The Secretary of State for Health (Alan Johnson): Our cancer screening programmes are renowned as being among the best in the world, with some of the highest uptake levels. It is estimated that the breast and cervical screening programmes save around 6,000 lives every year. The cancer reform strategy, published last December, set out improvements to the programmes so that more women will be included and more women will be made aware of the benefits of screening, particularly in poorer communities.
Andrew Rosindell: Does the Secretary of State accept that despite the good work that is being carried out, only 70 per cent. of women between 50 and 70 are regularly being screenedonce every three yearsand there are huge discrepancies across the country? Have not the Government failed to meet their targets on this and, in so doing, are they not letting the women of this country down?
Alan Johnson: No, we are not, but the hon. Gentleman identifies a problem that was contained in the cancer strategy. There are variations around the country. I am sure that he will join me in congratulating his own PCT in Havering, where 79 per cent. of eligible women have been screened in the last five years. He is right about the disparities, which is why the cancer strategy asked all strategic health authorities to work with PCTs to identify how they can have more consistency and, in particular, how to get to those poorer communities. Even in the areas covered by institutions such as Kings College hospital in London, which has a wide reach, there are still pockets of communities that those institutions are not getting to. That is a very important part of the cancer strategy.
Tony Lloyd (Manchester, Central) (Lab): Will my right hon. Friend comment on this matter? Where screening detects the existence of cancer and where women are forced to have mastectomies, medical advice suggests that it is far better to have reconstructive surgery at the same time as the removal of the breast, but this is not routinely offered in all circumstances. Will he ensure that that is now part of the routine exchange between doctors and their patients?
David Tredinnick (Bosworth) (Con): Is the Secretary of State aware that most NHS oncology units now offer a range of complementary services in support of their work with cancer? Is he further aware that many of those links were developed at the Royal London Homeopathic hospital, in particular the use of acupuncture, and that PCTs have been withdrawing their support for that world-famous hospital? Will he now issue guidelines to PCTs, stressing that the Royal London Homeopathic and the other hospitals, such as Tunbridge Wells, threatened with closure offer a wide range of services, in line with Government policy?
Alan Johnson: I understand the hon. Gentlemans interest in this area, but it is for PCTs to contract the right care for patients and for them to make decisions. There are many who do contract in respect of homeopathic medicines and it is important that we leave them free to decide what is best for their communities.
Mr. David Evennett (Bexleyheath and Crayford) (Con): According to The Lancet, the five-year survival rates for cancer sufferers in Britain are among the worst in Europe. Detecting cancer early is vital for improving the survival rate, so why are some women waiting up to 12 weeks to receive the results of their cervical smear?
Alan Johnson: We have screened 3.4 million women since 2006-07 and we are reducing the number of deaths from cancer by about 2 per cent. a year. We started off well behind the rest of Europe, but as the cancer strategy is pointing out, we are now catching up, although we need to do much more. Much of that is about early diagnosis, but I accept the problem of women being called back within a proper time if their screening determines that there is a problem to resolve. We have made enormous strides on that and we believe that we have a record of which we can be proud in this country.
2. John Penrose (Weston-super-Mare) (Con): What steps he is taking to ensure that drug addicts referred for out-of-area treatment have a fully developed care plan and that the referring agency retains responsibility for the client through subsequent stages of their treatment and rehabilitation. 
The Minister of State, Department of Health (Dawn Primarolo): Following the issuing of guidance in 2007, the National Treatment Agency has been working closely with the local partnership in Weston-super-Mare, and the National Offender Management Service is working closely with the relevant probation service to resolve the difficulties identified by the hon. Gentleman.
I thank the Minister for that reply, but outside the probation servicein terms of medical referrals for addicts going for treatment in places such as Weston-super-Marewill she commit here and now
to the principle that the referring agency sending the addict for treatment retains responsibility for that addict throughout their programme of treatment and rehabilitation, rather than just allowing them to be abandoned into the care of local services after one or more of the initial steps in their treatment has been completed?
Dawn Primarolo: I absolutely agree with the hon. Gentleman on his important point, particularly with regard to the experiences of communities in Weston-super-Mare. I intend to follow this through, because treatment plans are an important part of the process and of supporting individuals. First, I will speak to my colleagues in the Ministry of Justice, specifically about referrals through probation services. Secondly, we will work with the NTA, the local authority and the local partnership to ensure that we address other referrals to the area in the way he suggests, because that is the only way to ensure that the treatment plans are delivered and work. I commend him for working so hard on this issue for so long.
Mr. David Kidney (Stafford) (Lab): The January National Audit Office report on community sentences drew attention to the shortage of alcohol misuse treatment courses. Should not the NHS be working with the probation services locally to make sure that rehabilitation for alcohol misusers is available everywhere in the country?
Dawn Primarolo: We expect the local area partnerships, including probation services, local authorities and the primary care trusts, to develop the relevant strategies, treatment and support for their communities, including treatments in residential places for those with alcohol misuse problems. If my hon. Friend has specific issues concerning his area that he wants to draw to my attention, I will be happy for him to do so, and I will follow them through.
Anne Milton (Guildford) (Con): According to the Governments own figures, since 1997 deaths due to misuse of drugs have increased by almost a quarter and we have also seen the street price of class A drugs almost double. Is the Minister concerned that the fully developed care plans are not really happening and that the lack of integration is causing some of those deaths, and what will she do about that?
Dawn Primarolo: As I am sure the hon. Lady knows, there has been a 13 per cent. fall in drug-related deaths since 2001, and the number of people in treatment is now at record levels. I am sure that she would also like to congratulate the Government on the extra resources they are putting into drug treatment, and in particular into ensuring the delivery of effective treatment. Ten years ago, there was no treatment, but there is treatment now, and we must ensure that it is effective and co-ordinated. That is the Governments objective.
Margaret Moran (Luton, South) (Lab): Is my right hon. Friend aware that people from as far afield as Bournemouth are being referred to private drug clinics in my constituency, causing concern to both local police and the drug action team? What action does she intend to take to ensure that there is proper supervision and regulation of such clinics and a constant, proper treatment plan for individuals?
Dawn Primarolo: If there is a referral from a probation service outside my hon. Friends area, the guidance is clear: that probation service needs to refer to the relevant probation service with a care plan. On treatment centres, the Commission for Social Care Inspection is responsible for registered care homes and making sure they are properly provided for; the Healthcare Commission is responsible for making sure that registered hospitals come up to standard; and her local authority is responsible for all other registered treatment centres. If my hon. Friend is concerned about these matters and feels that the local partnership is unable to deliver that co-ordination, I will be happy to receive representations from her and put them to the NTA.
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.
Mr. Anderson: What can be done to ensure that the organisations that deliver these services for vulnerable people are properly trained and have knowledge of health and safety, that police records are checked and that the organisations are capable of doing the job that we are going to pay them to do?
Mr. Lewis: My hon. Friend is right to raise those issues. Personal budgets put maximum power and control in the hands of people using services and their families, recognising that they are best placed to make choices about where they want to get care from and allowing them to control their own care and support. Of course, we also must ensure the right balance between giving people that power and control, and appropriate protection in terms of the quality of the support that people receive.
Miss Anne McIntosh (Vale of York) (Con): The Minister will be aware that it is much more expensive to deliver these services in rural areas. What assessment has his Department made of the impact on delivering this social care policy of the 2p extra per litre from this autumn? I understand that it will have a big impact on those making visits and delivering these care services, particularly in rural areas.
Mr. Lewis: Of course, this matter relates to how local authorities receive their finance from the Department for Communities and Local Government. Account is taken of a variety of factors when deciding about the allocation of those resources. When local authorities commission services from care agencies or organise services through them they must make adequate resources available so that domiciliary care agencies, or residential and nursing homes, can offer the quality care that people have a right to expect.
Mr. Ken Purchase (Wolverhampton, North-East) (Lab/Co-op): We congratulate the Minister on the pilot schemes that have been conducted whereby disabled people in particular have had personalised budgets. Can he assure the House that older people, some of whom have mild difficulties and experience some confusion, will not be disadvantaged by what I see partly as an atomisation of these funds to people who may not have the power of advocacy shared by everyone, which means that they may not do particularly well and could be overlooked completely in the new scheme of things that he has planned?
Mr. Lewis: Of course, my hon. Friend raises an important point. First, the principle is that we should assume that individuals have the ability to make choices and exercise self-determination about their lives. Where someone clearly has difficulty making such choices because of disability or their health, family members are often better placed to make decisions about care and support than professionals ever will be. If family support is not available, what matters is that we put in place professionals and advocates who can ensure that money is spent in the best interests of the person. All the evidence from the individual budget pilots suggests, first, that where people have more control, they get better quality of life outcomes in terms of what they want in order to live an independent life and, secondly, that we get much better value for public money.
Mr. Henry Bellingham (North-West Norfolk) (Con): Many of these social care users are either in residential or nursing care homes, many of which are under extreme financial pressure. What can the Minister do to speed up payments to the homes?
Mr. Lewis: I say to the hon. Gentleman that, with all due respect, we cannot have a set of policies that aim to provide maximum devolution, localism and control located in local communities, rather than top-down diktats from Westminster and Whitehall, and then ask Ministers to interfere in decisions that properly belong with local authorities. We want local authorities to use their commissioning responsibilities to ensure that they incentivise and encourage high-quality care that puts dignity and respect at its heart, particularly for older people, and that they close down homes that cannot offer that quality and dignity to older people. It is important that local authorities treat providers fairly, but those decisions have to be taken at local level.
Mrs. Joan Humble (Blackpool, North and Fleetwood) (Lab): What guidance is given to local authorities to ensure that maximum flexibility is allowed to those in receipt of individual budgets? The Minister will know from correspondence that when people have moved from the part of my constituency in the Lancashire county council area into the Blackpool council area they have found that the budgets that they have been allocated cannot be transferred and that some of the care that they have purchased is not the sort that the other local authority will allow. We need uniformity around the country.
My hon. Friend has been a champion for older people and for social care generally since she was elected to this place and was a distinguished chairman
of her local authority social services committee, and she raises an important issue. It is one of the reasons why we are conducting a fundamental review of the eligibility criteriawe know that peoples entitlement to services can be very different depending on where they liveand why we are committed this year to a fundamental consultation involving people throughout the country on the nature of the future care and support system for older people, disabled people and people with mental health problems. We face significant demographic pressuresan aging societyand different expectations, in that people want to live in their own homes and have independent lives, so we need to have a debate and then a new funding settlement on care and support in the future.
Mrs. Madeleine Moon (Bridgend) (Lab): When direct payments were introduced, my local authority drew up a service level agreement with the Shaw Trust to act as a management agency, supporting people with learning disabilities to manage their care packages. Does my hon. Friend agree that such a management agency will be vital for local authorities to help vulnerable older people manage the money to manage their care?
Mr. Lewis: My hon. Friend is absolutely right. The encouraging news is that in 2004, 20,000 people were using direct payments, but by 2006 nearly 60,000 people were using them. So, contrary to the myth, the system is incredibly popular when people are given a genuine choice. Having said that, when personal budgets and payments become the norm and part of the mainstream of the social care system, we will have to build systems in every locality that enable people to exercise that choice and control. One of the issues that we will have to address is minimising the bureaucracy and the red tape, including payroll, human resources and employment law.
The Minister of State, Department of Health (Mr. Ben Bradshaw): The average waiting time for hospital treatment has fallen from 13 weeks in March 1997 to less than five weeks at the end of January 2008. By December this year, no one should have to wait for longer than 18 weeks from the time of GP referral to treatment. By contrast, in 1997 it was not uncommon to wait for more than two years and people died languishing on waiting lists.
Mr. Bone: I thank the Minister for that answer, but it was not an answer to the question that I asked. Since 1997, the average waiting time for hospital treatment has increased by 20 per cent. Why does it take 20 per cent. longer under this Government to receive treatment than it did under the Conservatives?
I did answer the question that the hon. Gentleman asked. He has made the mistake of not analysing a recent misrepresentation of a particular statistic on the BBC website that took the median
weight for people who had actually had their treatment. The reason [ Interruption. ] Wait for it: I can explain it to the hon. Gentleman. The reason why the median increased up to 2004-05 was that all the people who had been waiting for an extremely long time under the previous Government were now getting their treatment. Previously, those people were not even included in the figures. So it is entirely misleading for the hon. Gentleman or anyone else to suggest that average waiting times have increased under this Government. Of course they have not, and it is complete nonsense.
Tony Baldry (Banbury) (Con): Waiting lists will, to a large extent, depend on the configuration of services, and the Minister will know that in north Oxfordshire we are anxiously waiting to discover what is going to happen to proposals for the Oxford Radcliffe NHS Trust and the configuration of services at the Horton hospital. Can any Minister explain to me why it was not possible for the independent reconfiguration panel to publish its proposals today, when we have health questions, instead of on Thursday, just before the House rises for the Easter recess? If they had been published today, Ministers could have been held accountable, but as it is we will not be able to ask Ministers questions about those proposals for more than a month.
Mr. Bradshaw: The hon. Gentleman appears to suggest that the independent reconfiguration panel should set its timetable for the convenience of Ministers. I would have thought that that was exactly what he would not want. He will have to be a little more patient, because it is an independent panel and we do not set its timetable. I am sure that he would be very critical of us if we were to do so.
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