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Mr. Stephen Dorrell (Charnwood) (Con):
Will the Minister confirm that when making decisions about the structure of emergency care in the years ahead, it will be increasingly important to take account of not only the evidence on how to achieve the best clinical outcomes
but the resource implications of the different structures of emergency care? The Government have been signalling for some time that the rate of growth of cash available to the health services is going to slow down. In the pre-Budget report, the Chancellor made it clear that spending cuts were intrinsic to the Governments plans. Against that background, is it not important to begin to manage expectations about the structure of emergency care that is likely to be delivered by the health service in the years ahead?
Mr. Bradshaw: Lower increases would, I think, be a more accurate description of future spending projections. Of course, last week we announced annual increases of 5.5 per cent. and 5.5 per cent. for PCTs in each of the next two years. There will be lower increases from the Government, but there would be cuts from the Opposition, were they to get into government.
The right hon. Gentleman is absolutely right, and I commend the thoughtful remarks that he made at the Kings Fund discussion either today or yesterday, which I read. He is right to say that high-quality care is often the most cost-effective care. There is no doubtthis is the pattern not just in this country but in other countries around the worldthat when it comes to accident and emergency services it is safer, better and more effective to concentrate care in a smaller number of specialist units. It is often better for in terms of survival rates and health outcomes people to travel a little bit further to those specialist units.
Dr. Richard Taylor (Wyre Forest) (Ind): In view of the confusion that still exists among patients about whether they should go to accident and emergency, urgent care centres, minor injuries units or the out-of-hours GP centre, will the Minister tell us what progress he is making in establishing a single telephone number, less than 999, that would be relevant to each area and would direct every patient down the appropriate pathway for their area?
Mr. Stephen O'Brien (Eddisbury) (Con): Will the Minister find time before Christmas to go to Enfield and tell the people there why they do not need an accident and emergency department at Chase Farm hospital and why it will be replaced by a non-blue light service at the urgent care centre? The most recently published report by the experts, the College of Emergency Medicine, concluded:
There is no evidence of the clinical or financial benefits
clinically unproven and against the principle of patient choice of access to proper emergency care.
The hon. Gentleman is awareor at least he should bethat there is a potential legal challenge, if not an active legal challenge, to that case. I shall
therefore not comment on his specific point. He will be aware that the proposals in north-east London have been through the democratic check of both the overview and scrutiny panel and the independent reconfiguration panel. Everybodyincluding the four primary care trusts, most of which cover boroughs with Conservative majoritiesis agreed that the proposals are the best solution for the north-east London health economy.
The Minister of State, Department of Health (Mr. Ben Bradshaw): My right hon. Friend the Secretary of State was pleased to announce last week that North Yorkshire and York primary care trust will receive an 11.6 per cent. increase in funding over the next two years. That places my hon. Friends primary care trust in the top quarter of increases in allocations.
Hugh Bayley: I have been arguing for years that the North Yorkshire and York PCT did not get enough money to meet the health needs of the large number of elderly people who live in what is a largely rural area, so I congratulate the Government on changing the funding formula to put that right. I am pleased that the PCT will get larger increases than the national average in future, but will the Minister do everything he can to ensure that it clears its deficit as soon as possible? That will ensure that this large amount of extra money will be used to provide new and better health services for patients, and not to clear historical debts.
Mr. Bradshaw: Yes, and I am delighted that my hon. Friends persistent and effective lobbying on behalf of his local PCT has paid off. He will be aware that the PCT has gone through some difficult personnel issues, which are now being addressed. It is working very closely with his regional strategic health authority to ensure that the challenges to which he refers are overcome as quickly as possible.
Miss Anne McIntosh (Vale of York) (Con): Although I welcome the additional expenditure, will the Minister tell the House for how long the extra money will be available, and does he accept that the funding formula has to change? Per patient, the PCT and the individual hospital trusts have been receiving much less than the average, so will he review the patient formula? Will he reintroduce the factors that reflect the sparsity and rurality of the population because, as the hon. Member for City of York (Hugh Bayley) suggested, our ageing population lives in deeply rural areas? [ Interruption. ]
Exactly, we have just done thatthe new formula has been changed to take into account elderly populations, and that is why the hon. Ladys PCT has benefited so dramatically from the increase in funding. She asks how long the funding formula will apply, and I can tell her that it is for the next two years. At the end of that period, her PCT will still be 2.4 per cent. below target, but that is a good position for it to be
in as it will then have more catching up to do. However, it is far less likely to catch up under a Conservative Government, as her party is committed to cutting spending on health.
Mr. Robert Goodwill (Scarborough and Whitby) (Con): Will the Minister review the role of patient referral units? They cajole patients to take up operations at the Capio private hospital in York, even though many would otherwise choose to have their operations in Scarborough.
Mr. Bradshaw: It is interesting to hear a Conservative Member running down the use of the private or independent sector in health care. No one is being cajoled to go into the Capio centre, but people are being offered a choice. I thought that Conservatives were in favour of choice.
The Secretary of State for Health (Alan Johnson): The responsibilities of my Department embrace the whole range of NHS social care, mental health and public health service delivery, all of which are of equal importance.
Mr. Drew: May I congratulate the Department on its foresight in supporting the local campaign to reuse the Standish hospital site in my constituency? It would appear that in January we are to get the good news that the site will be transferred back to the PCT, and we look forward to the development of a fully integrated care setting there. There have been two obstacles to the campaigns progress: my hon. Friend the Minister will know about the security issues with the site, but I am pleased to say that the listing of block C seems to have been sorted out. Will he ensure that this wonderful proposal sees the light of day, and will he give every support to the PCT so that it can see it through?
Mr. Bradshaw: Yes, and let me commend my hon. Friend for his active interest in this matter. He is right to point out that the two remaining blockages to progress have been removed: the Department for Culture, Media and Sport has decided not to list block Chaving visited the site with my hon. Friend, I believe that that is a very sensible decision. In addition, problems to do with security and vandalism have been sorted out, and I look forward to an announcement that he will be pleased with being made in January.
Mr. Hugo Swire (East Devon) (Con):
I recently chaired a seminar on Lyme disease in Westminster Hall, and two things became clearthat diagnoses of people suffering from Lyme disease are on the increase, and that sufferers are beginning to encounter the same scepticism that people with other chronic fatigue syndromes such as ME have been subject to. Will the Under-Secretary of State for Health, the hon. Member for Brentford and Isleworth (Ann Keen), address that matter? What
instructions can she give to GPs to ensure that they treat more seriously the symptoms of long-term sufferers from Lyme disease?
The Parliamentary Under-Secretary of State for Health (Ann Keen): May I congratulate the hon. Gentleman on the work that he is doing on Lyme disease, and indeed other hon. Members who have shown an interest in that relatively new disease? Guidance on the diagnosis and treatment of Lyme disease is provided to general practitioners and other clinicians by the Health Protection Agency and is published on its website.
T6.  Christine Russell (City of Chester) (Lab): My right hon. Friend the Secretary of State will be aware that more than 90 million working days are lost in Britain every year through mental health issues such as stress, anxiety and depression. Many employers do not quite know what to do about mental health problems, so may I invite him to look at the innovative work being developed by the Cheshire and Wirral Partnership NHS Foundation Trust, together with local employers across Cheshire and the Wirral, which is having significant results? In particular, I point out the partnership between the trust and Airbus; their work has resulted in a 20 per cent. reduction in staff absences at Airbus.
The Minister of State, Department of Health (Phil Hope): I am very grateful to my hon. Friend for drawing to my attention, and the attention of the House, the excellent work done by Cheshire and the Wirral, and the scheme involving Airbus, which she identified as working very well. She is quite right; there are issues to do with mental health and employment that need to be addressed. She will know that we launched a consultation on the subject earlier this year, and a report on the issue is due in the spring. Dame Carol Black is chairing a steering group that is looking into how mental health provision can be better tailored and integrated to help people to find, stay in or return to work. I will certainly draw to the steering groups attention the excellent work that my hon. Friend describes in her constituency.
T2.  Andrew Stunell (Hazel Grove) (LD): Will the Secretary of State agree to take an urgent look at the perverse effects of the NHSs so-called choose and book system, which my constituents think should be renamed confuse and book? My local primary care trust is so fed up that it now routinely explains to my constituents that the system is nothing to do with it. It is certainly nothing to do with general practitioners, who often end up making the bookings on behalf of my bemused constituents, who cannot work their way through the system. Choose and book is certainly not helping my constituents, the overwhelming majority of whom would rather go to the local district hospital, Stepping Hill, than have what often turn out to be illusory offers of treatment elsewhere. Do Ministers accept that choose and book is putting at least three extra leaps between the consultant and the patient, and that the matter needs to be tackled urgently?
Mr. Bradshaw: No, we do not accept what the hon. Member for Hazel Grove (Andrew Stunell) says. I am afraid that it is the responsibility of his local primary care trust and GPs to manage the system efficiently and competently, as most primary care trusts and GPs across the country do, to the great benefit of their patients.
Mr. Kevin Barron (Rother Valley) (Lab): Will my right hon. Friend the Secretary of State confirm that the introduction of GP-led health centres will improve access to GP and primary care services, 12 hours a day, seven days a week, and that such health centres do not threaten well-run, easily accessible village surgeries?
Alan Johnson: I shall be very pleased to confirm that. Indeed, Bradfordnot too far from my right hon. Friends constituencyhad the very first GP-led health centre, which I opened on 28 November. There, we found that people can drop in at any time. They are guaranteed not to wait more than half an hour, even if they have not got an appointment. The contract was given to a fabulous social enterprise formed by GPs in the area who are doing excellent work throughout Yorkshire. Such health centres are about improving access and increasing the capacity of primary care, so it remains totally mystifying why the Conservative party opposes those new services.
T3.  Mr. Henry Bellingham (North-West Norfolk) (Con): Is the Secretary of State aware that there has been a very serious outbreak of norovirus at the Queen Elizabeth hospital in Kings Lynn? Wards have been closed and all non-urgent operations have been cancelled. Obviously, the problem comes at a bad time for the hospital, as it is trying to pay off its historical debt. The problem could well have an impact on waiting lists and affect the hospitals finances. What advice could and does the Secretary of State give to hospitals in that position?
Mr. Bradshaw: Hospitals should know what to do in that position. This is not a new problemas I am sure the hon. Gentleman is aware, it happens regularly at this time of yearand our latest understanding from the Health Protection Agency is that it is less bad this year than in previous years. However, it is important that hospitals take swift and immediate action and it is important, too, that people, not least hon. Members in the House, should not spread undue alarm by, for example, comparing this to health care-associated infections, the implications of which can be fatal.
T7.  Mr. David Kidney (Stafford) (Lab): Will the Secretary of State confirm that the incidence of health care-acquired infections such as MRSA and C. difficile is down in 2008? Does he agree that at this time of welcome reductions it is all the more vital that all parts of the NHS remain focused on maintaining those clinical practices, standards of cleanliness and public education to drive out those infections completely?
My hon. Friend is absolutely right. We have halved MRSA bloodstream infections across England, hitting our target, and we are making excellent progress towards the 2010-11 target to reduce C. difficile infections by 30 per cent. However, we must continue to drive that
forward and drive home the message, not just with health professionals but with the public at large, and I am extremely happy that all our people are working all the time to make sure that that happens.
T4.  Andrew Rosindell (Romford) (Con): Will the Minister explain to my constituents in Romford and the London borough of Havering why the operating framework from the Department of Health for 2009-10 does not give priority to the health and well-being of our increasing ageing population?
Alan Johnson: The operating framework that we issued this year has been well received in the NHS. We have ensured that instead of trying to prioritise everything, and thus prioritising nothing, we have focused attention on health care acquired-infections, which are a huge issue for older people, particularly the over-65s; on dementia; and on greater patient involvement. Those priorities all apply to older people. The dementia strategy, which we will shortly publish, is of particular benefit to older people, as is the debate on the reform of adult social care which, although not restricted to the over-65s, is very much the focus of that report.
T5.  Tony Baldry (Banbury) (Con): It would be churlish to allow 2008 to close without thanking the Secretary of State for accepting in full the recommendations of the independent reconfiguration panel regarding Horton general hospital, and a lot of work has been done to try to balance accessibility issues and safety. May I trespass on the seasonal mood of good will to point out that the Leader of the Opposition, the shadow Secretary of State for Health and at least three members of the shadow health team all visited Horton general hospital in 2008? May I invite the Secretary of State or one of his team to come to visit the Horton general hospital in Banbury at some stage in 2009, so that when he considers these issues he can visualise the balance that we are trying to strike?
Alan Johnson: I thank the hon. Gentleman for his comments. What happened with Horton hospital was verification of the process, and the independent reconfiguration panel made those decisions on the basis of the clinical argument. I should be glad to visit the hospital, but I do not believe that I have ever received an invitation. Usually, I depend on an invitation before I pop up, so it would be nice to receive one.
T8.  Ben Chapman (Wirral, South) (Lab): Can the healthy schools programme be revised, so that medicine policies and support systems for children with diabetes and other long-term conditions are taken fully into account?
Ann Keen: We are committed to improving diabetes care for children and young people, including the way in which the condition is managed in schools. The national clinical directors for children and for diabetes are working together to look at how to support the NHS to improve the way it cares for children with diabetes and other long-term conditions.
Mr. Andrew Lansley (South Cambridgeshire) (Con): The Secretary of State will know that the NHS Information Centre provided to 10 Downing street information from hospitals about people presenting with knife woundsdata that were unpublished, not yet validated and incomplete. That was done on the basis that the information would not be used publicly in that form. Can the Secretary of State tell the House whether he knew about 10 Downing streets intention to use those data and, whether he did or not, what steps he personally is taking to make sure that NHS data are not used for partisan purposes in that way?
Alan Johnson: I have nothing to add to the Home Secretarys comments yesterday, particularly her apology for what happened. The hon. Gentleman has written to the Information Centre and made a number of points, all of which will be answered in due course.
T10.  Tony Lloyd (Manchester, Central) (Lab): Are my right hon. and hon. Friends aware of the campaign by thalidomide survivors, who make the point that that increasingly elderly population who were victims of a great tragedy many years ago are now beginning to suffer the ill-health effects of ageing? How do the Government intend to respond to their aspiration for proper recognition of their plight?
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