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The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): Through the recent comprehensive spending review settlement, the Government have already committed an additional £2.6 billion by 2010-11 to local authorities that provide social care, with an additional £190 million for social care through Department of Health grants. Last week, we announced £520 million funding for councils to redesign and reshape their systems for social care.
Ann Coffey: I thank my hon. Friend for his reply and welcome the Secretary of States announcement last week of cash for authorities such as Stockport to reform the way carers deliver to older people. Often, the frustration for older people and their carers is negotiating a way through the different funding streams and agencies that provide health, social care, community transport, leisure and benefits. Does my hon. Friend agree that funding streams need to be simplified if older people are to have real choice and control in accessing the services they need?
I agree entirely, and I pay tribute to my hon. Friends championing of social care over many years. It is absolutely true that we need to define the amount of money available in every local community in terms of health and well-being, not just the money spent through adult social services departments. We spend large amounts through local authority mainstream services and the area-based grantwe have announced
the social care reform grant. We also spend resources through the local NHS and the voluntary sector. We must be much better at co-ordinating those resources to create a single health and well-being system that is easy to access for the people who need the services and for their family members.
Sir George Young (North-West Hampshire) (Con): But will the Minister not recognise that next years local government settlement is enormously worrying for adult social services departments, and is he not concerned by the warnings that we are getting from directors of adult services that next year they will have to restrict services to either life-threatening or emergency conditions and cut back severely on preventive work?
Mr. Lewis: The right hon. Gentleman reinforces the need to recognise that there is a large amount of resource that goes through a variety of channels in local communities to support maximum independence for older people, disabled people and people with mental health problems. We need to ensure that we are making the best use of those resources. However, some very inconsistent decisions are being made at a local level. One local authority is spending £300,000 launching a TV station and increasing charges for domiciliary care to the same level. Other local authorities are able to cut council taxin London, I am told, by 3 and 4 per cent. Of course there are genuine demographic challenges that we have to face in terms of a new funding system for social care in the long term. That is why the Government are committed to a Green Paper. But in the meantime we could do an awful lot to improve services for older people and disabled people by changing the way in which we provide those services.
Mr. Clive Betts (Sheffield, Attercliffe) (Lab): I very much welcome the Governments proposals to give personal budgets to the elderly who need care, so that they can have a real choice about the type and nature of care that they receive. For many people that will be a really liberating experience, but some elderly people will feel a bit daunted by the prospect of having to manage the budgets. Some will have family who can help them, but will the others be offered advice and assistance that is independent of those who provide the care, so that people can make genuinely informed choices that will benefit them?
Mr. Lewis: My hon. Friend makes a really important point. It is a significant advance in public service reform to put maximum power and control in the hands of people who use services and their families, but that requires different levels of support, depending on the needs and circumstances of individuals and their family members. Some people will be able to exercise that control and choice over the use of personal budgets with little additional support. Other individuals will need a high level of support in order to make those choices and exercise that control. However, we should not hesitate to sign up to the notion that, as a starting point, everybody is entitled to self-determination and maximum control and choice. That is entirely consistent with the values of this party and this Government throughout their history.
Mr. Mark Harper (Forest of Dean) (Con): The Minister will know that a recent study by the Office for National Statistics showed that productivity in social care had been falling by 2.3 per cent. every year. The problem is that putting in more money will not get us very far if productivity is worsening. What is the Minister going to do to turn those figures around?
Mr. Lewis: There is a lot of objective evidence that the quality of provision of social care is going up year on year. The announcement that we made last weekwhich was unprecedented in the sense that it was cross-Government and involved partnership with local government, co-producing public service reformis about our ability to transform the social care system significantly within existing resources. We want quality information, advice and advocacy for all, including self-funders, and we want a shift to early intervention and prevention. What is crucial is world-class commissioning that incentivises and rewards high-quality provision, but is punitive in relation to care homes and providers that do not offer people quality services.
Mr. Stephen O'Brien (Eddisbury) (Con): Need I even mention the utter nonsense that demographics and falling social care productivity make of the Governments social care funding announcements? It would be a welcome surprise to end the year without another rant from the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), but let us see. Does he recall that, 18 months ago, his predecessor started a review of social care funding? However, the Government have published nothing. Will he share the findings of the review with the House, in the interests of his much-vaunted consensus, or will he admit that the review and next years Green Paper are thinly disguised attempts by the Government to kick the issue into the longest grass that they can find and to cover up his failure to persuade the Prime Minister to make a decision on social care funding and to protect home ownership?
Actually, for the first time we have a very clear route map towards improving the system in this country for older people, disabled people and carers. We have a commitment to a long-term process with a Green Paper. We must respond to not only demographics, but the rising expectations of people who need social care services. We have a transformation programme, which will begin over the next three years, that will involve a radical transformation of services, shifting to early intervention and prevention and putting personal budgets at the heart of a system that gives people far more control over, and choice about, the care that is provided. In spring next year, the Prime Minister will announce a new deal for carers in recognition of the fact that increasing numbers of families are caring for older relatives and children with disabilities. We face the whole question of young carers and, with regard to older people, dementia.
The Minister of State, Department of Health (Dawn Primarolo): The Medicines and Healthcare products Regulatory Agency continuously monitors the safety of all medicines in the UK, including concerns about misuse, and takes suitable action to safeguard public health when necessary.
John Mann: This is a huge and growing problem in this country and across the western world. Should not the Government be commissioning additional research to find out precisely how prescription drugs are being misused and the extent of the misuse? Is it not worth considering whether the National Treatment Agency for Substance Misuse should have its remit expanded to include the misuse of prescription drugs?
Dawn Primarolo: May I reassure my hon. Friend that there are several checks on the prescribing and use of drugs? That occurs through the MHRA, the yellow card scheme that monitors drug safety, and the periodic safety update reports that come from pharmaceutical companies when they have a legal obligation to submit them. In addition, the Government have more than 1,200 prescribing advisers in England and Wales who are working with GPs on specific issues to do with safe prescribing. Given the protocols for systems of prescribing, primary care trusts can now engage with GPs through the prescribing advisers, if necessary, when repeat prescriptions are being used. I assure my hon. Friend that the national treatment agency follows these issues very closely. When action is required, it is taken.
Peter Luff (Mid-Worcestershire) (Con): Is not the research into prescription drugs that is really needed research on the heartbreaking decisions facing many women with life-threatening cancers for whom drugs are available, but not as prescription drugs? As a result, they are forced to settle for a health service that will not make them well, or a private health system that they cannot afford.
Miss Anne Begg (Aberdeen, South) (Lab): One of the drugs that has fallen foul of the MHRA because of its misuse is Co-proxamol. I thank my right hon. Friend for meeting me and a small delegation last week to discuss the drug. As a result of the drugs misuseit has been used in suicidesit will be withdrawn from general use at the end of the year. However, there is a small group of people for whom Co-proxamol is a good drug that works effectively. Will my right hon. Friend reiterate that the drug will continue to be available beyond the end of the year on a named-patient basis? Will she ensure that the supply of the drug will continue for that small group of people?
As my hon. Friend will know, 300 to 400 fatalities a year result from the misuse of Co-proxamol. It accounts for a fifth of all drug-related
suicides. I confirm that prescriptions on a named-patient basis will continue to be available beyond the end of the year. I assure her that I listened carefully to the points that she and others in the delegation raised and that I am taking them forward.
The Minister of State, Department of Health (Mr. Ben Bradshaw): Last week, we announced that local health services, which have a statutory duty to address health inequalities, would receive a 5.5 per cent. increase in their funding for next year. We also recently announced a £250 million investment in new general practitioner practices in the most disadvantaged areas. I am pleased to announce that we have today approved the latest tranche of new NHS community hospitals, worth £132 million. It includes a £17 million scheme in Portsmouth, which will further improve primary care services in my hon. Friends constituency.
Sarah McCarthy-Fry: I thank my hon. Friend for that response. He will know of the severe deprivation in parts of my constituency, with the health consequences of high levels of obesity, heart disease and cancer. For some time, I have asked for that to be recognised through increased funding, so I greatly welcome the £17 million for community health facilities at St. Marys hospital, which serves my constituency. Does my hon. Friend agree that putting money into such community facilities means that we can do primary care outreach work in the wider community, and particularly in peoples homes?
Mr. Bradshaw: Absolutely, and I congratulate my hon. Friend on campaigning so hard, ultimately successfully, for the new community hospital at St. Marys. It will provide some of the services that she advocatesmore services in peoples homes, more preventive work, and more public health work to help to address the serious inequalities that exist everywhere in the country, and not just in those primary care trusts that face the most serious challenges.
Dr. John Pugh (Southport) (LD): One of the greatest needs in my constituency is an urgent care centre for children; a town of 70,000 needs such a facility. What can be done to oblige a primary care trust to commission one?
Mr. Bradshaw: It is not good enough for the Liberal Democrats to pretend to be a party that advocates local decision making, but to come to the House with such a question. The simple answer is that it is the hon. Gentlemans PCTs job to commission services on behalf of his constituents. The Liberal Democrats cannot constantly bleat about
Joan Ryan (Enfield, North) (Lab): My hon. Friend the Minister will know that Professor Sir George Alberti identified the need for improved primary care services in my constituency. He might also know that Barnet, Enfield and Haringey clinical strategy board has now reported its findings on the proposed hospital reconfiguration. At present, we have a commitment to a local accident and emergency service being provided for only 12 hours a day at Chase Farm hospital. I am concerned about that, and I ask my hon. Friend to undertake that no changes will occur in Barnet, Enfield and Haringey, and particularly at Chase Farm hospital, until the independent reconfiguration panel has had the chance to review all the clinical evidence, and until the primary care services that need to be improved are improved.
Mr. Bradshaw: I am well aware of the concerns that my hon. Friend raises, because she has raised them with me on a number of occasions. She has been fighting hard on behalf of her constituents on the issue of services provided at Chase Farm. My understanding is that a formal consultation is under way, and if the local overview and scrutiny committees remain unhappy with the proposals, it is perfectly open to them to refer the proposals to the independent reconfiguration panel. My right hon. Friend the Secretary of State has made it clear that he will not interfere in that process. The recommendation will be made by the independent reconfiguration panel, once it has analysed the clinical evidence provided. That is the assurance that I can give, and I will certainly keep a close eye on developments in north-east London.
Sir Michael Spicer (West Worcestershire) (Con): As one of those who has today been given a £19 million new hospital in my constituency at Malvern, it would be churlish of me not to wish the Minister a happy Christmas.
Mr. Neil Turner (Wigan) (Lab):
My hon. Friend will be aware of Labour Members intense disappointment that he has not taken recent opportunities to further his stated aim of reducing health inequalities by reducing health funding inequalities. Does he really believe that
the formula funding revisions will eliminate the problem whereby some PCTs are over-provided for by £30 million, £40 million, or even up to £50 million?
Mr. Bradshaw: If my hon. Friend was present for an earlier exchangeI am sure he washe will know that I pointed out the huge narrowing of the gap between trusts that were way below their fair funding formula target. That gap has gone from up to 22-plus per cent. just three years ago to a maximum of 3.5 per cent., with one exception. I hope that the process will continue when the Advisory Committee on Resource AllocationACRAfinally reports. However, I would not want to pre-empt ACRAs work. That is why we have an independent body that makes recommendations on funding. As I said earlier, there has been some delay because ACRA wanted to take care to ensure that it addressed the health inequalities raised by my hon. Friend before making its final recommendations to Ministers.
The Parliamentary Under-Secretary of State for Health (Ann Keen): The most recent access data for the two-year period ending 30 June 2007 show that 27.9 million people in England and 365,000 people in Leicestershire County and Rutland primary care trust accessed NHS dental services at least once during that period. We have made it a priority for the NHS to deliver year-on-year increases in the numbers of patients receiving NHS dental services.
Mr. Robathan: That might be how many people attended, but the same figures will tell the Minister that since the implementation of the new dental contract, more than 250,000 fewer patients in England and 13,500 fewer in Leicestershire and Leicester city have attended a dentist. Some 85 per cent. of dentists consider that the new contract has not improved access to dental care and believe that there is a crisis in dentistry in this country. Does the Minister believe that the new contract has been a success?
Ann Keen: The new contract is a success. Many reports contradict what the hon. Gentleman says. Our children have the best oral health in Europe. The contract is working well and I praise the dentists who have worked so consistently with their primary care trusts. Commissioning is well under way. We have made dental care a priority in the operating framework. I hope that all Members in the House will work together to see how well our dental services are going in this country compared with others in Europe. We are making great strides and progress.
Mr. Lindsay Hoyle (Chorley) (Lab): Will my hon. Friend ensure that Central Lancashire primary care trust spends the money it has in the bank on the provision of NHS dentistry? The waiting lists grow longer, but the money remains in the bank. Will she see what she can do through her good offices to ensure that the money is spent urgently in Chorley on NHS dentistry?
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