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Organ Donation (Devolved Administrations)
5. Gordon Banks (Ochil and South Perthshire) (Lab): What discussions he has had with counterparts in devolved administrations on promoting organ donation. [194626]
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): All four UK Health Ministers have accepted the 14 recommendations of the organ donation taskforce and will work together to promote organ donation. The taskforce believes that implementation of the recommendations will increase donor rates by 50 per cent. over five years and enable around 1,200 additional transplants each year.
Gordon Banks: I thank my hon. Friend for that answer. As we await the organ donation task force report, which is expected later in the summer, I urge the Minister to ensure that the organ shortage in the UK is tackled and solved on a UK-wide basis and not on one that is decided by regional assemblies and Parliaments.
Mr. Lewis:
My hon. Friend is absolutely right. We have worked closely so far in partnership with devolved Administrations. I want us to move to a UK-wide approach to these issues. We should remember the human nature of the issue. People all over the UK are waiting to have transplants right now. We need more organs. It is important for both people’s lives and their
quality of life that we significantly increase the availability of organs in the future. It is about people’s quality of life.
Elderly People (Care)
6. Mr. Phil Willis (Harrogate and Knaresborough) (LD): What steps he is taking to improve provision of care to the elderly. [194627]
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): A number of steps are being taken to improve the provision of care to the elderly, including a three-year social care transformation programme, the first ever national dementia strategy, the new deal for carers, the extension of our dignity and care campaign, CSCI’s review of social care eligibility criteria, the introduction of star ratings for care providers, the review of the adult protection framework, Lord Darzi’s NHS next stage final report and public consultation that will lead to a Green Paper on the future of care and support.
Mr. Willis: I compliment the Minister on producing a series of policy documents. The sadness is that there is a huge disconnect between the policy and its delivery. An elderly lady in North Yorkshire was discharged from hospital last week into the care of North Yorkshire social services. She was not able to make a cup of tea, to eat or to get to the toilet. Five days later, she is back in hospital with a broken wrist and dehydration. When will the Minister make two clear criteria for care of the elderly? First, nobody should be discharged from hospital unless they have 24-hour access to support. Secondly, the elderly in particular should receive rehabilitation before they are discharged into their own homes without any support at all.
Mr. Lewis: The hon. Gentleman raises a serious point. I take personal responsibility for ensuring that he is well looked after in his retirement. The serious point is that the experience of that elderly lady in North Yorkshire is entirely unacceptable. The relevant local authority and health services need to get their acts together. There is no excuse whatsoever for older people being discharged from hospital and left without appropriate care in their homes. That is why we are reviewing the eligibility criteria and why, from April, we will radically transform the way in which social care is carried out in every part of the country, including Yorkshire. We are reviewing the eligibility criteria, as they mean that far too many older people are left alone without adequate care and support. The hon. Gentleman is right. Of course, we need to ensure that national policy supports an improvement in people’s experiences. Equally, we need better local leadership to take responsibility for closing the gap between health and social services.
Mr. Brian Jenkins (Tamworth) (Lab):
As my hon. Friend knows, most elderly people want to stop in their own homes. We want to support them. Given that we are going to have individualised budgets, does he not realise that he has to come to a decision and make it a duty on every local authority that provides social care to maintain a list of the providers of services so that
elderly people have the information to make a confident decision about whom they will purchase their services from?
Mr. Lewis: I agree entirely with my hon. Friend. Older people and their families tell us time and again that they do not have high-quality, easy-to-access information that enables them to make very difficult choices about their care or the care of a vulnerable relative. That is why at the heart of the transformation of the social care programme in every local authority area will be a new approach to information, advice and, where necessary, advocacy. That need for high-quality information and advice must apply to people who fund their own care as well as those who receive public funding.
Greg Mulholland (Leeds, North-West) (LD): A big issue in the care sector is the staff turnover rate, which is as high as 25 per cent. in domiciliary care, with as many as half those leaving the profession, or possibly more, doing so for good. As well as the severe implications for continuity of care, which the Government acknowledge is very important, there is a clear cost implication. Training costs £980 per person and in 2004-05 local authorities spent £20 million on advertising for vacancies and £151 million on agency staff. This is a problem: what does he intend to do about it?
Mr. Lewis: May I say to my good friend that he raises a really important issue, because we need to address the status and value of people working in social care? The work force tend to be low-paid and low-skilled, and that is one reason why the Government are investing a large amount in training. It is important that some of that money gets through to the private sector, as 75 per cent. of social care is provided by organisations in the private and voluntary sectors rather than by local authorities. Moreover, in the new care and support system that we will need in the future, it is vital that we get right the leadership, management and commissioning of the work force.
We must also have the right front-line staff. Last night, I was fortunate enough to give out awards to the heroes who, every day of the week, make a massive difference for the most vulnerable people in our society. However, we do not have enough such people, and we need to do better with our work force.
Ms Sally Keeble (Northampton, North) (Lab): Is my hon. Friend aware that Northamptonshire county council is withholding the extra funds provided by the Government to pay for increased care for older people, and not passing the money on to care homes? Is that happening elsewhere? What will the Government do to ensure that the funds that they provide to pay for old people’s care are not withheld by local authorities and used instead on internal bureaucracy?
Mr. Lewis:
It is for local authorities to decide the level of fees that they are willing to pay to providers, but it is difficult to justify zero per cent. increases when everyone knows that, at the minimum, care providers must take account of inflation. Increasingly, we want local authorities to use their commissioning power to reward with premium rates those homes and domiciliary
care agencies that offer quality and dignity, and to be much tougher on those services that achieve only the minimum standards and that do not offer the dignity and respect that older people in particular deserve.
General Practitioners (Opening Hours)
7. Annette Brooke (Mid-Dorset and North Poole) (LD): What representations he has received from general practitioners on extended opening hours. [194628]
The Secretary of State for Health (Alan Johnson): I have received representations from GPs and the British Medical Association, as well as from patients and patient groups. I am pleased that the BMA has agreed new arrangements for GP practices to be open in the evenings and at weekends. The new arrangements will benefit patients, the NHS and GPs.
Annette Brooke: I thank the Secretary of State for his answer. Do the Government have any plans to force GPs to open for a set number of hours? Does he agree that forcing them to open for extended hours in the evening when there is no demonstrable need would have a knock-on impact on the general quality of primary care services?
Alan Johnson: The answers are no and yes: no, we will not force any GPs to open longer; and yes, there would be an adverse effect if we were to do what the hon. Lady suggests. Our negotiations with the BMA were based on getting GPs to open for an extra half an hour for every 1,000 patients on their books, which would mean that an average-sized practice would be open for an extra three hours a week. A much smaller practice would not be open for so many extra hours, while a much bigger one would be open for more. Our formula takes into account the fact that in many areas—rural areas, for instance—there is no need or demand for GPs to be open longer.
In the ballot that was held, 92 per cent. of GPs who voted accepted a system that will not force them to do anything that they do not wish to do. However, the system will ensure that the taxpayer’s money that is there to incentivise GPs will, among other things, give them an incentive to open for longer. That is what the patients in the vast majority of our communities want.
Mr. Andy Reed (Loughborough) (Lab/Co-op): Does my right hon. Friend agree that the flexibility to which he has referred should reflect the fact that a town may have a walk-in centre that also provides health services? In his discussions with the BMA and GPs, has he been able to make it clear that there will be no financial disincentive for GP practices in areas where such walk-in centres exist? Sometimes, as is the case in my area, a GP practice and a walk-in centre are located in almost exactly the same premises.
Alan Johnson:
My hon. Friend makes a good point. Along with the BMA, we will be implementing the process. The BMA has made it clear that now that it has the ballot result it will work with us. Our ambition will be to ensure that there are no unintended consequences. My hon. Friend is probably right to say that the availability and accessibility of walk-in centres
are fine as they are. As a result of the process, we expect about 50 per cent. of GP practices across the country to be open for longer. That will get the balance right and probably, with the 250 new GP practices that we are introducing across the country, which will be open from 8 am to 8 pm—150 of them, seven days a week—it will give the required choice to customers who want to visit their GP later in the evening or on Saturday mornings.
Mr. Gary Streeter (South-West Devon) (Con): May I confirm what the Secretary of State has already said? Many GPs in my constituency have contacted me to say that most of their patients are either the elderly retired or mums with young children and there is simply no demand to open practices until 8 o’clock at night. I encourage the Secretary of State not to impose a one-size-fits-all solution on areas such as mine in South-West Devon.
Alan Johnson: I do not accept the argument that patients who are mainly older people and young mothers do not want surgeries to be open for longer. To me, that is in the same category as the comment of a BMA representative, who said that accountants did not open more than five days a week so why should GPs. The evidence is that where surgeries are open for longer—for example, in Tower Hamlets, where they recently opened on Saturday mornings, or Kingston, where there has been such a service for much longer—the people who visit them on Saturday mornings are indeed elderly people and mothers with young children, who welcome the choice of going there either in the week or on Saturday mornings. I really think we shall find that there has been a bit of a myth, although I accept the hon. Gentleman’s point about rural areas, which relates to my original answer.
Mark Simmonds (Boston and Skegness) (Con): It is now accepted that the Government originally mismanaged the GP contract negotiations, leading to an overspend of £1.76 billion. To address that imprudent miscalculation, the Government have reneged on agreements, including renegotiating the GP contract and unlawfully capping GP pensions. GPs are demoralised and disengaged; 97 per cent. of GPs have no confidence in the Government’s handling of the NHS—
Mr. Speaker: Order. The hon. Gentleman must not make a speech. He should ask a question, but he has not asked one so far. Perhaps the Secretary of State could try to answer, because I have to get down the Order Paper and I am getting rather fed up with Front Benchers taking too long.
Alan Johnson: I think Opposition Members are on the wrong side of the argument about GP access. They are also wrong to say that the new contract in 2004 was an error—[Hon. Members: “Oh.”] Or erroneous? That contract was designed to address a situation in which GPs were largely leaving the service and no medical graduates wanted to be GPs. We were facing a huge shortage and, incidentally, under the old arrangements, GPs were disgracefully underpaid and worked for too long. I think we did exactly the right thing. Yes, one of the consequences is—
Mr. Andrew Lansley (South Cambridgeshire) (Con): Would you do the same again?
Alan Johnson: Yes, because now GPs work 17 per cent. less—the number of hours they work has fallen by 17 per cent.—
Mr. Speaker: Order. I am going to be even-handed. I call Mr. Hollobone.
NHS Dentistry
8. Mr. Philip Hollobone (Kettering) (Con): If he will make a statement on access to NHS dentistry in (a) the area covered by Northamptonshire teaching primary care trust and (b) England. [194629]
The Minister of State, Department of Health (Mr. Ben Bradshaw): There was an increase of 7 per cent. in the number of dentists in Northamptonshire in the year to March 2007. In Kettering itself, there were 44 per cent. more dentists in 2006 than in 1997. Nationally, there are 4,000 more dentists than in 1997, and investment in NHS dentistry has more than doubled.
Mr. Hollobone: According to the NHS information centre, the number of patients in Northamptonshire seen by their dentist has fallen by 13,000 since the new dental contracts were introduced. Given that Northamptonshire is among the one third of primary care trusts that have yet to undertake a needs assessment of children’s orthodontics, what measures will the Minister take to ensure that children in Northamptonshire who need orthodontic treatment will get it?
Mr. Bradshaw: I certainly urge the hon. Gentleman’s primary care trust to get on with that work. There is no excuse now for any primary care trust in the country not to do so, given the increased investment in dentistry: there is an 11 per cent. increase this year and in the next comprehensive spending review period. There is a requirement in the current operating framework for all PCTs to increase, year on year, public access to NHS dentists. There is no excuse for any PCT, including the hon. Gentleman’s, not to improve its results.
Linda Gilroy (Plymouth, Sutton) (Lab/Co-op): Will my hon. Friend join me in congratulating Plymouth PCT, which only a short time ago had 12,000 patients outstanding on its waiting list, who had to wait anything up to 18 months? It has turned things around, and before Christmas—the situation may have further improved by now—it had about 500 patients on its waiting list who were waiting only up to 12 weeks. Does he share my hope that the Peninsula dental school, which in a couple of years’ time will be doing—
Mr. Bradshaw: I am happy to congratulate Plymouth PCT, and I also congratulate my local PCT, which has halved the number of people waiting for NHS dentistry in the past 12 months. The south-west is one part of the country that historically has had problems, but they have been addressed, partly by the Government’s creation of new dental schools, including one in Plymouth, for the first time in more than 40 years.
Mike Penning (Hemel Hempstead) (Con):
Yet again we have heard a Minister deny that there is a crisis in NHS dentistry. However, the Patients Association
recently published a report entitled “The New Dental Contract—Full of Holes and Causing Pain?” Whom should we believe: the Government or the Patients Association, which tells us that there is a crisis in NHS dentistry?
Mr. Bradshaw: I would rather listen to the testimony of hon. Members of this House, speaking from experience of their constituency, and to the facts. Given the introduction of the new contract, and the new investment that is now coming on stream in dentistry, I am afraid I have to tell the hon. Gentleman that not for much longer will he be able to say in the House that NHS dentistry is in crisis.
Procurement Targets
10. Andrew George (St. Ives) (LD): How many targets he has set on the procurement of services. [194631]
The Minister of State, Department of Health (Mr. Ben Bradshaw): I understand that the hon. Gentleman’s question relates to primary care. There are a number of national requirements, such as being able to see a GP in 48 hours and book appointments ahead. There are also new requirements this year for new GP-led health centres, new GP practices in the areas with the greatest need, and more convenient opening times for the public.
Andrew George: On 4 July last year, the Secretary of State told the House that he would give the NHS a
“sustained period of organisational and financial stability”
“there will be no further centrally dictated, top-down restructuring”—[ Official Report, 4 July 2007; Vol. 462, c. 962.]
Does the Minister not accept that there is a centrally dictated, top-down method of procurement for the alternative providers of medical services—GP practices? That contradicts the Secretary of State’s welcome words. Why does the Minister not accept that PCTs are in the best position to decide how best to expand capacity and choice in primary care?
Mr. Bradshaw: The hon. Gentleman is wrong: there is no top-down diktat from Whitehall on how the new health centres should be procured. That is up to primary care trusts in each area. In his own area, the primary care trust is at the moment out to consultation on where best to put the new health centre. He talks about stability in the system; his own primary care trust has seen a 20.1 per cent. increase in its funding in the last two years, and it is getting a 5.5 per cent. increase in the next financial year.
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