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The Parliamentary Under-Secretary of State for Health (Ann Keen): Putting Prevention First states that everyone aged 40 to 74 will receive an individual risk assessment for vascular conditions, including diabetes. The associated Reduce Your Risk campaign, announced in High Quality Care for All, will be aimed at raising awareness among the general public of the risks of diabetes and other vascular diseases.
Keith Vaz: I discovered I had type 2 diabetes only after I attended a local screening centre organised by my local GP. It is estimated that half a million people in the UK have undiagnosed diabetes. In fact, some right hon. and hon. Members will have diabetes but will be unaware of it. Does my hon. Friend agree that the best way is to spend money on prevention rather than cure and that awareness is therefore crucial? Will she welcome the establishment of the new centre of excellence for diabetes in Leicester that is being paid for by the PCT?
Diagnosing people with diabetes so that they can receive care and treatment is vital and I am pleased that my right hon. Friend has had the treatment that he needs to manage his diabetes. He will be pleased to know that the quality and outcomes framework has resulted in an extra 200,000 people being diagnosed with diabetes in the past year alone. Initiatives such as
the Silver Star Appeal are vital in reaching all areas of the population. I congratulate my right hon. Friend and Leicester PCT in particular on the work that they have to done for those who are at an increased risk of diabetes. I congratulate him on establishing that charity. The work on the proposed diabetes centre of excellence will continue and that centre will, we hope, spread good practice around the country.
David Tredinnick (Bosworth) (Con): Apart from the excellent work in Leicester, is the Minister aware of the work at Kings college hospital, particularly the DAFNE course? That one week course in dose adjustment for normal eating has been described in the British Medical Journal as improving
blood glucose control, quality of life and treatment satisfaction.
Will the Minister look closely at that one-week course? If she does, she will probably find that it is much safer for diabetics once they have done the course and that it reduces the amount of insulin consumed.
Ann Keen: That is a very interesting comment. We need always to be ready to learn and to consider new research. I would be happy to look at that research and to take the subject up with the hon. Gentleman if he wishes.
Jeff Ennis (Barnsley, East and Mexborough) (Lab): May I declare my interest as a diabetic? I agree with the comments made by my right hon. Friend the Member for Leicester, East (Keith Vaz); diabetes is an illness that creeps up on a person. I guess that it was more than two years before I was diagnosed with diabetes. Early diagnosis is crucial.
Will the Minister join me in congratulating Barnsley district general hospital on its recent improvements and investment in its diabetes centre? That has really improved the service for diabetics in Barnsley.
Ann Keen: Of course, I am pleased to congratulate Barnsley. I give my hon. Friend my best wishes in dealing with his diagnosis. We should perhaps screen more Members. If more of us are confident with our own health care, we can go out and be ambassadors to our constituents.
Anne Milton (Guildford) (Con): The incidence and prevalence of diabetes are greater in areas of high deprivation, the incidence of type 2 diabetes is five times higher in black and ethnic minority groups, and diabetes is predicted to grow by 9 per cent. by 2010. Will the Minister outline what she is doing to address the health inequalities that are very prevalent as regards the disease?
Ann Keen: The strategy published last week addresses all those issues. I am pleased to see that the hon. Lady is concerned about health inequalities, because we want our health centres and our out-of-hours facilities to address them. Screening with specialist nurses, in particular, will take place so that we can look after members of BME communities in a special and different way.
The Parliamentary Under-Secretary of State for Health (Ann Keen): Plans to centralise childrens in-patient and critical care at the Leeds general infirmary are well under way. Each specialty within childrens services has established a planning group to look at how improvements can be delivered, and the location of childrens facilities has now been agreed.
Mr. Truswell: I thank my hon. Friend for that response. I also thank her on behalf of the young patients, their parents and the health professionals for the personal interest that she has taken in this project, which is very much to be commended. The strategic health authority has submitted a bid for public dividend capital to part-finance the project. Can she assure me that she will look at that bid favourably and speedily and that she will retain her interest in the project to make sure that it is delivered by the target date of November next year?
Ann Keen: My hon. Friend has been exceptionally persuasive in developing my interest in this local scheme, as have all other Members in the area. I thank him for his comments, but the people of his constituency, and of Leeds in general, also need to thank him, because he has certainly led the campaign to improve and change childrens services. I have had the privilege of meeting the parents, carers and clinical staff, and the parents and carers in particular have done sterling work. I believe that my hon. Friend is meeting the chief executive tomorrow, and I am sure that they will both keep me informed and update me as appropriate.
6. Mr. Graham Stuart (Beverley and Holderness) (Con): What effect he expects the outcome of the pharmacy consultation to have on the viability of local GP practices in (a) Beverley and Holderness constituency and (b) England. 
The Minister of State, Department of Health (Dawn Primarolo): We have no proposals in the pharmacy White Paper Building on strengthsdelivering the future that should affect the viability of GP practices. The White Paper is considering the control of entry provisions for dispensing services, not general medical services offered by GPs.
Mr. Stuart: GPs who serve rural areas, such as the Hedon group practice, which I visited on Friday, provide a highly valued dispensing service to the surrounding areas. The practice uses some of the income from that to subsidise unprofitable branch surgeries, such as the one in Keyingham. Does the Minister accept that the pharmacy White Paper proposals threaten the viability of those carefully constructed and excellent services?
No, I do not. The average GP partner of a practice who does not dispense earns about £120,000 a year; a dispensing GP partner would earn,
on average, about £20,000 a year more, taking their income to £140,000. It is also true that dispensing GPs have smaller list sizes, but even allowing for that, the average income a year for a GP dispensing medical services would not become unviable. I reiterate that there are no proposals to end dispensing by doctors. I accept entirely the point that Members have made about the need to look carefully at each area to make sure that provisions are available, but we have a duty, when considering the extension of pharmacy, to consider the rules for dispensing doctors, which have been in place since 1912.
David Taylor (North-West Leicestershire) (Lab/Co-op): But the suggestion is that where dispensing chemists exist within 1 mile of a GP practice, the right of that practice to dispense will cease. That would hit very hard practices that serve rural areas in north-west Leicestershire, such as the Measham medical unit, which uses the money that it gets to provide more doctors and better facilities. Can the Minister suggest how the high reputation of such practices and the high quality of service that they provide to many thousands of patients in rural areas will be protected under the proposed framework?
Dawn Primarolo: If my hon. Friend looks at the White Paper on pharmacies, he will see that it is to do with extending the provisions through the 10,000 pharmacies in this country, making them health centres and ensuring that they can do some of the diagnostic work that Members discussed earlier, such as diabetes testing. As regards the 1,100 dispensing practices in this country, I would say to my hon. Friend that there is no suggestion whatever in the White Paper that dispensing GPs are to be abolished. That is an unfortunate proposition, which is being put around by some, and it simply is not true. The points that my hon. Friend makes about ensuring continued provision in rural areas are entirely accepted on the basis of the services needed.
Mr. Philip Dunne (Ludlow) (Con): I have listened very carefully to the Minister. Can the House take it from what she has said that, in contrast to the comments madequite properly, as I interpreted the White Paperby the hon. Member for North-West Leicestershire (David Taylor) dispensing GPs who are more than a mile from an existing commercial dispensary will continue to be allowed to dispense, irrespective of the consequences of the consultation?
Dawn Primarolo: With respect to the hon. Gentleman, I would say that if he can find in the White Paper the proposition that dispensing GPs are to be abolished, I would be grateful if he pointed it out. It is not there. The purpose of the White Paper is to consider the control of entry for pharmaceutical services in local areas. There are 10,000 pharmacies, and the issues are to do with access to those services. I am sure that he would accept that, while wanting to protect dispensing GP services where there are no other services available, which makes those services essential to the rural area, it would be quite remiss of the Government not at least to look at the rules concerning circumstances in which a GP dispensing service is on the opposite side of the road to a pharmacy. That is all we are doing.
7. Mrs. Siân C. James (Swansea, East) (Lab): What progress his Department has made in gathering information on the number and distribution of sunbeds, as referred to in paragraph 10 of the cancer reform strategy. 
The Minister of State, Department of Health (Dawn Primarolo): We have carried out some preliminary scoping work and are examining the findings. I know that my hon. Friend is a great champion on this matter. We are considering the commissioning of further collections of information in order to inform decisions in due course.
Mrs. James: I appreciate the Ministers answer. I know that she is aware of my campaign, as she has kindly said. There has recently been another incident of a young person being seriously burned by a sunbed, in the constituency of my right hon. Friend the Member for Darlington (Mr. Milburn). Such incidents are still happening too often. Within the cancer reform strategy, can some of the information that is collated concentrate specifically on which salons are staffed and which are unstaffed, and on the number of incidents that occur?
Dawn Primarolo: I am sure that the whole House is appalled at the prospect of children who use tanning machines being severely burned, and at the fact that they are using them in an unsupervised manner. I entirely accept my hon. Friends point, and I will certainly consider how it will be possible to collect the information that she is seeking regarding salons with tanning machines that are not properly staffed, or not staffed at all, and that therefore pose a greater risk to minorsand, indeed, to all who use them.
Mr. Lindsay Hoyle (Chorley) (Lab): This is also about people who have tanning machines at home. What can we do to protect such people? What advice are we giving them? We know that these machines are not good for us; we know that they are bad. What can we do to bring in real legislation? The statistics are there. The information is there. We need to take real action to ensure that we get the message across that the machines are unsafe. I look forward to the Ministers reply.
Dawn Primarolo: My hon. Friend raises an important point about the provision of information and guidance regarding facilities that people have in their homes. I entirely agree that part of the consideration, in addition to collecting information on unsupervised machines in public places, and on who has access to them, should involve the Government considering carefully whether the proper mechanisms are in place to inform individuals of the risks of using them, so that they can decide whether to do so.
The Parliamentary Under-Secretary of State for Health (Ann Keen):
The Department is not directly funding research to develop vaccines for health care-associated
infections, but is funding the national vaccine evaluation consortium, which provides the infrastructure through which clinical trials on a clostridium difficile vaccine will be conducted.
Mr. Kidney: We heard exciting news just over a week ago that there might be a vaccine for such killers as MRSA and clostridium difficile in the next 10 years, and I urge my hon. Friend to ensure that the Department supports that research. Given the time scale, however, does she agree that it is important that health trusts do not take their eye off the ball when it comes to protecting patients against those potential killers by following the guidance on hygiene, clean premises and wards and screening newly admitted patients?
Ann Keen: My hon. Friend raises a very important point. In fact, he must have raised it in his constituency, as the rates of MRSA and C. difficile infection in the Mid Staffordshire NHS Trust were in decline in March this year. All health staff in the area are to be congratulated. We have reduced infection rates significantly for MRSA and C. difficile. Latest data from the Health Protection Agency for January to March show that MRSA bloodstream infections are down 33 per cent. from the same quarter of last year, and by more than 49 per cent. from the 2003-04 monthly average. The same is true for C. difficile infections: in the most vulnerable group of those aged 65 and over, the rate is 32 per cent. lower than in the same quarter of last year. NHS staff work extremely hard to drive down the number of infections. I agree that we must not take our eye off the ball, but we must also recognise such significant improvements.
The Parliamentary Under-Secretary of State for Health (Ann Keen): We are continuing to make good progress against the diabetes national service framework standards. Data from the quality and outcomes framework demonstrate that the vast majority of people with diagnosed diabetes are receiving the key processes of care. The national health service continues to pursue a range of initiatives to address all the standards in the national service framework.
Mr. Sanders: I think that all progress is welcome, but the problem that is being identified is that progress is not universal. In particular, there is no universal access to specialist diabetes services. What are the Ministers plans for addressing that?
Data from the quality and outcomes framework also show that the service is improving year on year, and I believe that a progress report with examples from across the country is due to be published in August. We are working with the national diabetic support team and key stakeholders such as Diabetes UK to produce advice, guidance and the practical tools to support the NHS in achieving the vision set out in the national standards framework. There is more to do, and although improvements have been made, the increase
in type 2 diabetes in particular means that as soon as we feel that there has been an improvement, the figures change. The problem is therefore very difficult to monitor, and I look forward to the report that I believe will be published in August.
Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab): The focus on more mature people and type 2 diabetes means that there is a danger that the needs of children with diabetes may be overlooked. Will the Minister commend the way in which the Milton Keynes PCT has worked with the local parents support group MK Kids With Diabetes to make sure that local services for children with diabetes reflect the desires of those children and their parents?
Ann Keen: I thank my hon. Friend for those comments, and I should be very interested to learn more about what is taking place in Milton Keynes. We are very concerned about childrens health education in the schools framework, as the Every Child Matters scheme shows, and are very pleased to hear about the initiative in Milton Keynes.
The Secretary of State for Health (Alan Johnson): Local NHS organisations are best placed to assess the needs of their local community and commission the required number of training places to develop the work force to meet those needs. We will respond more fully to the issues raised by the Bercow review in our child health strategy.
Simon Hughes: I am grateful to the Secretary of State for that answer. Following yesterdays very successful and well-attended debate on children and young people, may I ask him specifically about adults? The estimates are that more than 250,000 adult stroke survivors have speech and communication difficulties. The Royal College of Speech and Language Therapists is based in my patch, and a survey that it carried out found that more than half of adult stroke survivors say that either they did not receive services quickly enough or that they were not given enough therapy. Will the Secretary of State look at that problem, as resolving it would enhance the quality of life of people who survive stroke and who want, as anyone would, to go back to living a full life?
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