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Ann Keen: Under all Governments, co-payments for different treatments have not been in place. Dental treatment is different from any other treatment, and the new contract shows that. We are working well with commissioning to deal with that. Dental treatment in this country has never been the same as other treatments in the NHS.
Mr. Gordon Prentice (Pendle) (Lab): I wrote to my friend recently about the marvellous new dental school that has opened in Preston. My concern is that the number of students is artificially capped at 32, when it can take 100. My friend replied by telling me that there is a steady stream of dentists coming from Poland and India. Is it not much better for us to grow our own dentists and ensure that the dental school operates at full capacity?
Ann Keen: There is no shortage of dental students. We are working to get a full dental service in place, and all dental schools are performing well in enrolling dental students. I am happy to reconsider the subject of my hon. Friends comments, but we are looking at a comprehensive service for dentistry, and that is what our students look forward to delivering.
The Minister of State, Department of Health (Dawn Primarolo): The Government are concerned about the increasing incidence of and mortality from liver disease. We are already taking action on a number of fronts to combat the primary causes of liver diseasealcohol misuse, viral hepatitis and obesity. In addition, we are investigating the possibility of developing a strategy for liver disease, which would cover health promotion as well as the full range of health services.
Mr. Laxton: I thank my right hon. Friend for that answer. In 2000, liver disease killed more men than Parkinsons disease and more women than cancer of the cervix. The death rate from alcoholic liver disease has doubled in the past 10 years, and one person in 254 per cent. of the populationhave tested positive for abnormal liver function. Is it not time that we had a proper screening programme for liver diseases such as hepatitis B and C? It might be expensive to introduce, but I believe that it would be considerably more cost-effective than doing nothing and then having to pick up the resulting cost of the medical intervention required to deal with cancer of the liver.
As my hon. Friend rightly points out, liver disease is the fifth most common cause of death in England, yet it is almost entirely preventable.
On screening for hepatitis B and C, he will be aware that the Governments approach involves targeting support specifically on those who are at the highest risk, but we keep under active consideration the question of whether further steps need to be taken, including screening.
Anne Milton (Guildford) (Con): Between 1997 and 2001, alcoholic liver disease went up by 46 per cent., and in the past year by a massive two and a half timesthat is, 244 per cent. What will the Minister do to ensure that the Government recognise not only the extent of the problem but the researchsuch as that carried out in Bathwhich shows that anti-drinking advertising can be catastrophic, to ensure that their strategy actually stops this massive increase in alcohol-related liver disease?
Dawn Primarolo: The Governments Safe, sensible, social campaign to encourage people to drink responsibly has been very effective. The hon. Lady rightly identifies the growing pressures resulting from alcohol-related liver disease. The Government are awaiting further reports and an overview from Professor Ian Gilmores group, and a final report from the rapid evidence review undertaken by a team at Newcastle university, in order to look at the full range of causes of liver disease, including alcohol, and at what further steps need to be taken.
The Secretary of State for Health (Alan Johnson): The responsibilities of my Department embrace the whole range of NHS social care, mental health and public health service delivery, all of which are equally important.
Robert Neill: Is the Secretary of State aware that his Departments Christmas present to the people of Chislehurst and Sidcup is to take away the delivery of full A and E and maternity services from Queen Marys hospital? Given that that is the only site of four in south-east London that is not subject to a private finance initiative contract, how is he going to assuage their fear that the real purpose is to sell it off to bail out the debts of other trusts? Will he include in the public consultation any proposal to dispose of all or part of the site, so that people can make known their views on any such option?
Alan Johnson: There will be a local consultation. This is not being driven from Richmond house in Whitehall; it is being driven by local clinicians. It has to be clinically led. If the proposals are referred to me by the overview and scrutiny committee, I will refer them to the independent reconfiguration panel, which is clinically led, and I can think of no circumstances in which I would not accept its recommendations.
T2.  Mr. Andrew Robathan (Blaby) (Con):
The hon. Members for North-West Leicestershire (David Taylor) and for North Norfolk (Norman Lamb) mentioned the pathway project, and the large amount of public
money that has been spent on the honourable resignation of the respected chief executive of the University Hospitals of Leicester NHS Trust. However, no one has mentioned the £25 million of public money that has been wasted on consultants fees, or the fact that there is £2 billion of unspent capital provision in last years budget. Why did the Government allow the pathway project in Leicester to be abandoned? My constituents do not have the provision of good hospitals that they were promised.
The Secretary of State for Health (Alan Johnson): The Government did not allow the pathway project to continue: we stopped it, which was a difficult decision to make. I recognised that it was a problem in an earlier answer to my hon. Friend the Member for North-West Leicestershire (David Taylor). It is not indicative or representative of PFIs across the country, but when we saw how much public money was being
Alan Johnson: Squandered might be a better word. When we saw that, it was time to stop it. My ministerial colleague has consulted all the MPs involved and the trusts to ensure that we recover and move on. The hon. Gentleman will, I am sure, accept that it was right to stop it rather than continue with poor PFI provision, which would probably have been the easiest option.
Mr. John Grogan (Selby) (Lab): May I congratulate all those involved in the local health service and the local councils in the successful bid announced today to the community hospital fund for the rebuilding of the Selby war memorial hospitaltruly the Christmas present that all of Selby was waiting for?
Alan Johnson: I am sure that the people of Selby are dancing in the streets as we speak. I am also sure that they will pay tribute to my hon. Friend who has been a tireless campaigner for establishing the community hospital in Selby. I hope that it will be called the John Grogan memorial hospital!
T3.  Mr. Alan Beith (Berwick-upon-Tweed) (LD): Will the Secretary of State remind Northumberland primary care trust of the importance he attaches to rural-proofing, given that the trust is proposing £1.6 million of cuts in general practice budgets in a very rural area where economies of scale are not possible on any significant level in practices where branch surgeries have to be maintained, and where practices have a record of providing treatments that are elsewhere provided in hospitals?
The Secretary of State for Health (Alan Johnson): The right hon. Gentlemans local trust has to take account of the needs of rural communities. I would suggest, however, that with an 18.8 per cent. increase in funding over the last two years alone, whatever the problems of providing rural-proofingI do not know the details, so perhaps the right hon. Gentleman would like to write to uslack of funding cannot be one of them.
T4.  Barbara Keeley (Worsley) (Lab):
The £500 million extra funding in the social care reform grant announced last week as part of the personalised
adult social care arrangements is very welcome, but will not only new applicants but those already receiving social care be able to benefit from personalised care? What advice and support will be available to help them make their choices?
The Secretary of State for Health (Alan Johnson): I can reassure my hon. Friend that those already in receipt of social care will qualify for payments from the social care grantand £520 million is, of course, ring-fenced. Before we begin the process, we need to consult local authorities. The Local Government Association was one of the 12 organisationssix Government Departments were also among the numberthat signed up to the concordat. We have to ensure that the money is accessed properly. There is also an element of advice and guidance to it, not just for people who receive social care, but for self-funders who sometimes find getting good-quality advice and guidance very difficult. Taken together, all this will mean a transformation of adult social care for present users as well as for those coming into the system in the future.
Mr. Andrew Lansley (South Cambridgeshire) (Con): Last financial year, Britain reclaimed £38 million from other EU member states for treatment provided to their residents in this country, but we paid out £526 million to other member states. Will the Secretary of State explain that vast disparity?
Alan Johnson: My hon. Friend mentions Spain. We are thinking of supplying the winter fuel allowance in air miles this year, which might be simpler for those who like to spend their winters abroad. There is an issue about the disparity with the rest of Europe, but the far more interesting questionI am sure that the hon. Member for South Cambridgeshire (Mr. Lansley) will want to follow this upis how we deal with the matter under the European directive that is currently being mooted. That will have some serious ramifications, so we will need to keep a close eye on it.
Mr. Lansley: I am interested in that. The Secretary of State is right. Surely the real question is the extent to which additional UK residents will be seeking treatment abroad, so will he say whether he will support or oppose the draft directive to be published by the Commission tomorrow, or is he frightened that, in addition to the £490 million extra that we already pay for British residents abroad or visiting other EU member states, many more will choose EU continental European health care in hospitals that perhaps have lower infection rates or lower waiting lists? Are the Government going to support choice for patients or oppose it?
The hon. Gentleman was doing well until the last bit. A couple of weeks ago, one of the Sunday newspapers took three pages to say that 70,000 people in this country had sought treatment abroad,
when we treat 1 million people every 36 hours in the NHS. When one delved into the article, one found that those 70,000 wanted cosmetic surgery or cosmetic dental surgery that could not be provided in this country. It was portrayed as though people were, in the words of the hon. Gentleman, going abroad to escape long waiting times and get cleaner hospitals.
However, the start of the hon. Gentlemans point was absolutely right. We have to consider the directive carefully. I have not seen its terms yetit is not published until tomorrowbut I have made it clear to Commissioner Kyprianou, as has the Minister of State, my right hon. Friend the Member for Bristol, South (Dawn Primarolo), that we must maintain the crucial principle that clinicians will decide what treatment to give in this country. We need to ensure that the principles that have guided the system for many years are not sacrificed to something that might seem like a good idea for a European directive, but which reduces patient choice in the long run.
T6.  Mr. David Chaytor (Bury, North) (Lab): Has my right hon. Friend seen the article published this week in the International Journal of STD and AIDS by researchers from Southampton university and others, which suggests an enormously strong link between the rapid growth of binge drinking and the continuing growth of sexually transmitted diseases? The authors recommend as one solution adopting a different approach to the provision of condomsthat is, providing them free in pubs, clubs and taxis. What is my right hon. Friends view of that, and does she think that it might have a role to play in reducing the
The Minister of State, Department of Health (Dawn Primarolo): I have seen the reports of the research on the links between unsafe sex and binge drinking. In addition to the Governments strategy on sexual health and tackling binge drinking, we will need to reflect on the main points carefully. I should remind my hon. Friend and the House that campaigns are under way for the Christmas season as well, to ensure that people understand the necessity of taking care and of taking precautions, to help reduce sexually transmitted infections.
T5.  Mr. Desmond Swayne (New Forest, West) (Con): May I take the Secretary of State back to the first answer that he gave to my hon. Friend the Member for South Cambridgeshire (Mr. Lansley)? It is undoubtedly the case that there are very large numbers of EU migrants in this country making significant use of the NHS, particularly maternity services. Is the Secretary of State sure that we are being as rigorous as we ought in seeking payments from those foreign Governments?
The Secretary of State for Health (Alan Johnson):
Yes, I am sure that we are being rigorous in receiving payments from those overseas countries, just as I am sure that those migrants are making a contribution to the British economy. The issue is about more and more people from the UK choosing to spend their retirement or pre-retirement living in other European Union countries, which is an important facet of being a member of the EU. That interchange and that freedom
for people to live anywhere in the EU is important. What we must not do is worsen the provision of health care as part of the directive. The foundations are sound, but we must ensure that we do not go backwards.
T7.  Mr. Lindsay Hoyle (Chorley) (Lab): Would one of my right hon. or hon. Friends like to congratulate Dennis Benson, who is stepping down as chair of Lancashire Teaching Hospitals NHS Foundation Trust, on having set up the first and only computed axial tomography centre operating out of Chorley hospital that is funded by the NHS, run by the NHS and for people of the NHS, and on what a success story this will be?
The Secretary of State for Health (Alan Johnson): I am very happy to congratulate Dennis Benson. That will be a big surprise to him as we have never met, but I hope that having enshrined his name for posterity I can eventually have a cup of tea with him.
T8.  Mr. Nigel Evans (Ribble Valley) (Con): The Secretary of State says that he reads the Sunday papers, so he will have read about Colette Mills, the lady who has cancer, is having treatment on the NHS and wants to top it up but has been told that if she does so she must pay for the entire NHS treatment. Surely that cannot be right. Will the Secretary of State reconsider this issue? If people wish to have add-on drugs to top up their treatment, they should not be denied that opportunity and should have to pay only for the add-on drugs.
The Secretary of State for Health (Alan Johnson):
This is precisely why topical questions are useful; the hon. Gentleman hits upon one that two or three Members have tried to ask previously, with varying degrees of success. I will be very surprised if Opposition Front Benchers feel differently about this matter. A founding principle of the NHS enshrined in every single code of practicemost recently the 2003 code of practiceis that someone is either a private patient or an NHS patient. They can be a private patient and decide to resume their treatment as an NHS patient, but they cannot, in one episode of treatment, be treated on the NHS and then allowed, as part of the same episode and the same treatment, to pay money for more drugs. That way lies the end of the founding principles of the NHS. I realise that this is in the news at the moment, and I understand why the hon. Gentleman, who has a constituent in this situation, wants to raise it. However, we need to
think very carefully about any suggestion of moving from that principle. That was not done under any previous Government, and it would make nonsense not only of the founding principles of the NHS but of the 10 core principles of the NHS plan of 2000, which the Opposition signed up to and are as vigorously in favour of as we are. We should ensure that we look at this very carefully before suggesting any changes.
T9.  Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab): In Milton Keynes over the past five years age-related cancer mortality rates have fallen faster than the national average. Does my right hon. Friend ascribe that to the measures that are being taken to speed the patient pathway from initially being seen to treatment or to the successful preventive health programme that has reduced the level of smoking?
The Parliamentary Under-Secretary of State for Health (Ann Keen): I thank my hon. Friend for that remark. Falls in cancer rates and the success of cancer treatments are due to a package of measures that the Government and the House have supported, particularly the smoke-free programme and other areas of care in relation to diet. Professor Mike Richards and his team in the Department have led this brilliant cancer plan, which is supported by all the stakeholders and cancer charities, and they will continue their work with the example of Milton Keynes at the forefront of their minds.
Mr. John Leech (Manchester, Withington) (LD): Will the Secretary of State take note of the recent findings of the north-west cancer intelligence service at Christie hospital, which found that men are 8.5 per cent. and women 6.7 per cent. more likely to die from cancer in the north-west than in the rest of the country, and will he ensure that the necessary funding is put in place to deal with those health inequalities?
The Secretary of State for Health (Alan Johnson): We will take account of that analysis and research. There are enormous disparities. The starkest statistic is that a man living in Manchester is likely to die seven years earlier than a man of exactly similar circumstances living in Kensington and Chelsea. If one gets on the Jubilee line at Westminster and travels eight stops to Canning Town, ones life expectancy goes down by one year every stop. That is nothing to do with the underground systemit is to do with health inequalities, which we must tackle. That is why in the new year we will publish our strategy on how to move even faster in closing those inequalities.
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