Mr. David Chaytor (Bury, North) (Lab):
My hon. Friend will know that the reorganisation of maternity services in Greater Manchester is one of the largest, if not the largest, in the whole country. She will also know that the report of the Independent Reconfiguration Panel gave an absolute assurance that no change should take place to local services until community midwifery
and community paediatric services were fully in place. Can she repeat the importance of that guarantee now in view of the fact that, last week, the health authority published a timetable that would appear to make it extremely difficult to fulfil the promise of the IRP?
Mr. Nicholas Soames (Mid-Sussex) (Con): Is the Minister aware of the magnificent work done by the Support the Princess Royal campaign in Haywards Heath to save the maternity services mentioned by the hon. Member for Lewes (Norman Baker)? Is she also aware that because of the Governments outlandish housing targets for the north of Sussex, the population is growing at such a pace that to have the idea that it would be sensible to downgrade maternity services at the Princess Royal is really an act of folly? Will she receive a delegation from the Support the Princess Royal campaign to discuss this matter with them?
Ann Keen: The hon. Gentleman raised this issue in an Adjournment debate of which I took serious note. As I have said to the House, the views of clinicians and the safety of mothers are paramount at all times. If he wants to bring new evidence to me, he should by all means do so.
Mr. David Burrowes (Enfield, Southgate) (Con): If the Minister is serious that clinicians views and the interests and safety of mothers and babies are paramount, why is a proposal being made to downgrade maternity services at Chase Farm hospital without the clinical evidence? Why is it that that unit, along with the others mentioned in the House today, are close to the level that the Royal College of Obstetricians and Gynaecologists recommends should be kept open?
Ann Keen: There is no evidence at all that the clinicians views in any of the reconfigurations are not being taken seriously. Safety for mothers is paramount, and that is why we have the safest record in Europe and one that is even safer than that of the United States. That point is on the record. We have to say that reconfiguration sometimes causes distress through the consultation, but the consultation will proceed at all times by taking into account the safety of mothers and babies.
Charles Hendry (Wealden) (Con): Is the Minister aware that on the first Sunday in June, the maternity units at Brighton, Eastbourne, Worthing, Hastings and Haywards Heath were all full and stopped admitting pregnant mothers? With a rapidly growing population in Sussex, and with units already at capacity, is it not madness to be suggesting that there should be fewer units, rather than maintaining those that are there now?
Ann Keen: I am sorry to keep repeating this, but there is no other answer. We have to look at the safest practice for mothers and babies, and clinicians are asking us to do so. I am sure that the local health economy has taken these points into account.
Sir Nicholas Winterton (Macclesfield) (Con): Would the Minister accept that the quality and safety of maternity services very much depends on the midwifery profession? I declare an interest as an honorary vice-president of the Royal College of Midwives. I know that the Minister is aware that there is a shortage of midwives in both the community and hospitals. Will she seek to do something to increase the number of midwifes to benefit maternity services throughout England, including in Sussex?
Ann Keen: I am sure that the Royal College of Midwives is very pleased to have the hon. Gentleman as an honorary vice-president. Being a friend to midwives is always a popular thing to do. I assure him that 1,000 extra midwives are being recruited. We are looking seriously at return-to-practice courses for midwives who have left for a variety of family reasons. I agree with the hon. Gentleman that more needs to be done, but that is what we are doing, and I look forward to working with him to achieve that.
Anne Milton (Guildford) (Con): Is the Minister aware that my hon. Friend the Member for Eastbourne (Mr. Waterson) is leading a march through the streets regarding maternity services in his area? Is she also aware that according to a recent survey by the Royal College of Midwives, two thirds of midwives say that they have considered leaving the profession, while almost half those people state that increased work load and having to compromise care are the main reasons why? How does the Minister expect to fulfil the Governments aspirations of choice when people in the maternity services are demoralised, when more midwives are leaving than joining, when the birth rate is up 12.5 per cent.
Ann Keen: Perhaps I could give some general tips on marching because I marched throughout the 80s and 90s when the Conservative Government were in power. We were constantly marching and raising money for services. Many members of the profession were leaving then, but members of the profession today are pleased to be involved in the review in which the NHS is participating, and they will be celebrating 60 years of the NHS with us next year.
The Minister of State, Department of Health (Mr. Ben Bradshaw): Progress with NHS computer systems is measurable in hospitals, general practices and pharmacies across the NHS in England. Despite the challenges associated with all large IT programmes, the connecting for health system is bringing benefits to doctors, nurses and, most importantly, patients.
Dr. Pugh: I thank the Minister for that answer, but hospital patient administrations from the supplier, iSOFT, are still not in place. After an £80 million bung from the NHS, financial meltdown, an investigation of the company and a takeover by the Australians, can the Minister guarantee that hospital software ordered from iSOFT is written, workable and ready for roll-out by 2008, or are we being a tad optimistic?
Mr. Bradshaw: Progress is good, as the Health Committee accepted in its recent report. There have been delays, but any cost overruns are being borne by not the taxpayer, but the private suppliers. When the private suppliers have been unable to deliver the goods, they have been replaced by other private suppliers.
Mr. Kevin Barron (Rother Valley) (Lab): Is any further training taking place in the national health servicein both the primary and acute sectorsso that people are able to use the connecting for health system?
Mr. Bradshaw: Yes. One of the criticisms in the Health Committees reportwe responded to it in full yesterday and almost entirely accepted itwas about the need for better clinician engagement. That is certainly going on across the health service. It is worth the House acknowledging the enormous benefits for not only patients, but health service staff, from having proper IT systems that are integrated and can deliver better patient care.
Dr. Howard Stoate (Dartford) (Lab): My hon. Friend will know that to maximise the usefulness of all our health service professionals, especially in primary care, it is essential that we make maximum use of the expertise of pharmacists. What plans has he to ensure that pharmacists will soon have read and write access to patient records, so that we can maximise everyones skills in primary care?
Mr. Lewis: Pharmacies use of IT for e-prescribing is increasing all the time. My hon. Friend will have to wait a little while, until we publish our pharmacy White Paper, for us to say more about that, but he is right to say that there is enormous potential for pharmacists to deliver better services to patients if they have full access to IT and their access is interoperable with the rest of the health service.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): My hon. Friend the Member for Exeter (Mr. Bradshaw), in his capacity as a local constituency MP, has passed on concerns raised by his constituents. The organisation of services is best decided locally, and the Devon overview and scrutiny committee has recommended formal consultation on the proposals.
The Minister will be well aware of the well regarded provision of keyhole surgery in the treatment of gastro-intestinal cancer, as performed by
the Royal Devon and Exeter hospital. He will also be aware that in his NHS next stage review interim report, Lord Darzi states:
Localise where possible, centralise where necessary.
Does the Minister not agree that it is quite unnecessary to move the provision of that treatment from Exeter to Plymouth, and will he hold urgent discussions with the Devon primary care trust to point out the error of its ways?
Mr. Lewis: No final decision has been made. The local authority has said that, even before it decides whether to refer the matter to the Independent Reconfiguration Panel, it wants to consult locally. I urge the hon. Gentleman to engage fully in that consultation, which will take place before any final decision is made. I should also point out that there is a contradiction in saying that it is inappropriate for the Government to issue central diktats and directions from Westminster and Whitehall while demanding central Government intervention in local decision making.
When considering the reconfiguration of gastro-intestinal cancer services in Devon and, indeed, elsewhere, will the Minister bear in mind the innovative straight-to-test GI cancer assessment service pioneered by Dr. Madhotra at Milton Keynes, which has drastically cut the time taken to get patients through diagnostic services? That is clearly relevant to the examination of GI cancer services everywhere.
Mr. Lewis: That was ingenious and innovative, like the doctor my hon. Friend mentions. Her point is incredibly important, because it underlines the fact that developments in medicine and technology and the genius of clinicians are changing the health service all the time, so to maintain services as they were before those changes occurred would be a complete nonsense. That is why calling for a moratorium on any change in the NHS is irresponsible.
6. Mr. Adam Holloway (Gravesham) (Con): What the average waiting time was for hearing aid assessments in (a) Gravesham and (b) England in the last period for which figures are available; and if he will make a statement. 
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): The median waiting time for a diagnostic audiology assessment, including hearing assessment, is 52 weeks at the Medway NHS Trust, which includes the area of Gravesham. The average for England is 16 weeks.
Does the Minister think that the Government will hit their own target of six weeks to initial assessment by 2008, given that now some of my
constituents are waiting up to 12 months? Has he thought about the distressing effect of such waits, especially on the elderly?
Mr. Lewis: The length of waiting times in the hon. Gentlemans local trust and in some others is entirely unacceptable. That is why we have a target of a maximum wait for assessment of six weeks to be achieved everywhere by March 2008. It is also the reason why, in March, I issued the new audiology framework, which is essentially a strong message to every trust in the country that they must reduce waiting times to the level achieved by the best PCTs, which is already happening in many parts of the country.
Charlotte Atkins (Staffordshire, Moorlands) (Lab): Is my hon. Friend aware of North Staffordshire primary care trusts use of mobile facilities, particularly in Leek? It massively reduces waiting times, both for assessment and for fitting devices.
Mr. Lewis: That is exactly the kind of innovative and imaginative process that was suggested in the framework that we issued in March. In every locality, the most effective way of reducing waiting times for assessment and the fitting of hearing aids should be deployed. Where that imagination and innovation is to be found, we need to learn about it, and we need to ensure that it is mainstream throughout the system. As the hon. Member for Gravesham (Mr. Holloway) said, not having access to appropriate hearing services is distressing for people, and it affects their quality of life; that is why the issue is so important.
Norman Lamb (North Norfolk) (LD): The Royal National Institute for Deaf People estimates that over 500,000 people are waiting to have hearing aids fitted. In many parts of the country, people are waiting far more than a year to have one fitted. Will not those who are waiting feel badly let down by last weeks announcement that the 18-week target will not be quite as watertight as we were all led to believe? Is not that yet another instance of manipulation of Government targets, as the Government knew full well that they had no chance of meeting the target?
Mr. Lewis: It seems eminently sensible that when we set targets, we take account of practical issues such as the fact that patients sometimes fail to turn up and fail to co-operate with the clinicians and the health service. It would be nonsense to tell hard-working NHS professionals that they had failed to meet a target due to circumstances outside the control of either the trust or the professionals and clinicians involved. Think of the damage to morale that that would cause. The announcement made last week is entirely sensible, and it will not affect the fact that we will get waiting times down for audiology services in every part of the country.
The Secretary of State for Health (Alan Johnson):
Deep cleaning will occur in all hospitals starting this winter, and it will be completed as soon as possible
thereafter. Resources will be allocated through the strategic health authorities. Trusts deep clean plans will vary according to local need, and trusts will be able to identify what additional training is needed to ensure that their local programme is delivered to the appropriate standards. All trusts will submit costed deep clean plans to their lead primary care trust, which will monitor performance against the plan, according to normal performance management arrangements. Strategic health authorities will take an overview of progress across their area and will report to the Department. We will assess the progress and impact of the programme.
Philip Davies: Given the importance of tackling hospital-acquired infections, perhaps the Secretary of State will explain why it has taken the Government 10 years to come up with a rigorous cleaning programme, say how many fewer cases of MRSA we can expect in our hospitals as a result of the initiative, so that we can test whether it has been successful, and say how deep cleaning compares with using environmental cleansing equipment, such as Steriss vaporised hydrogen peroxide equipment, to tackle the disease.
Alan Johnson: The deep clean is one of a series of initiatives. The issue is the subject of huge public concern. We are the only country in the world that has mandatory comprehensive surveillance, and the only country in the world that knows exactly what the situation is with our health care-acquired infections. As a result, we are able to tackle the issue through a series of measuresnot just through the deep clean, but through the bare below the elbows policy, which has been used at the Royal Marsden hospital for many years, just as deep cleans have been used in many hospitals for many years. It is a case of ensuring that every hospital follows best practice.
There are other initiatives, of course, such as the new powers that we are giving the care quality commissionan issue that we will discuss in the debate on the Gracious Speech. There is pre-screening for MRSA for all people coming into hospital, whether for elective or emergency surgery. There is a whole series of other measures, which means that we have a comprehensive programme to address the problem, which affects all countries around the world.
Mr. David Anderson (Blaydon) (Lab): Does the Secretary of State accept that what is needed for clean hospitals is not just deep cleaning but an assurance that we will continue to clean them, and thus a motivated, well-funded work force? Will he learn the lessons of the 1980s, when the Conservatives reduced the number of ancillary workers in England from 177,000 to 60,000?
Alan Johnson: I agree with my hon. Friend about the need to ensure that there are proper cleaning facilities. He may wish to know that spending on hospital cleaning has increased from £403 million in 2000 to £662 million in 2006-07, which is an increase of almost 65 per cent., so it is essential to ensure that there is investment in cleaning services as part of a range of measures to tackle those problems.