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Alan Johnson: My hon. Friend may know that a very important report on dental care has recently been published by the Health Committee, whose Chairman is in his place [Interruption.] And of which my hon. Friend is a memberI was about to say that. A number of points in it are really important, not least the recitation of the history of the problem, which points out how bad dentistry was in the 1990s, and the need to introduce a new contract. The report raises issues that we need to look at. I believe that fluoridation is a major force in tackling dentistry inequalities, and a dentist said to me recently, It gives poor kids rich kids teeth. That is why the consultation that is going on in the south-west and will soon take place in the north-west is so important.
Mr. Paul Burstow (Sutton and Cheam) (LD): In tackling health inequalities, particularly regarding access to new drugs and treatment, does the Secretary of State agree that we should have a system that is far more transparent about NICE decisions, so that it is more accountable, and that the models used in appraisal decisions should be published?
Alan Johnson: We need greater transparency in all aspects of the process. The greatest transparencyI shall say more about this latercomes in the decisions of PCTs exceptional circumstances committees where NICE has not ruled on a drug, and where there is a lack of transparency and consistency. That is the major problem, and we shall consider some of the issues relating to NICE that arose from a recent case. In a sense, the matter the hon. Gentleman raises is second on the agenda.
Mr. Neil Turner (Wigan) (Lab): May I urge my right hon. Friend to press the Treasury to release the moneys that have been allocated to the NHS in the current comprehensive spending review round? Will he work to ensure that the ACRAAdvisory Committee on Resource Allocationrecommendations that will be released shortly are implemented as quickly as possible so that all PCTs will have the resources necessary to eradicate health inequalities in our country?
Alan Johnson: The situation on allocations is that we are waiting for the pre-Budget report. We can then issue the operating framework along with the ramifications of the Darzi review, and that is when the ACRA report that my hon. Friend mentioned, which is crucial in tackling health inequalities, will become part of the process. He will not have to wait long; it will certainly happen well in advance of the beginning of the next financial year.
Mark Simmonds (Boston and Skegness) (Con): While my party of course agrees that reducing health inequalities must be a key priority, the Governments record has not been good, despite what the Secretary of State has said. The gap in life expectancy and infant mortality has increased during the past decade, and we have the highest health inequalities in Europe. Does he agree that there can be no reduction in health inequalities without improvement in public health driven by local control of public health budgets, accurately reflecting communities needs and tackling social and environmental issues, overseen by locally appointed directors of public health?
Alan Johnson: I do not blame the hon. Gentleman personally, but I wonder where we would have been on health inequalities if the Black report, which was commissioned in the late 1970s but reported in the early 1980s, had been implemented. Three hundred copies were published on a bank holiday Monday, with a foreword by the then Conservative Secretary of State, Patrick Jenkin, stating that everything in the report was basically rubbish. [Interruption.] They are chuntering on the Conservative Front Bench, but they know that health inequalities worsened between 1979 and 1997. The hon. Gentleman might like to know that, since then, in eight years, the health of the poorest and most deprived in our nation has now reached the level that the rest of the population attained eight years ago. Infant mortality is down and life expectancy is up in spearhead areas. That shows what one can do with a Government who genuinely set tackling health inequalities as a priority. The Conservative party did nothingindeed, we went backwards during their 18 years in government.
The Minister of State, Department of Health (Phil Hope): No assessment has been carried out centrally because it is for primary care trusts, in consultation with local stakeholders, to determine how best to use their funds for improving health and to commission occupational therapy services accordingly. However, today gives me the opportunity during national occupational therapy week to thank the profession for its huge contribution to helping improve the health and well-being of service users throughout the country.
Mr. Amess: Let us deal now with 2008 issues, for which the Government are responsible. Earlier this year, my mother broke her hip while in hospital and I observed at close hand the wonderful work of occupational therapists. However, the Minister knows that, in adult social services, occupational therapists form 2 per cent. of the work force, yet deal with 35 per cent. of referrals. With health and social services becoming integrated, how will the Minister and the Government tackle the increasing number of referrals with such a small work force?
I am happy to say that the number of occupational therapists working in the NHS has increased to 17,024an increase of some 48 per cent. since 1997. There has therefore been a huge increase in the number of NHS occupational therapists. In addition, local authority occupational therapists provide social care and help. The integration of the two services is important, and I would like more of that to happen. We have good examples, such as the Torbay care trust, which is not in the hon. Gentlemans constituency, of local authorities working closely with PCTs to create a single referral pathway for those who wish to use occupational therapists. Self-referral is also popular. Those who self-refer get much benefit from going straight to an occupational therapist and gaining the treatment that they need to give them successful lives and improve their well-being.
Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab): An occupational therapist assessment is the first stage in accessing a disabled facilities grant. What is the point in having enough occupational therapists if there is then, as in my constituency, sometimes a two-year wait for people to get a disabled facilities grant? Work was done for one disabled child in my constituency only because the NHS intervened and paid for the adaptations that the council should have funded. Otherwise, he would have waited two years for an essential stairlift. What is the Minister doing to ensure that that is put right?
Phil Hope: I understand my hon. Friends concern for her constituents, and she is right to express concern about waiting times that vary from one local authority to another. I hope that local authorities throughout the country, including the one to which she referred, will pay attention to the importance of speedier access when somebody has had a diagnosis and is clearly in need of some form of facility to help them with their condition.
6. Peter Luff (Mid-Worcestershire) (Con): What assessment he has made of likely changes in demand for health services in the west midlands resulting from new housing developments in the region; and if he will make a statement. 
The Minister of State, Department of Health (Dawn Primarolo): The local NHS, in conjunction with other stakeholders, plans, develops and improves services to local people. In addition, the Department provides guidance and support to encourage local NHS services to promote well-planned, healthy and sustainable communities.
Peter Luff: The Minister knows about the genuine concern in south Worcestershire about the demand on our local infrastructure posed by the significant increase in housing numbers, planned under the regional spatial strategynumbers that the Government want to increase still further. What reassurance can she give that the necessary increase in the areas health service infrastructure will be in place before the houses are built to ensure that existing residents and newcomers have full and proper access to the NHS?
Dawn Primarolo: As the hon. Gentleman knows, the local health service will constantly be looking to ensure that it is planning for the population that it has and for expected population growth. However, there are further requirements on both local authorities and the NHS to work together through their local area agreement to ensure that any planned housing development includes the plans for any necessary health or social care. He will know that Worcestershire PCT has formally set up a committee to look into exactly what the future growth in housing in the area may be and, therefore, what any future demands may be, including the development or expansion of Evesham community hospital.
Mark Pritchard (The Wrekin) (Con):
The Minister will know that the Government have overridden many of the housing targets set by local authorities for their
areas. Therefore, there is a growing disparity between the increased number of houses being put into areas and the health provision that those areas are given. An example in my constituency is that we are expected to have 30,000 new houses in a single borough in the county of Shropshire, and yet the paediatric service is about to be downgraded. Is that joined-up government?
Dawn Primarolo: I say to the hon. Gentleman that the development of housing is intended to satisfy demands in the area. The gap between the current and future population is not always that great, but he is quite right; the work has been done on the local authority side, through the requirement both to plan for the health and well-being of their populations, acting in partnership with the local NHS to look at sustainable communities and take that forward. Of course, within that will be the development of new services for the current population as well. I assure the hon. Gentleman that there is no question of extra housing being put in place without consideration being given to the future demands for health and social care.
The Minister of State, Department of Health (Dawn Primarolo): For England, the health inequalities national public service agreement target is to reduce inequalities in health by at least 10 per cent. by 2010, as measured by infant mortality and life expectancy at birth. There are additional health inequalities public service agreements to narrow the gaps in cancer and cardiovascular disease mortality and to reduce the prevalence of smoking in routine and manual groups.
Simon Hughes: Is mental health and mental illness taken into account in the assessment of health inequality? The Minister will know that south London, for example, has the highest rate of psychosis in the United Kingdom, which clearly has a huge knock-on effect in any family affected. Can she tell us that mental illness is taken into account and that it is in the Governments sights as a major issue that we need to tackle in order to reduce peoples chances of experiencing mental health problems and increase their chances of being well?
Dawn Primarolo: I can assure the hon. Gentleman of that, yes. The issue is crucial to the investments that we are making in mental health and to improve the health of the nation as well. He will know that huge strides have been made in his area of Southwark in increasing life expectancy and reducing the low levels of infant mortality. In fact, progress is so good in Southwark that women now live on average for 82 years, which is higher than the English averageonly just, but definitely higher.
Paddy Tipping (Sherwood) (Lab): One of the ways of reducing health inequalities is to ensure that resources follow need. When will the Minister and her colleagues be in a position to increase funding to primary care trusts that are currently below target?
Dawn Primarolo: As my right hon. Friend the Secretary of State said earlier, the announcements regarding PCTs funding and the operational framework are expected to be made later this year. That will include the allocations arising from the working party considerations.
Mr. Gary Streeter (South-West Devon) (Con): As poor access to GPs perpetuates health inequalities, will the Minister agree to do nothing to undermine the excellent work of dispensing surgeries in rural parts of England? As she well knows, some of the proposals set out in the pharmacy White Paper threaten the very existence of some of those surgeries.
Dawn Primarolo: There are no proposals to curtail or reduce the provision of services in rural areas, and the Government have made no proposals to abolish dispensing GPs. I have said that repeatedly at the Dispatch Box in this House.
Fiona Mactaggart (Slough) (Lab): In Slough, we have seen two quite contrasting attitudes to health inequalities, as our local primary care trust was merged with those serving the much more prosperous areas of Windsor, Maidenhead and Bracknell, where people live longer. We have narrowed the age gap between Slough and elsewhere by targeting public health in Slough but, in the consultation about the new PCT, the residents of Windsor, Maidenhead and Bracknell said, Will Slough take all the money? Will the Minister ensure that areas of extreme need in PCTs get the resources that they need?
Dawn Primarolo: My hon. Friend raises a good question. I can assure her that, where there are small pockets of deprivation in an otherwise reasonably affluent area, resources will be directed to those areas of high health inequality within PCTs. Regardless of comments made by other residents, the Government are determined to continue to keep health inequalities at the top of the agenda so that we can narrow the gap.
Mike Penning (Hemel Hempstead) (Con): Londoners will have heard the complacent comments of the Minister today, but a more frank assessment comes from her ministerial colleague, Lord Darzi. In his report, he states that:
healthcare in London is not equitable, either in terms of mental or physical health outcomes, or in terms of the funding and quality of services offered.
Dawn Primarolo: I am proud that all the spearhead groups in London in the areas of highest inequality are narrowing the gap. I am also proud of Lord Darzis report, particularly in relation to London and to identifying polyclinics as the way forward to ensure that services are made available on an equitable basis to the population. That is a policy that the Conservatives have opposed.
The Parliamentary Under-Secretary of State for Health (Ann Keen): We are working with key stakeholders, including the national diabetes support team, on a range of initiatives to support the NHS in improving diabetes care. We particularly recognise the valuable role that diabetes specialist nurses play in supporting people with diabetes. In March 2008, the national diabetes support team published Improving emergency and inpatient care for people with diabetes, which highlights the importance of the diabetes specialist team, including the specialist nurses.
Ms Keeble: I am grateful to my hon. Friend for that response. Is she aware that Friday 14 November is world diabetes day? Will she mark that day by taking up the concerns expressed by Diabetes UK about the patchwork of provision that exists across the country for this illness, which costs the NHS £1 million an hour?
Ann Keen: Yes, of course. World diabetes day is on 14 November, and this year its theme is diabetes in children and adolescents. I am pleased to say that I shall speak at the Diabetes UK parliamentary reception on Tuesday 18 November.
Sandra Gidley (Romsey) (LD): By 2025, there will be an estimated 4 million people with diabetes, yet Diabetes UK has already received reports of cuts in services. What plans does the Minister have to ensure that people with diabetes have the support that they need in order to prevent the serious complications that can result from poor diabetes management?
Ann Keen: We are in constant touch with Diabetes UK and, in particular, with its support teams working on the Silent Assassin campaign, which was launched on 6 October. The campaign highlights the fact that diabetes is a very serious condition that causes heart disease, stroke, amputations, kidney failure and blindness. The advertising campaign includes a series of outdoor posters as well as newspaper and consumer magazine advertising. The Department will continue to work with Diabetes UK and to encourage all primary care trusts, and the NHS in general, to continue to work on this very important issue.
Mr. James Plaskitt (Warwick and Leamington) (Lab): Is my hon. Friend aware of the Apnee Sehat programme that has been introduced in Warwickshire by Dr. Shirine Boardman? It particularly addresses the concerns of the Asian community, whose traditional cooking methods and dietary habits contribute to the very high incidence of diabetes in that community. Will she encourage other PCTs to consider such schemes as well?
Ann Keen: I welcome my hon. Friends contribution. We are aware that the prevalence of diabetes can be up to five times higher among those from a black or minority ethnic backgroundfor example, those from a south Asian background in the UK. That increased prevalence may be due to different underlying behavioural, environmental and lifestyle mechanismsand, of course, the wonderful food that is produced. On a recent trip to India, I realised the seriousness of the escalation of diabetes in that country, with 40 million diagnosed with the disease and another 30 million undiagnosed. It is a serious issue, and I know that many innovative PCTs are looking into cooking methods. I would be pleased to hear more about the scheme that my hon. Friend mentioned.
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