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The Health Committees suggestions on the hon. Gentlemans point are taken very seriously by the Department. We want to work with Professor Steele to see how access to oral health can be improved, which
the hon. Gentleman rightly raises as a concern; it is a concern to all of us. We want to make the contract work. So many people and PCTs are doing so, and this House should congratulate the dentists who have been working so hard through the new contract.
Joan Ryan (Enfield, North) (Lab): Availability of NHS dentists in Enfield is not our problem. In fact, there will be an 8 per cent. increase in the coming year, but there is a shortfall in uptake. It is a small shortfall, but none the less it is there. My PCT is going to run a major advertising campaign in the new year to deal with the matter, but constituents tell me that they are not entirely clear what they are entitled to and what it might cost them. Can I suggest that the way in which we communicate with constituents on such matters should be a major part of the review?
Ann Keen: I thank my right hon. Friend for her comments on behalf of Enfield. We have to look to PCTs, so many of whom are very imaginative in their advertising and in their use of communication skills, to encourage the best to help the rest. I believe that world-class commissioning will help in that process.
Mr. Gregory Campbell (East Londonderry) (DUP): Although health is a devolved matter in Northern Ireland, what steps can the Minister take in conjunction with other Health Ministers right across the UK to ensure that newly qualified dentists take on NHS patients, and that they do so in rural areas and in less populous areas, where the difficulty is more acute?
Ann Keen: We are increasingly looking at how we can share best practice with the devolved Parliaments, because we can learn so much from each other. Our new students coming out of dental school are showing a great willingness to work throughout areas, particularly where health inequalities exist, which tends to be more in rural areas because of issues of access.
Rob Marris (Wolverhampton, South-West) (Lab): Telephone services have an effect on access to NHS dentistry and to GPs. What is the NHS doing to cut back on the very regrettable but widespread use of 084 telephone numbers, which cost patients extra money? It is a scandal throughout Government, with thousands of 084 numbers being used, including a lot in the NHS. What are the Government going to do about that?
Ann Keen: I thank my hon. Friend for that topical point. We have announced and launched a public consultation today on this issue, which is due to run until 31 March 2009. It will inform the Governments decisions on the future of such numbers in the NHS. I certainly share my hon. Friends concern about those actions, as do the ministerial team.
Mike Penning (Hemel Hempstead) (Con):
The British Dental Association will be fascinated by what the Minister said earlier about working with it. This contract was imposed on dentists even though the BDA warned that it would not be any good for British dentistry. Also, a Minister was invited to this years BDA national conference, but no Minister turned up, even though one was on the train going to Manchester when I was travelling to speak at the event. I know that we will debate this
important issue later, and we have had an excellent report from the Health Committee, but can the Minister explain why she thinks things are going so well when 4,000 patients a day are not able to see an NHS dentist?
Ann Keen: On the point about the conference and meetings with the BDA, the chief dental officer and I have regular meetings with the BDA, and the consensus around the table is to work together, which I suppose would be alien to the hon. Gentleman. Working together in partnership with professional organisations that represent health workers right across the board comes naturally to Labour Members, and it will always continue to do so.
The Minister of State, Department of Health (Phil Hope): I have no such plans. The then Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), met representatives of the company on 10 July 2008 and conveyed to them the concerns expressed by Members.
Tim Farron: I thank the Minister for his answer. My constituent, Mr. David Jones of Elterwater, is just one of the many hundreds of innocent UK victims who have suffered severe health problems as a result of taking the anti-arthritis drug Vioxx. Following the landmark victory of Les Thomas in last weeks court case in Cambridge and the $4.85 billion settlement already paid to American victims by Merck and Co., will the Government now put pressure on Merck to ensure that all patients whose health has been damaged by Vioxx are given the compensation they deserve?
Phil Hope: The hon. Gentleman knows that this is a very complex issue, and I have every sympathy with those UK patientsincluding his constituent whom he has mentionedwho believe that they have been adversely affected by Vioxx. As the hon. Gentleman knows, I cannot comment on individual cases, but I understand that the case he mentioned is not related to the matter concerning cardiovascular disease. It would be inappropriate for Ministers or Government officials to intervene in, or comment on, any current or potential claims for compensation from the company in question in this country, as they are properly for the legal system. However, patients who believe they have a case are not prevented from taking a test case to a court of law.
Miss Anne Begg (Aberdeen, South) (Lab):
I wonder where the Minister draws the line on patient responsibility when they may know the potential dangers of a drug but still wish to take it because it is effective. I should declare an interest: I took Vioxx and I found it wonderful. It probably caused an ulcer, but I still agreed with my doctor to continue to take it because of its effectiveness, despite knowing of the risks. It was then withdrawn, so I could no longer do that. Vioxx is not the only such drug; there is also co-proxamol, for example, which has been withdrawn from use, too. It is difficult for people
with arthritis or joint pain to find an effective analgesic, because the ones on which they have come to rely have been withdrawn. Nevertheless, many such patients would accept the risks involved in taking those drugs and still take them.
Phil Hope: My hon. Friend speaks with great personal experience, and her question illustrates the complexity of these matters. It must, therefore, be right for it to be up to individual patients who believe that they may have been adversely affected in any such circumstance to make their own decisions about claiming for compensation and pursuing that through the legal system. It is certainly not appropriate for the Government to try to bring pressure to bear on an individual company in the circumstances my hon. Friend describes. These must be matters for clinicians and individual drug companies to decide, and it is for the National Institute for Health and Clinical Excellence to make recommendations as appropriate.
The licensing of Vioxx and its continued use in the face of unambiguous evidence of harm have been public health catastrophes.
This year, a leading US American journal claimed that Merck had drafted dozens of research studies on Vioxx and then got prestigious doctors to put their names to themthere was ghost-writing, in other wordsand had misrepresented data. Given that most of the 400-plus victims of Vioxx in this country were NHS patients, is it not incumbent on the Government to intervene in this scandal and demand that Merck treats British victims in exactly the same way as US victims have been treated in the $4.8 billion settlement from which they have benefited?
Phil Hope: I understand the concerns of the hon. Gentleman and other hon. Members. My predecessor met a parliamentary delegation on the matter only this July, so representations have been made. I must emphasise to the hon. Gentleman that it is not appropriate for Ministers or for Government to intervene in, or comment on, a potential claim for compensation that might be carried out in this country and that is properly a matter for the legal system to address. I repeat to him that the Government do not have any ability to bring sanctions to bear on the company that he is describing. If patients believe that they have a case, they are not prevented from taking it forward in a court of law in this country.
The Minister of State, Department of Health (Phil Hope):
Annual growth in primary care prescribing costs in the year to March 2008 was 1 per cent. That is set against a 5 per cent. increase in the number of prescription items dispensed. Unfortunately, it is not possible to attribute a specific cash sum to more efficient prescribing, because variables, such as the cost of the drugs themselves, will affect the savings that are made by primary care
trusts. I think that the hon. Gentleman can see that there has been some progression in efficient prescribing over the past year or so.
Mr. Leigh: The Minister may recall that in its 2007 report, the Public Accounts Committee recommended, and the Government accepted, that more than £200 million a year could be saved for the NHS by prescribing generic drugs, rather than branded ones, without any adverse effect on patients. Has that target of £200 million been achieved? Which PCTs have made the most progress and which have made the least progress? If he does not have the information to hand, he may write to me.
Phil Hope: The PAC report was very helpful, and I am grateful to the hon. Gentlemans Committee for the work that it has done. The health service pays an £8 billion drug bill at the moment, so I am pleased to be able to tell him that PCTs are making considerable progress. Generic prescribing has increased from 51 per cent. in 1994 to 83 per cent. in 2008that is the highest rate in Europe. He will know that PCTs are independent bodies and that they make their own decisions about these matters, but we have issued guidance to PCTs. Although it is ultimately for them to decide, the practice-based commissioning that we have seen and other guidance that we have issued is definitely driving the NHS forward in the right direction, towards the more efficient prescribing of drugs.
John Mann (Bassetlaw) (Lab): Five thousand of my constituents have written to the Minister, via me, asking that their general practitioners be allowed to continue dispensing. Will he take heed of this Bassetlaw common sense?
Phil Hope: My hon. Friend has been at the forefront of the campaign on the issue of dispensing by doctors. We are analysing the responses to the consultation on pharmaceutical provision in England, and we will be making an announcement on these wider issues as soon as possible in the new year. I am aware of the strength of the responses we received on the various options for amending the criteria for dispensing by doctors. We have taken into account the views of those attending the listening events, the meetings and so on, and as a result I am pleased to announce to him that there will be no change to the current arrangements on GPs dispensing medicines to their patients.
David Tredinnick (Bosworth) (Con): Building on the remarks made by my hon. Friend the Member for Gainsborough (Mr. Leigh), does the Minister accept that if his June steering group report recommendation that there should be statutory regulation were implemented for complementary medicine, herbal medicine and acupuncture, that would create further downward pressure? That is because doctors would be prepared to refer to these practitioners, who charge a lot less, and, thus, the cost to the health service would be less.
Mr. Eric Illsley (Barnsley, Central) (Lab):
Has my hon. Friend considered the wastage of drugs through inefficient prescribing, especially in relation to free
prescriptions? Many people accept the drug offered on the prescription, but do not use it. Even though the drug is unused and still in its original packaging, it cannot then be used and has to be destroyed. That loses the NHS a huge amount of money.
Phil Hope: I understand my hon. Friends concerns and those of other hon. Members who have written to me about wastage. We are all concerned about wastage caused by unused medicines. The difficulty is that the recycling of medicines in the way that he and others have suggested is regarded as unethical and unsafe according to the code of ethics produced by the Royal Pharmaceutical Society. Indeed, some hon. Members have suggested that we could donate unused drugs to other countries, but the World Health Organisation guidelines state that no drugs should be donated that have been issued to patients and then returned to pharmacies. I understand the concerns about wastage, but we must take clinical matters into account when making decisions.
Dr. Andrew Murrison (Westbury) (Con): The Government have shown themselves willing to qualify the autonomy of primary care trusts when they feel it necessary to do so. Why then are they ignoring the huge disparity between the best and worst performing primary care trusts in the drug-prescribing habits of their practitioners and the related costs?
Phil Hope: I referred to that matter when I answered the question asked by the hon. Member for Gainsborough (Mr. Leigh). We are drawing the attention of primary care trusts to the value of more efficient prescribing commissioning, andas I saidgeneric prescribing has increased from 51 to 83 per cent. We are making excellent progress and I hope that PCTs, autonomous bodies as they are, will none the less take notice of the guidelines that the Government have issued, which will ensure that we have more efficient drug prescribing in future.
6. Mr. Gordon Prentice (Pendle) (Lab): Whether any of those accident and emergency departments redesignated as urgent care centres have subsequently been reinstated as blue light accident and emergency departments. 
The Minister of State, Department of Health (Mr. Ben Bradshaw): Not as far as we are aware. It is up to the local national health service to ensure that urgent and emergency care meets national performance requirements as well as reflecting local needs.
Mr. Prentice: That is a disappointing reply. The transfer of blue light accident and emergency from Burnley to Blackburn has been a running sore for more than a year. Given the present capacity problems at the Royal Blackburn hospital, ambulances are again taking patients back to Burnley. Why cannot we reinstate our accident and emergency at Burnley general hospital, if necessary with a published protocol indicating where patients should be taken with their various injuries and conditions, whether it be to Burnley, Blackburn, Preston or even Manchester?
Mr. Bradshaw: I am nervous about intruding on what I understand to be the historic but friendly rivalry between Blackburn and Burnley. Seriously, however, I understand the organisation of services there to be a result of what clinicians felt would be the best way to concentrate specialist accident and emergency care in Blackburn and elective planned surgery in Burnley, which would avoid some of the cancellation problems that his local hospital was experiencing because of the need to deal also with accident and emergency cases. My hon. friend will also be aware that the democratic check on those organisationsin his case, the Lancashire overview and scrutiny committeestrongly supported the proposals. The recent problems that he mentions happen in many accident and emergency services when there are particular, localised and sudden pressures, and they are not peculiar to the reorganisation to which he refers.
Sir Nicholas Winterton (Macclesfield) (Con): Could the Minister confirm that the urgent care centres are in addition to accident and emergency provision, and not in place of it? The care centres are a better use of the expensive professional staffdoctors and consultantsinstead of a way to close accident and emergency services. People who would have automatically gone to accident and emergency are being transferred to a more appropriate form of treatment.
Mr. Bradshaw: Yes, the hon. Gentleman is absolutely right. The decision at local level is made on a case-by-case basis, but he is right to draw attention to the benefits of urgent care centres in reducing the pressure on, and unnecessary referrals to, accident and emergency departments.
Mr. David Drew (Stroud) (Lab/Co-op): I hear what my hon. Friend says. One of the most difficult aspects of the way we now treat accident and emergency departments is how they must lock in carefully with the ambulance service. One of the continuing problems in Gloucestershire is the number of times that ambulances back up in the car parks of our two main acute centres. Is it not time to look at how the ambulance service operates in relation to accident and emergency, and consider ways we can improve that operation?
Mr. Bradshaw: Let me say loud and clear to the trusts, through my hon. Friend and any other hon. Members who experience that problem, that it is totally unacceptable for ambulances to back up either because they are being forced to do so by the accident and emergency department or because the ambulance service has decided to do so. I am sure he is aware that the clock starts ticking on the four-hour maximum wait 15 minutes after the ambulance arrives. Any accident and emergency department that thinks it can fiddle its achievement of the four-hour figure by keeping ambulances stacked up outside the hospital is wrong. That message has gone out loud and clear many times from this Department and I am happy to repeat it in the House today.
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