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The hon. Gentleman is absolutely right, and the stroke strategy that we published in December highlighted that issue, in relation to the need for aftercare. I am happy to say that an increasingly large number of people survive strokes because of techniques such as thrombolysis, and lead a normal, or near-normal, life afterwards. Let me be absolutely clear with him: in total, the number of speech and language therapists has increased by 38 per cent. since 1997, and the number of students training to be speech and language therapists has increased by 69 per cent. We need to address the issue; it is a crucial part of the stroke strategy. The hon. Member for Buckingham (John Bercow)
has done a splendid job in relation to children and young people, but the hon. Member for North Southwark and Bermondsey (Simon Hughes) is absolutely right to raise the issue in the context of adults, too.
T1.  Mr. Philip Dunne (Ludlow) (Con): If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Alan Johnson): The responsibilities of my Department embrace the whole range of NHS social care, and mental and public health service delivery, all of which are of equal importance.
Mr. Dunne: Did the Home Secretary ask the Secretary of State for his advice on the impact on patients, staff and security arrangements of the Home Secretarys proposals for hospital visits by convicted knife-crime assailants, and if so, what advice did he give her?
Alan Johnson: There was never a proposal to take a person who had stabbed someone to meet their victim in accident and emergency, or in any other part of the hospital. [Interruption.] No, there was not; there was no such proposal. The hon. Gentleman will be interested to learn that the proposal is that, as part of a restorative justice process, youngsters who have been caught in possession of a knife but have never used one will be taken by a physician in the local health service to see the damage that knives can cause. I think that that is eminently sensible, and that was the proposal all along.
Mr. Kevin Barron (Rother Valley) (Lab): Will my right hon. Friend tell us when he will publish the review of prescription charges?
Alan Johnson: Shortly, I think. There is a bit more work to do, but we hope to be able to publish the review in the next few months.
T2.  Simon Hughes (North Southwark and Bermondsey) (LD): As we continue to celebrate 60 wonderful years of the NHS, may I ask the Secretary of State or Ministers to make sure that, up and down the land, it is invariably the case that when people who work for the NHS deal with a patient in a hospital or clinic, or with their family, their name and job description are identifiable, and they introduce themselves to explain why they are there?
Alan Johnson: I doubt whether that was part of Bevans initial vision for the NHS; I do not think that name badges were involved, but the hon. Gentleman makes an important point. We want to ensure respect and dignity, and seek to measure the compassion and quality of care that people receive. That, quite aside from wonderful surgery, great medicine and so on, can be an important part of a patients experience of the NHS.
T4.  Mrs. Linda Riordan (Halifax) (Lab/Co-op):
I welcome the work of the secondary breast cancer taskforce, which has identified the fact that women living with secondary and metastatic breast cancer frequently have no individual to co-ordinate their
care and support. With treatments having improved significantly over the past decade, and with more and more women living with breast cancer, will the Minister ensure that those women get the care and support that they need from a clinical nurse specialist?
The Parliamentary Under-Secretary of State for Health (Ann Keen): I thank my hon. Friend for her question. I have met representatives from Breast Cancer Care and the secondary breast cancer taskforce on two occasions to discuss raising the profile of secondary breast cancer. The Department of Health is aware that patients with secondary breast cancer have very different needs from those with primary breast cancer, and those two bodies made that very clear to me. I thank the all-party group on breast cancer for its guidance; it does sterling work. We continue to look at specialist services, particularly those provided by specialist nurses, in that area. The National Institute for Health and Clinical Excellence is also currently developing clinical guidance for the diagnosis and treatment of advanced breast cancer; we expect it to be published in February 2009.
Mr. Stephen O'Brien (Eddisbury) (Con): It is the last day of term and time for some end-of-term reports. First, on the serious subject of superbugs, given that there were 4,500 cases of MRSA in 2007-08nearly 600 more than the level needed for the Government to meet their target of halving MRSA rates by last Marchand that clostridium difficile has increased by 6 per cent. compared with the previous quarter, despite the statistics read out by his colleague a moment ago, does the Secretary of State accept that the deep clean programme was a flawed gimmick from a Prime Minister desperate for a headline? Will he now heed the advice of The Lancet that the Government should stop pandering to populism about hospital cleanliness and listen to the evidence about washing hands, screening and bed occupancy rates?
Alan Johnson: It is just as well that I am not presenting an end-of-term report on the Opposition Front Bench[Hon. Members: Go on.] I resist the temptation. The hon. Gentleman may be a better concert pianist than he is a Front-Bench spokesman. I do not understand the attitude of Conservative Members towards the current figures: a 33 per cent. reduction in MRSA and a 32 per cent. reduction in C. difficile. He talks about C. difficile rising against the previous quarter, not the previous year. That is always the case, because the figure includes the winter period when more older peoplethese are post-65 statisticsgo into hospital. I would have thought that he would celebrate the latest statistics and that he would know by now that no one on the Labour Benches or anyone in the health service has stopped saying, Wash your hands, responsibly prescribe antibiotics and ensure that you isolate with cohort nursing anybody who has shown symptoms of MRSA.
On screening, we announced that we will pre-screen everyone in elective surgery and everyone in emergency surgery over this comprehensive spending review period. The Conservatives should be congratulating us on a real success story.
Mr. Speaker: Order. I remind Front Benchers that there are Back Benchers to be considered. Topical questions were and are for the benefit of Back Benchers.
Mr. O'Brien: I am grateful, Mr. Speaker.
On another equally important aspect, in 2002, the Prime Minister, when he was Chancellor, committed all Departments to ensuring by April 2006 that the price for contracts reflected the full cost of the service. That would have ended the scandal of charitable giving to hospices being used to subsidise NHS care. The Prime Minister has now broken that promise because he failed to use the end-of-life strategy to introduce full cost recovery. Does the Secretary of State defend the Prime Ministers broken promise in not using the tariff in end-of-life care?
Alan Johnson: The publication of the end-of-life care strategy last week was welcomed in all quarters and was drawn up with the full involvement of the hospice movement. For the first time, we are seeing a proper strategy in this country for people in end-of-life situations, not just for the patient but for their carers.
T5.  Helen Southworth (Warrington, South) (Lab): Considering the impact on health of excessive consumption of alcohol, will my right hon. Friend tackle irresponsible promotions in pubs and clubs, including, for example, Buy two glasses of wine and get the rest of the bottle free or Four shots for £5, which are encouraging people to drink excessively?
The Minister of State, Department of Health (Dawn Primarolo): I know that Members and reports from outside have expressed growing concern at the damage to health and the harmful drinking to which such discounted promotions perhaps contribute. We are awaiting research and independent reviews on this and the reports are expected in September. If promotions are demonstrated to contribute to harm and if restricting or banning them would improve health, we will certainly take action.
T3.  Mr. John Baron (Billericay) (Con): We are two years into a national bowel cancer screening programme, and yet the east of England lags far behind other regions. Indeed a recent letter from my PCT confirms that no hospital in Essex has received accreditation for the programme and, therefore, no screening invitations have been sent outnot one. Will the Secretary of State please look into this poor state of affairs and ensure that Essex and the east of England receive the help they need to catch up with other regions across the country?
Alan Johnson: Yes, I will look into that. I recently visited the cancer screening programme in the south-east. It is not due to go on stream nationwide until next year, but if one region is lagging as far behind as the hon. Gentleman has suggested, we need to look into the matter and ensure that it catches up.
T7.  Jeremy Corbyn (Islington, North) (Lab):
I am very concerned about the current level of funding for mental health services in London. I recognise that the Government have made a big increase in funding over the past few years, but I am interested to know what system the Department is using to assess future
demand for mental health services. In my experience, there is huge unmet demand in my area that is not met by counselling services. More investment and support are needed to help people get through what can be a traumatic period in their lives.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): My hon. Friend is right that mental health services are crucial. The World Health Organisation has said that mental health services in Britain are better funded, better structured and better supported than those anywhere else in Europe. In London, we spent £26.3 million on mental health in 2002-03, and we are now spending £75.7 million. We have asked local authorities and primary care trusts in every locality to conduct joint population needs assessments to identify the future need for mental health services. We are also significantly expanding access to psychological therapists, which will be crucial in terms of mental health and primary care.
Norman Lamb (North Norfolk) (LD): In view of the horrifying level of admissions to hospital for alcohol-related reasons, which has been highlighted today, I want to raise the issue of the impact of violence on accident and emergency staff. It is surely intolerable that staff regularly suffer abuse, threats and violence as a result of alcohol-induced behaviour. Does the Secretary of State endorse the approach adopted in the Royal Bolton hospital, where through co-operation between police and A and E staff, patients who behave in that way face the possibility of on-the-spot fines or prosecution? The pilot appears to have been very successful in reducing violence against staff.
Alan Johnson: I endorse that approach. The hon. Gentleman knows that recent Home Office legislationI cannot remember the exact titleintroduces a new NHS power to remove people who are causing low-level nuisance in A and E, which can escalate into the kind of violence that he mentions. The power will be available once that Bill has received Royal Assent. Until then, I am sure that the initiative that he mentions will be copied elsewhere.
T6.  Andrew Selous (South-West Bedfordshire) (Con):
The Secretary of State knows that the NHS is fortunate in having a number of national centres of excellence, such as the Royal National Orthopaedic hospital at Stanmore. It has recently come to my attention, however, that practices at district general hospitals do not always reflect the expertise of the national centre. I ask the Secretary of State to
investigate whether the knowledge of the top surgeons at the national centres is being passed down to district general hospitals, so that patients do not have operations that they should not have and that money is not wasted.
The Minister of State, Department of Health (Mr. Ben Bradshaw): I will happily do that. I reassure the hon. Gentleman that we are working closely with the all-party specialist orthopaedic services and hospitals group, of which he may be a member; if not, I suggest that he joins. It is important that the expertise that he has mentioned in specialist hospitals is disseminated to hospitals locally and that people are treated in the right hospital for a particular condition. If people have a particular condition, they may need the specialist care that he has discussed.
Ms Dari Taylor (Stockton, South) (Lab): Researching drugs and introducing new products is a fast-changing activity. Does the Minister accept the belief that the National Institute for Health and Clinical Excellence is not geared up to respond equally quickly? As a consequence, many patients believe that a drug is available, but not in their locality.
Alan Johnson: My hon. Friend is right. We have taken measures to speed up the NICE process, not least by ensuring that the process can begin before a drug is licensed, rather than waiting until the licensing process is complete. The point is very important. She will have seen in the recently published constitution for the NHS a real emphasis on giving a right to patients to access NICE-approved drugs and treatments, but the process by which those become available must be speeded up, which is a large part of the Darzi review.
T8.  John Bercow (Buckingham) (Con): Given that the list of medical exemptions to prescription charges was drawn up as long ago as 1968 and that the first case of HIV/AIDS in the United Kingdom was diagnosed only in the 1980s, does the Secretary of State agree that it would now be timely to update the list and add HIV/AIDS to it?
Alan Johnson: That is one of the purposes of the review to which my right hon. Friend the Member for Rother Valley (Mr. Barron) referred earlier. The review of prescription charges is to look again at that 1968 list to see whether we need to remove any of the illnesses that qualify for free prescriptions, or, as the hon. Gentleman suggests, add to the list.
Mr. Speaker: It may be for the convenience of the House to know that the Prime Minister has suggested to me that I convene a Speakers Conference. The following terms of reference have been agreed through the usual channels:
To consider and make recommendations for rectifying the disparity between the representation of women and ethnic minorities in the House of Commons and their representation in the UK population at large; and to consider such other matters as might, by agreement, be referred to for consideration.
It is proposed that the Conference will be set up as a Committee of the House. A motion to establish the Conference as a Committee of the House will be tabled by the Government in October for decision by the House.
The Prime Minister (Mr. Gordon Brown): Following my visit last weekend to Baghdad and Basra, I would like to update the House on the latest developments in Iraq.
Let me start by paying tribute to the British servicemen and women who have served in Iraq with distinction since March 2003; in particular, I pay tribute to those who have given their lives in service of our country. I know that the whole House will join me in honouring the memory of the fallen and saluting the courage of all our military and civilian personnel. The House will also want to know that during my visit I had discussions with Prime Minister Maliki about the British hostages who have been unjustifiably held for more than one year. We want them released immediately, and I will continue to update the House on progress.
As I set out in my October statement, our objective is the creation of an independent, prosperous, democratic Iraq that is free of terrorist violence, secure within its borders and a stable presence in the regionsomething that is firmly in Britains interests and in the interests of the world as a whole. To achieve this, we have sought with America and other allies to support the Iraqi Government as they now take on greater responsibility for their own security and safeguarding their new democracy, challenging thosewhether terrorists, insurgents or militiawho threaten their citizens and undermine the rule of law. We have also sought to foster democratic and accountable government and support national reconciliation, giving all of Iraqs communities a genuine say in the future of their country, and we have worked to help the Iraqis build their economy and give their people an economic stake in the future.
In the last year, this has led us to pursue the strategy of overwatch, which is to move from a combat role to the training and mentoring of the Iraqi forces and the Iraqi police, to encourage the development of local government and to work with the Iraqis on a Basra economic development strategy.
In recent months, conditions in Basra have shown a marked improvement. Incidents of indirect fire against British troops in the Basra air station have fallen from 200 a month at their peak last summer to an average of fewer than five a month since April this year. As the all-party House of Commons Defence Committee, which has visited Iraq recently, says in its report today, the security situation in Basra has been transformed.
As General Petraeus and Ambassador Crocker confirmed to me in Baghdad at the weekend, thanks to operations by Iraqi and coalition security forces, violent incidents right across Iraq are at their lowest level since 2004. Sunni groups have now joined the Iraqi and American forces in driving al-Qaeda from areas where it had been able to terrorise the population, and Iraqi troops, with British and American support, have had success against the illegal Shia militias, giving the Government of Iraq more control over the country. Of course, this progressoften fragilecannot be taken for granted. Millions of Iraqis are still refugees, either inside Iraq or in other countries; and the two car bombs that were detonated at the gates of an Iraqi army recruitment centre on 15 July remind us that there are groups still determined to inflict violence.
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