9. Mr. Eric Illsley (Barnsley, Central) (Lab): What recent discussions he has had with other Government Departments on the public health effects of smuggled tobacco. The Minister of State, Department of Health (Dawn Primarolo): Tackling the problem of tobacco smuggling is a major priority for the Government. The illicit trade in cheap tobacco is helping to sustain high levels of smoking, particularly in deprived communities and among young people. My officials are working in co-operation with a range of organisations and stakeholders locally and nationally to tackle the problem.
Mr. Illsley: My local authority health scrutiny commission met last week to discuss that issue. It is a problem in my area because much of the local smuggled tobacco is counterfeit, which means that it is full of dangerous chemicals, and much of it is targeted at young people. As a consequence, health conditions are worsening because of those poor-quality cigarettes and young children are getting health problems at an earlier age. Smoking cessation programmes have been a success story, so can my right hon. Friend give any encouragement to my area about the possibility of those programmes being extended, in particular to children
Dawn Primarolo: My hon. Friend raises an important point about access to smuggled tobacco, particularly in areas of high deprivation where smoking levels among adults and young people remain high compared with the rest of the country. It is necessary to establish co-operation between the local authority, trading standards, the local health providers and local community groupsI am glad to hear that that has started in his local areato get across a clearer message about the damage that smoking tobacco, whether contraband or not, does to health.
The Parliamentary Under-Secretary of State for Health (Ann Keen): As the birth rate continues to rise, more midwives will, of course, be needed. We are working closely with the Royal College of Midwives and the national health service to ensure that the local maternity work force are in place to deliver Maternity Matters. Extra funding totalling more than £330 million will ensure that mothers get the best possible care and a full range of choices.
Sir Nicholas Winterton: Does the Minister accept that financial resources are the key to getting additional midwives in practice and delivering on the Maternity Matters strategy? She named a figure that is to be devoted to maternity provision. In order to the meet the strategy and the guarantees that the Prime Minister gave me in this House only a few days ago, will she bring forward that additional cash so that it is available very quickly?
Ann Keen: We are working closely with the NHS and the Royal College of Midwives on the plans for how the money will be delivered. We are also working towards a conference in the spring, the aim of which is to see how we can bring about the much-needed return of experienced midwives practising out in the community. I am confident that a larger midwifery work force will be in place this year.
Mr. Bill Olner (Nuneaton) (Lab): May I welcome my hon. Friends comments about the extra Government money for maternity services? The George Eliot hospital in Nuneaton, which has a very good birthing unit, has been given some excellent reports and commendations. It has got through the bureaucracy of an acute services review, so the baby unit is staying, as is the special care baby unit, but services are operating in a 1960s building, which is now very unsuitable. Will she urge that some of the extra money be invested in a new birthing unit for that hospital?
Ann Keen: My hon. Friend raises an excellent point about the work being done in buildings that have sometimes had years of neglect. We must show our NHS midwives and doctors respect, because practitioners and clinicians have been asked to practise in these buildings, and of course mothers have been asked to give birth in them, which is why the reconfiguration is so welcome. Leadership is essential in maternity care. The UK is the safest country in the world in which to deliver babies, and we should all congratulate our NHS staff.
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 of equal importance.
The primary care trust is the important backbone of how funding and services are delivered. Will the Secretary of State tell me why a postcode
lottery exists in a PCT area? One part of the PCT area in my constituency does not get incontinence pads whereas the constituency next door, which is in the same PCT area, does get them. The postcode lottery should not exist, so can he put it right?
Alan Johnson: May be I will pay a visit to Chorley and talk to my hon. Friends PCT, because that is where the root of that problem lies. He will know that, just in the past four years, his PCT has received a 30 per cent. funding increase. We also recently announced a 5.5 per cent. increase across the board. If that money does not buy incontinence pads for people who need them, some serious questions need to be asked of his PCT.
T2.  Mr. Paul Burstow (Sutton and Cheam) (LD): Research has found that as many as 100,000 people who are living in care homes with dementia might be being prescribed anti-psychotic drugs. They might be being prescribed drugs that have not been licensed for the treatment of dementia. Surely it is time that those people, who find their lives shortened as a result of those drugs being prescribed to them in care homes, should not be treated as people who have been ill managed and should not be placed in chemical straitjackets, but should be treated with dignity.
Alan Johnson: That is not an acceptable situation. Indeed, as part of our adult social care review we must examine the issue of the prescription of drugs. That will be part of the national conversation leading up to the Green Paper later this year. The issue concerns Members on both sides of the House, because, as the recent Commission for Social Care Inspection report and the Wanless report showed, we must take long-term measures. Medium-term and short-term measures are important too, but we must take long-term measures to ensure that our adult social care system is equal to the NHS service that we provide
T6.  John Robertson (Glasgow, North-West) (Lab): In the last three years, the Medicines and Healthcare products Regulatory Agency has issued nine withdrawal notices for counterfeit imported products. The British Medical Association and Revenue and Customs have said that the problem stems from the internet. What is the Minister doing to address the issue with those organisations and how can she co-operate with foreign agencies to stop it happening?
The Minister of State, Department of Health (Dawn Primarolo): I can let my hon. Friend know that the Department is working with the two agencies that he mentioned both inside the UK and in European Union discussions. Access both on the internet and through mail order is increasing, and patients cannot be assured of safety or effectiveness. I had a meeting only last week with the MHRA about further steps that could be taken to provide the necessary protection.
Norman Lamb (North Norfolk) (LD): Last week, just two days after the extraordinary admission that the Government have been perpetuating for the last 11 years the myth that we would eradicate mixed-sex wards, the Mental Health Act Commission reported
a truly scandalous and tragic situation
with vulnerable women being frightened for their safety. Last year, the Count Me In census reported that 58 per cent. of women in mental health units are in mixed-sex wards. In two years, there have been 19 alleged rapes and more than 100 alleged sexual assaults.
Alan Johnson: I will give that commitment, because I think that in some ways it is even more important to eradicate mixed-sex accommodation in mental health care than it is in the NHS. As far as the NHS is concerned, in this years operating framework we made it clear that we want to make progress towards eradicating mixed-sex accommodation. To be honest, we are responsible for some of the difficulties in the sense that our manifesto spoke of mixed-sex wards, whereas the guidelinesincluding the guidance from the previous Conservative Governmenttalk of mixed-sex accommodation. I agree with the hon. Gentleman that eradication is even more important in mental health care than it is in the rest of the NHS, and I am happy to give the commitment that he seeks.
T3.  Mr. Peter Bone (Wellingborough) (Con): Given the revised guidelines on the treatment of wet age-related macular degeneration issued by the National Institute for Health and Clinical Excellence in December, does the Secretary of State agree that it is unacceptable that Northamptonshire primary care trust is still treating AMD patients as low priority and effectively telling them either to seek private treatment or to go blind?
Dawn Primarolo: If the situation is as the hon. Gentleman describes itand I have no reason to doubt himit is scandalous. It is clear that the local PCT should assess the health needs of its local community and ensure that cost-effective and clinically safe treatment is available. The hon. Gentleman has raised the issue several times in the House and I commend him on that. I will certainly take up his specific concern about the priority given by his PCT to this issue.
Kerry McCarthy (Bristol, East) (Lab): Yesterday I received some answers to written questions that I had tabled to the Department on dental fluorosis in children. Those questions were prompted by the mother of a seven-year-old child whose adult teeth were starting to come through very discoloured and with the enamel missing. The mother was distraught, because the dentist had just said casually, Oh, that is because she was swallowing toothpaste and wasnt rinsing her mouth. Should we not do more to warn patients of the dangers of children swallowing toothpaste? This girl will not be able to have anything done about her teeth until she is 16.
I agree that we should do more, and we are. Fluorosis, the discolouration to which my hon. Friend referred, is caused by children eating lots of toothpaste. Guidance has gone out from the chief dental officer to the parents of very small children saying that the amount of toothpaste on the toothbrush should be about the size of a pea. That guidance contains graphic illustrations, too, to ensure
that young mothers in particular are aware of the dangers of putting too much toothpaste on the brush. That is not to say that that is potentially fatal, but it does cause problems with fluorosis. My hon. Friend is right to draw attention to the need for that guidance, which went out only a couple of weeks ago.
Mr. Andrew Lansley (South Cambridgeshire) (Con): On the GP contract, the Secretary of State must be aware that Members on both sides of the House will be disappointed that the Government and the BMA seem to be in dispute when they have shared objectives, including the objective of ensuring quality service and access for the patients. Given that under the existing contract primary care trusts can commission extended opening hours as a local enhanced service, will the right hon. Gentleman tell the House how many PCTs have commissioned those extended opening hours?
Alan Johnson: I am not sure about the number of primary care trusts, but the percentage of the population who have access to such services is about 10 per cent. I have seen primary care trusts around the countryKingston was a recent examplewhich have introduced Saturday openings. Incidentally, the people who come to surgeries on Saturday mornings are the very people whom the BMA claims are happy to go to their surgeries mid-weekolder people and young mothers with children. They find it very convenient to go to the surgery on a Saturday morning.
We have tried hard to reach an agreement and we are still keen to reach one. We have not torn up any contracts or gone gung-ho at it. We have made a reasonable set of proposals that are good for the patient, the health service and the GPs. I hope that GPs will accept those proposals in the individual ballot that is being sent out from the BMA.
Mr. Lansley: The Secretary of State has accompanied his proposal, as he puts it, with the threat that he will impose a contract rather than complete negotiations. Does he recall the last general election, when we suggested that GPs should be commissioned with additional funds to open on Saturday mornings? The Government did not accept or endorse that proposal. Will the Secretary of State explain how he can pursue his dispute with the BMA when he does not know how many primary care trusts are already commissioning extended opening hours? Does he know how many GPs are offering extended opening hours, whether they are commissioned to do so or not? How can the Secretary of State go on the radio and accuse GPs
Let me say briefly that I have not issued any threats to anyone. We are determined to move ahead with greater access from April. If the BMA does not agree to the proposals, we will need to consult on the proposals that we will impose. To start that process, we must start the consultation now. The hon. Gentleman may want to run away from the argument, but we believe that patients deserve greater
access. If we cannot achieve that by negotiation, we will have to impose a solution. To do so, we will need consultation, which must begin now in order to introduce that solution in April.
T5.  Bob Russell (Colchester) (LD): The Secretary of State will be aware that the Bluebell surgery in Colchester occupies dilapidated temporary premises that would disgrace a third-world country. Alongside it, completed in August last year, is a purpose-built new surgery and community centre. Will the Secretary of State, this day, chase whoever is responsible to get that new facility open, as it has been standing shut for the past six months?
Alan Johnson: I am always happy to listen to Liberal Democrats who tell me that we ought to push down more autonomy to the local area and not interfere from the centre, yet ask me to intervene this very day. I shall find out what is happening in tribute to the hon. Gentleman, who I know is a fine constituency MP [ Interruption. ] Well, I am in a good mood. I shall let him know the result.
T4.  Mr. Andrew Robathan (Blaby) (Con): I am sure that the House would be grateful for further information about fluoride and the Secretary of States announcement today. Is it a fact that fluoride is a poison that is dangerous if it is absorbed in too great quantities? Is it a fact that it works topically to prevent tooth decay as administered via toothpaste? Does the Secretary of State believe in such mass compulsory medication given the concerns about fluorosis that we have already heard?
Alan Johnson: Fact No. 1: fluoride has been in the US water system for the past 60 years, and in Birminghams for the past 40. Fact No. 2: Birmingham is the 360th most deprived area in the country, but the incidence of dental decay there puts it 30th in terms of good dental health among children. We have been around this course many times. On a free vote, Parliament voted overwhelmingly that water companies had to put fluoride in the water if local people required it. I want to kick-start that process, and all the facts are in favour of greater fluoridation.
T10.  Andrew Mackinlay (Thurrock) (Lab): The Secretary of State will be aware that people needing long-term or lifelong treatment, such as those who suffer from diabetes, get free prescriptions. That is quite right, but will he address the anomaly that means that transplantees must pay for their prescriptions? Will he agree to meet organisations representing transplantees so that the question can be discussed and addressed? This is a serious anomaly and very unfair, as the people involved pay out large sums of money each week.
Alan Johnson: Some 88 per cent. of patients do not pay for their prescriptions. If the group that my hon. Friend mentions is not among them, I shall be happy to meet a delegation to discuss the problem and see what the facts are, as a precursor to seeing whether any action is necessary.
T8.  Steve Webb (Northavon) (LD): The Secretary of State refused to meet me to discuss the fact that he is closing a hospital in my constituency. Will he tell me, across the Floor of the House, whether he thinks that it is acceptable to close a hospital and not require the local ambulance trust to publish an independent report on journey times to the two accident and emergency departments that are affected?
The Minister of State, Department of Health (Mr. Ben Bradshaw): The hon. Gentleman and most of the House will be aware that the health ombudsman and all the local health trusts in his area support the reorganisation in Bristol. He has lost the argument, and his campaign did not succeed in the judicial review. We think that it is betterand the official Liberal Democrat position is in agreementfor local communities and health trusts to make decisions, as that is in the best interests of people in the area.
Mr. Graham Brady (Altrincham and Sale, West) (Con):
The Secretary of State prayed in aid the
American experience in respect of putting fluoride in the water supply, but Ministers will know that the American Dental Association has advised that fluoridated water is not safe for making up infant milk formula because it causes fluorosis. Is he not concerned about that, and what does he propose to do to keep childrens teeth safe?
Alan Johnson: May I repeat again that the science supports fluoridation? Parliament did the same, on a free vote. Whenever the public are tested on this question, they believe that there should be fluoridation. There is absolutely no clinical evidence whatsoever that links fluoridation with anything other than fluorosis. Fluorosis is a discolouration of the teeth, and there are perfectly simple ways to deal with it. The major things that we should be talking about are prevention of decayand fluoride will be extremely helpful in thatand tackling health inequalities. One of the biggest health inequalities is in dental health, and fluoride is there, available and waiting to assist in that process.