific matters that he raised, should he wish to come and see me.

David Tredinnick (Bosworth) (Con): May I congratulate the Secretary of State on his promotion, but say to him that I am astonished that Professor Darzi is working only two days a week on the project? I thought that it was urgent. Surely he should be doing more. May I alert the right hon. Gentleman to a potential problem at his Department of which he may not be aware? There are two important reports on the regulation of Chinese medicine and herbs by Professor Pitillo and the late Lord Chan. He must act on them because European legislation is round the corner, and it would be very much in the mode of Aneurin Bevan, who had a homeopathic doctor and wanted a fully integrated health service.

Alan Johnson: Well, well, if it was good enough for Nye, it is good enough for me. I will look into that, but may I clarify the fact that Professor Darzi is working two days a week for the NHS? He is an esteemed surgeon, and he does that free of charge, incidentally. It is important that he carries on his practice. I know that the Opposition will not appreciate this. I heard their comments from a sedentary position about his being a Minister, but I think it is right that he is a Minister and that he continues to practise. That gives him a special focus. He is already hugely esteemed and highly valued in the profession, but taking away one or other of those aspects would not make his role any easier and, indeed, would diminish it.

Ms Sally Keeble (Northampton, North) (Lab): In relation to the shape and location of hospital services, may I tell my right hon. Friend that our most pressing need in Northampton is for a new acute hospital? Will he ensure that when the proposals for that are drawn up, they will be expedited through the Department and given financial support—I see our new Chief Secretary
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to the Treasury on the Front Bench—so that my constituents in a growing town can have the quality of hospital that they deserve for the 21st century?

Alan Johnson: The Chief Secretary to the Treasury knows a thing or two about those aspects of the national health service. I can assure my hon. Friend that we will expedite the matter and make whatever decisions need to be made very quickly.

Dr. Evan Harris (Oxford, West and Abingdon) (LD): The Secretary of State spoke about a more robust partnership between patients and policy makers based on trust, honesty and respect. With reference to rationing, which means that some effective treatments are not available on the NHS, will he be the first Minister to accept that rationing is taking place and that that needs to be done transparently and rationally, as the National Institute for Health and Clinical Excellence seeks to do?

Alan Johnson: I do not know whether I would be the first Secretary of State to accept that that is the case, but I do. That is the reality of how the system works. We set up NICE to take those decisions out of the hands of politicians, and NICE is now world respected. In many countries there are attempts to replicate it. The hon. Gentleman makes an important point.

Mr. Neil Turner (Wigan) (Lab): I welcome my right hon. Friend’s resolve to tackle health inequalities. He will be aware that my primary care trust is underfunded by some £11 million compared with what its funding should be, according to the Department’s formula. May I press him to give an assurance that in the next comprehensive spending review he will make substantial progress towards eradicating funding inequalities so that primary care trusts have the resources to tackle those inequalities?

Alan Johnson: I thank my hon. Friend for those remarks. The report by Professor Darzi and in particular his extensive consultation right across the national health service, including on issues such as funding and inequalities in funding, will form a major part of our decision on the CSR. In that respect, I can give my hon. Friend the assurance that he requires.

Greg Clark (Tunbridge Wells) (Con): Whatever the Secretary of State’s intentions, my constituents will be worried by yet another review of the NHS, just as they will be worried by the absence from his statement of any reference to the story in the Financial Times that the previous Chancellor of the Exchequer, in his last act, cut by a third the NHS capital budget. Will the right hon. Gentleman reassure my constituents that neither the review nor that policy change will have any bearing on the approval of the new Pembury PFI hospital in my constituency announced by the current Chief Secretary three months ago? Can he reassure us that that will be unaffected by his statement and that policy change?

Alan Johnson: I can give the hon. Gentleman the reassurance that he seeks. I take the opportunity to say, while the Chief Secretary is on the Bench, that the Chief Secretary wrote to the Financial Times about the
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story about £2 billion of funding being taken out and made it clear that all we were doing was looking at how much money was spent that year in the NHS. The extra money is still available to be spent this year.

Barry Gardiner (Brent, North) (Lab): I warmly welcome my right hon. Friend to his new position and in particular the powerful way in which he spoke of the need to address health inequalities. Does he agree that health visitors are some of the most important people in our health service as they are able to reach out to some of the poorest families and most disadvantaged groups in our communities, and that the value that they bring to the health service by addressing those inequalities from an early age is of primary importance?

Alan Johnson: I agree with my hon. Friend about the importance of health visitors and health visiting, which is why we have recently had a review and are considering its recommendations, and I am sure that my hon. Friend, as always, will be following this with great interest.

Mr. Peter Bone (Wellingborough) (Con): How will the Secretary of State’s statement help my constituent, Mrs. Ruby Waterer, a 79-year-old, who went to hospital with an eye complaint only to be told that she would go blind if she did not have three injections? When Mrs. Waterer asked when she could have those, she was told that she could not have them on the NHS, but that she could go down the road a couple of miles and have them done privately for £3,300. That is not the Government’s intention, so how will the Secretary of State help Mrs. Waterer?

Alan Johnson: Various comments are being made by my hon. Friends about the hon. Gentleman raising this matter yesterday and his article—

Mr. Bone: Answer it then.

Alan Johnson: I doubt if I can answer it today, but, with respect, I care more about the hon. Gentleman’s constituent than I do about him. It sounds to me as if she has an issue that we need to tackle, and if he writes to me about it, I will look into it.


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Barbara Keeley (Worsley) (Lab): I welcome the review, but it is surprising that so far we have not touched on carers, particularly of people with dementia, which has been mentioned. Those carers are the experts, with whom the NHS must deal. Can my right hon. Friend assure me that in this important review, carers will be listened to, particularly the expert carers, such as those handling dementia?

Alan Johnson: My hon. Friend raises an important point. Alongside the Darzi review is a comprehensive review of carers that was announced recently by the Prime Minister. We are looking to see what extra help we can give to carers, having already done a lot in respect of pensions and the right to request flexible working, but we need to take a series of other measures, because carers save the Government a lot of money, which can be spent elsewhere in the health service. We are probably the first Government to recognise their importance, and we will ensure that the review is completed speedily.

James Brokenshire (Hornchurch) (Con): To what extent will some of the long-term financial pressures within the NHS be examined in the review, in particular the affordability of PFI-funded hospitals, when Professor Darzi may well come up with models of care that direct patients away from those hospitals, and therefore direct some of the income for those hospitals away from them, challenging their ability to pay the underlying PFI costs that are already entrenched within the system?

Alan Johnson: We will have to deal with Professor Darzi’s recommendations when they come up, but we could never have embarked on this huge programme of rebuilding hospitals without PFI. When we came into Government, most of the NHS estate was built before the NHS was created. Now only a fifth of it was there before 1948, and that is because of the biggest hospital building programme ever in this country, and probably one of the biggest in the world. PFI was necessary to ensure that we did that.


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Palliative Care

1.33 pm

Mr. Lindsay Hoyle (Chorley) (Lab): I beg to move,

In another place, Baroness Finlay has steered through a similar Bill, without amendment, so it is with that which I wish to continue in this House.

Palliative care is part of supportive care and it embraces many elements of supportive care. It has been defined by the National Institute for Health and Clinical Excellence as affirming life and regarding dying as a normal process; providing relief from pain and other distressing symptoms; integrating the psychological and spiritual aspects of patient care; offering a support system to help patients to live as actively as possible until death; and offering a support system to help the family cope during the patient's illness and in their own bereavement.

As at January 2006, in England, Wales and Northern Ireland there were 193 specialist in-patient units providing 2,774 beds, of which 20 per cent. were NHS beds; 295 home care services—this figure includes both primarily advisory services delivered by hospice or NHS-based community palliative care teams and other more sustained care provided in the patient's home; 314 hospital based services; 234 day care services; and 314 bereavement support services.

Everyone facing a life-threatening illness will need some degree of supportive care in addition to treatment for their condition. NICE has defined supportive care for people with cancer, and with some modification the definition can be used for people with any life-threatening condition. For example, I should like it to be extended to cover sufferers of motor neurone disease.

About 5,000 people are estimated to be living with motor neurone disease in the United Kingdom, and half of those with MND die within 14 months of diagnosis. Many people with MND are unable to access the palliative care services that they require. In a survey carried out by the Motor Neurone Disease Association in 2005, only 39 per cent. of people with MND had been referred to specialist palliative care services. In addition, there are unacceptable geographical variations in the quality of service provision and that can have a negative impact on the quality of life of people with MND and their families. Not surprisingly, the association believes that specialist palliative care services should be available to everyone with MND, in a setting and at a time of their choice.

My Bill seeks to broaden the scope of palliative care to cover all those with a terminal illness. It also aims to cater for the needs of those suffering from a terminal illness in allowing them the choice of where to die. In December 2005, a report by the NHS Confederation highlighted the real need to improve end-of-life care for the terminally ill. The report showed that 56 per cent. of terminally ill patients would prefer to die at home, but only 20 per cent. do so. Alternatively, only 11 per
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cent. of people want to die in hospital, yet 56 per cent. do so. Better co-ordination between service providers is urgently needed if we are to improve end-of-life care for the terminally ill.

We also need better access to palliative care services. According to Marie Curie Cancer Care, more than 155,000 die of cancer every year, yet Help the Hospices points out that only 3,250 hospice beds are available, and 2,489 are supplied by the voluntary sector. I have campaigned for many years, urging the Government to increase funding to hospices, particularly children’s hospices such as Derian House based in my constituency, which is a leader in child care. We must ensure that the Government release more funding. It is alarming that children’s hospices are the poor relation in palliative care.

First, there is an acute shortage of paediatric palliative care medicine consultants. Secondly, children's hospices receive only in the region of 5 per cent. of funding from official sources, compared with 30 per cent. for adult hospices, so we can already see the vast difference in funding from the NHS. I want that anomaly to be addressed, in addition to the clear postcode lottery that exists with palliative care. Terminal illness places great strain on families and loved ones. The least they can expect is to have the necessary support and help in making those final days as comfortable as possible. Extending palliative care would not involve a huge increase in expenditure—it mainly requires specialist knowledge in the use of pain-relieving drugs and holistic care to ease the dying process. Marie Curie Cancer Care, in its report "Dying at Home", states that for every £1 invested in home palliative care services, £2 will be freed up for the NHS. Despite that, 80 per cent. of resources are allocated to hospital-based care. We need to shift the emphasis in the funding streams.

In recent years, great strides have been made in palliative care—we all recognise that. Our hospices do a wonderful job in supporting the terminally ill and their families. However, we need to do much more to support the terminally ill. We must ensure that their needs are catered for and that access to treatments, help and support are equal regardless of postcode. The answer is not to legalise euthanasia or assisted suicide. Everyone has the right to life and the right to palliative care. That is what my Bill aims to achieve and I commend it to the House.

Question put and agreed to.

Bill ordered to be brought in by Mr. Lindsay Hoyle, David Taylor, Jim Dobbin, Mr. David Crausby, Geraldine Smith, Mr. David Amess, Mr. Julian Brazier, Mr. Ben Wallace, Mr. Nigel Evans, Simon Hughes, Dr. Brian Iddon and Mr. Bob Laxton.


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