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I stress the importance of striking the balance between consumer safety and choice, while ensuring that the potential harm to those who use sunbeds, including young people, is made clear. The figure that my hon. Friend cites for the increase in deaths that are attributed to sunbeds is shocking. The review will consider several matters, including the
recommendations of the World Health Organisation and restricting the age of those who use the beds. We will also ensure that correct information about the dangers is available to those who use sunbeds, and we also need to consider the role of local authorities.
Mr. Nigel Evans (Ribble Valley) (Con): It appears that demand for services from the beauty industry such as tanning, Botox injections and teeth whitening is increasing [Interruption.] I have no interest to declare. [Hon. Members: Shame!] I know.
When the services go wrong, it can be physically damaging and stressful for those involved. Will the Ministers review go wider than tanning to include the whole beauty industry, including the fillers that are put into peoples faces, to ensure that it is properly regulated?
Dawn Primarolo: The specific review to which I referred is, following from the cancer strategy, to consider sunbeds and the connection with skin cancer.
The hon. Gentleman raises another important matter: access to treatments that are normally paid for privately and may have health consequences for the individuals involved. The MHRAMedicines and Healthcare products Regulatory Agencycovers several of those matters, but he is right to make the point about whether fuller advice to individuals who seek such treatments is available and where it should be available.
Mrs. Siân C. James (Swansea, East) (Lab): What updates does the Minister have on any discussions between the Department and the Department for Work and Pensions about the publication of leaflet IND(G)209 on sunbeds?
Dawn Primarolo: I think that my hon. Friend is referring to the review that the Health and Safety Executive conducted to look specifically at guidance on controlling the health risks of using UV tanning equipmentat least I sincerely hope that that is the reference number. If that is indeed the leaflet to which she referred, it will be published shortly.
5. David Tredinnick (Bosworth) (Con): If he will take steps to encourage the development in the NHS of patient-centred practices as employed at the Royal London homeopathic hospital. 
The Minister of State, Department of Health (Dawn Primarolo): The Department is investing around £3 million to build capacity for research into complementary and alternative medicine, to strengthen the evidence base. As the hon. Gentleman will know, it is for health care organisations to make informed decisions on the funding and commissioning of services for their local communities, based on evidence, safety, effectiveness and the availability of treatments from suitability qualified practitioners.
Is the right hon. Lady aware that, despite the support that she has described, one fifth of PCTs have cut services in integrated health care in the past two years? One problem in particular is the possibility of Camden PCT withdrawing support for
the Royal London homeopathic hospital, despite its employing integrated services which have cut the costs of treatments for some conditions, such as irritable bowel syndrome, by between 50 and 100 per cent. Will she look carefully at the problems there and perhaps issue some guidelines?
Dawn Primarolo: I am sure that the hon. Gentleman will agree that primary care trusts have the responsibility to commission the very best care that they can for their local populations. In considering the role of complementary and alternative therapies, PCTs need to take account of the evidence on clinical and cost-effectiveness. I am aware that a number of PCTs are reflecting on precisely those points, which is influencing the contracts that they place. However, for a member of a party that supports local decision making, it ill behoves the hon. Gentleman to question it when things do not quite go his way.
Rob Marris (Wolverhampton, South-West) (Lab): In this country we use a lot of recycled water, but I am surprised that water, which supposedly has a memory, does not have a memory of the faeces that were in it and thereby make us all sick. My right hon. Friend has referred to research, but against that background is she aware of any peer-reviewed medical research that indicates that homeopathic medicine works through anything other than a placebo effect?
Dawn Primarolo: I am aware that someincluding, it appears, my hon. Friendare not impressed with homeopathic medicine. However, when I referred to complementary and alternative medicines, I was referring to a much broader base of practices. The whole point of the research is to build up the capacity to make evidence-based decisions about complementary therapies.
Dr. Evan Harris (Oxford, West and Abingdon) (LD): The Minister says that the decision is for commissioning authorities. However, if the Government believe in evidence-based commissioning as they say they do, is there not a role for them in issuing guidance or at least in asking the National Institute for Health and Clinical Excellence to issue guidance, so that PCTs do not spend resources on treatments that have no effectiveness? If the effectiveness of treatments such as homeopathy is zero, there can be no cost-effectiveness to them.
Dawn Primarolo: I am sure that the hon. Gentleman will be aware that the recent Select Committee on Health report on NICE made recommendations about the shortfall in good quality research evidence on the cost-effectiveness of different types of public health interventions, including complementary therapies. The Government will respond to that report in due course. The issue for the Department is to ensure that PCTs are aware of the evidence where it is available. We would certainly wish to consider where it is appropriate for NICE to consider complementary therapies alongside other treatments.
6. John Austin (Erith and Thamesmead) (Lab): What progress has been made in agreeing the GP quality and outcomes framework. 
The Secretary of State for Health (Alan Johnson): We are seeking to reach agreement with the British Medical Association to use resources from redundant indicators in the quality and outcomes framework for improving patient satisfaction, with access as a key indicator of quality. We are also proposing to use other resources within the contract to fund extended opening by practices. The BMA has decided to poll its members on the package. We hope that GPs will support our proposals to improve services for their patients.
John Austin: I wonder whether the Secretary of State has seen the recent evidence showing that only one in 10 women who have suffered a fragility fracture have been referred for a bone scan to discover whether they have osteoporosis. The figure for men is one in 50. I am sure that the Secretary of State is aware of the cost-effectiveness of early diagnosis of osteoporosis. Will he therefore ensure at an early stage that performance indicators for osteoporosis and incentives are built into the quality and outcomes framework? Does he agree that it would be foolish if money that could be available for osteoporosis was diverted into more flexible surgery hours, given the potential savings to the NHS from preventing secondary fractures?
Alan Johnson: I pay tribute to my hon. Friend for his work on the all-party osteoporosis group. Let me make it absolutely clear that this is part of some of the misinformation flying around about the very complex area of the quality and outcomes framework points. There has never been any incentive within the framework to treat osteoporosis. We are dealing with a number of points in the systemand therefore money paid to GPsthat are now redundant. We all agree that they are redundant. We want to use those points for greater access. The BMA has suggested that they be put towards issues such as osteoporosis, virtually as a piece of propaganda to strengthen its position[Hon. Members: Ooh!] The word propaganda is obviously an unparliamentary term.
I say to my hon. Friendwho I know takes a deep interest in this issue, as do many othersthat this is not about our not putting money into these areas. We just do not believe that GPs need to be incentivised in such areas. We believe that we should put more money into the national service framework for older people in order to tackle osteoporosis; and we should fundamentally ensure that people can get to their GP, which is the first step to dealing properly with any ailments, including osteoporosis.
Dr. Richard Taylor (Wyre Forest) (Ind): What consultation with patients and the public has taken place in the discussions on the GP quality and outcomes framework?
We have dealt with patient groups throughout the process. I mentioned that some points are redundant, and I do not think that there is any argument that GPs should be incentivised to do things that they should already be doingfor instance, writing out a person specification for job adverts to recruit staff to their practice. There should not be incentivisation for things that should be done as a matter of course. There is no disagreement with patient groups about that. About 6 million people in our patients survey said that
they want improved access to their GP in the evenings and on Saturdays, which is why we are seeking to reach a negotiated settlement with the BMA.
Mrs. Gwyneth Dunwoody (Crewe and Nantwich) (Lab): Is the Secretary of State aware that no one would deny the need for the Department to ensure good value for money in the health service? It is unfortunate that a very inexact contract was prepared for general practitioners. Does he accept that, whatever developments there are, the introduction of private health care, particularly from America, where I am sorry to say the state is unable to provide adequate health care for its own people, would not only undermine the confidence of general practitioners in the national health service, but would cause grave doubts for many hon. Members who believe that this is a service worth preserving?
Alan Johnson: I do not agree with my hon. Friend that the contract was a mistake or inexact. In fact, during the period leading up to 2004, we had a crisis in GP recruitment. We could not recruit undergraduates from medical schools and we had an ageing group of GPs. A huge shortage of GPs was the big worry at that time, but our medical schools are now fullthat problem has been resolved. I also do not agree that GPs who are called out at 4 oclock in the morning should be expected to deal with patients and difficult cases at 9 oclock when their surgery opens. The issue about working hours applies to GPs as well as others.
On my hon. Friends second point, we are not seeking to introduce private practice into these areas. We are seeking to negotiate with the BMA for greater patient access. We want to bring more GPs into under-doctored areas, which have been appallingly treated in the past. The basic point is that customers and patients should get the service that they deserve. I hope that that will be in our present GP practices, but, if not, we will provide those practices in some other way.
Mr. Speaker: Order. May I say gently that I must be able to call Back Benchers whose names are on the Order Paper?
Mr. Henry Bellingham (North-West Norfolk) (Con): This is a short question, Mr. Speaker. Did the Government miscalculate the number of points that GPs would earn in the quality and outcomes framework?
Alan Johnson: What we are quantifying in this instance is about £200 million for the number of points that are being moved around the system. There is no disagreement about that; the disagreement is about where to spend the money.
7. Sarah McCarthy-Fry (Portsmouth, North) (Lab/Co-op): How he plans to make individual budgets available to social care users over the next three years; and if he will make a statement. 
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): Local authorities will receive an annual social care reform grant in addition to mainstream resources over the next three years to support the radical transformation of social care in every area. Personal budgets for the vast majority of those receiving public funding are at the heart of that vision.
Sarah McCarthy-Fry: On Sunday I visited the Patey day centre in my constituency, which provides help for sufferers of dementia. I welcome the Governments announcement of the first ever national dementia plan, which I hope will stress the importance of enabling sufferers to stay in their own homes for as long as possible. Does my hon. Friend agree that individual social care budgets are vital to achieving that aim?
Mr. Lewis: I entirely agree. It is important that at long last we, as a society, are bringing dementia out of the shadows by establishing the first ever national dementia strategy. It will reflect the fact that dementia affects an increasing number of families, and is a pretty horrendous disease to cope with. The purpose of family budgets is to give families maximum control, power and choice over the care that is provided. They are in the best position to decide on the best way of responding to their own needs. When family members are not there to help people exercise that control and choice, advocates will be available to ensure that a personally sensitive service is provided.
Dr. Vincent Cable (Twickenham) (LD): Is the Minister aware of the dilemma faced by many seriously disabled people who reject the highest level of care available because it involves a transfer from social services and direct payments, which give them control over their lives, to the national health service, where they do not have that?
Mr. Lewis: The hon. Gentleman has raised an important point. We are committed to a fundamental review of the care and support system this year, to assess our ability to achieve a fairer funding settlement that redefines the respective responsibilities of state and citizen. One of the issues that we must consider is the relationship between the national health service, local government and the voluntary sector in every local community.
Clive Efford (Eltham) (Lab): Will my hon. Friend consider the problems faced by disabled people who, on engaging carers, effectively become employers? When my hon. Friend the Member for Erith and Thamesmead (John Austin) and I met disabled lobbyists recently at the House, they described their difficulties and the need for guidance and advice. They also pointed out that the different rates paid by local authorities can create problems of recruitment and retention. Will my hon. Friend consider providing some guidance?
Mr. Lewis: I agree with my hon. Friend. One of our reasons for organising a fundamental review of eligibility criteria is the inconsistency of decisions on funding to meet peoples needs, both within and between local authorities.
My hon. Friend referred to the difficulties experienced by people receiving direct payments who employ their own staff and take responsibility for their own care. As
we incorporate the new arrangements in the mainstream social care system, one of the challenges for the Government is to ensure that we take account of all the barriers and obstacles that prevent people from exercising self-determination. The belief that disabled and older people have a right to self-determination is entirely consistent with the long history of our partys values.
Mr. Stephen O'Brien (Eddisbury) (Con): Ifas we all agreethe use of individual personal budgets and direct payments for social care needs to be massively expanded, they need to be widely available. What is the Ministers responseand let us have some action, rather than yet another review such as the one that he mentionedto last weeks report from the Commission for Social Care Inspection? The commission found that in 2005-06 alone seven out of 10 local authorities restricted their services to people with substantial or critical needs, that there was a wide disparity in the levels of care and help provided even in the same areas, and that as a result 281,000 people in need of help were receiving none while another 450,000 were receiving less than they needed.
Mr. Lewis: The action that the hon. Gentleman calls for is the social care transformation that will begin in every local authority area in April; it will last three years and it is funded by half a billion pounds of social care reform grant. At the heart of the agenda will be personal budgets for the vast majority of people receiving public funding; information, advice and advocacy for everybody, irrespective of their means, including self-funders, who are all too often left on their own; and a shift to prevention and early intervention, so that we move away from current eligibility criteria, under which, for example, it appears to be nobodys responsibility to do anything about an older person who is lonely or isolated. From 1 April there will be a three-year transformation agenda in every local authority area, and later this spring the Prime Minister will announce a new deal for carers. That is action.
8. Mr. Gordon Prentice (Pendle) (Lab): How many paramedics there are in east Lancashire; and how many there were two years ago. 
The Minister of State, Department of Health (Mr. Ben Bradshaw): The data are not collected for east Lancashire. However, there were 1,175 paramedics in the North West Ambulance Service NHS Trust in 2006. The figures for 2007 will be available in March but, nationally, paramedic numbers have risen steadily over recent years, from 6,245 in 1996 to 8,222 in September 2006.
Mr. Prentice: It is regrettable that the figures for my area are not available because blue light accident and emergency services moved from Burnley to Blackburn on 1 November, which has prompted huge local concern that the transfer is not delivering the benefits that we were told to expect. Is my friend satisfied with how the move has gone, and will he meet me and other concerned Members from east Lancashire to discuss the problems in my area?
Mr. Bradshaw: I am always happy to meet Members. If my hon. Friend has specific examples or evidence of where he thinks the reorganisation has not gone well, I will happily look into them even before we have a chance to meet. I do not think it makes sense, however, for Ministers in Whitehall to second-guess the way that local health services and ambulance trusts organise their services. I am sure that my hon. Friend is aware that three additional ambulances have been taken on to help with the reorganisation. The accident and emergency services were not centralised in Burnley, and I am, of course, aware that concern was expressed there in particular, on account of that fact, but, interestingly, the figures do not point to a large increase in the number of people presenting themselves in Blackburn instead; there has been only about a 5 per cent. change.
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