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The Deputy Speaker declared the main Question, as amended, to be agreed to (Standing Order No 31(2)),


Daniel Kawczynski: On a point of order, Mr. Deputy Speaker. I am extremely shocked about what I am going to say. I was about to make my speech in the debate on savers when I received a note from my office saying that there was a police officer there, demanding to see correspondence. The police were already present in my
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office and I went to see them after making my speech. They said that they were investigating an important case with regard to correspondence that had been sent to Ministers and wanted to see handwriting samples from people who had written to me. I am appalled that officers can behave in that way—entering a Member of Parliament’s office, with no warrant, and demanding constituency correspondence. To my great embarrassment and eternal shame, I was so weak that I handed over the letter from my constituent that they demanded. I will have to live with that, but I am extremely embarrassed about it. After everything that has happened to my hon. Friend the Member for Ashford (Damian Green), it is disgraceful that this is happening and I urge you to investigate.

Mr. Tobias Ellwood: Further to that point of order, Mr. Deputy Speaker. It is clear that shocking events are taking place. Is it not appropriate for the Home Secretary to come here to make a statement? We had assurances that no offices would be entered unless a warrant was produced. That clearly has not happened today and we deserve some sort of clarification from the Home Secretary.

Mr. Deputy Speaker: I understand the great concern of the hon. Member for Shrewsbury and Atcham (Daniel Kawczynski). Clearly, I have no knowledge of the matter, but if it is as he says, it is obviously extremely serious, and my advice is to take it to the House of Commons authorities as quickly as possible.

Sir Patrick Cormack (South Staffordshire) (Con): Further to that point of order, Mr. Deputy Speaker. I was standing at the Bar of the House when my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) raised his point of order, of which I had no knowledge at all. It seems to me, Sir, that you are representing Mr. Speaker. Should the matter not be referred immediately by you to him?

Mr. Deputy Speaker: The House will have heard the point of order that has been raised. Hon. Members on both Front Benches have heard it, too. I can clearly report the matter immediately to Mr. Speaker and he will take whatever action he deems appropriate. That is all that we can do for the time being. My advice to the hon. Member for Shrewsbury and Atcham was on the course of action that he should take. I was not advising him of the course of action that I will take, which is as described by the hon. Member for South Staffordshire (Sir Patrick Cormack).

Business without Debate

delegated legislation

Mr. Deputy Speaker: With the leave of the House, we will take motions 22 to 26 together.

Motion made, and Question put forthwith (Standing Order No. 118(6)),

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Merchant Shipping


International Immunities and Privileges

Question agreed to.

Section 5 of the European Communities (Amendment) Act 1993

Motion made, and Question put forthwith (Standing Order No. 118(6) and Order 9 December),

The Deputy Speaker’s opinion as to the decision of the Question being challenged, the Division was deferred until Wednesday 28 January (Standing Order No. 41A).

delegated legislation

Mr. Deputy Speaker: With the leave of the House, we will take motions 28 and 29 together.

Motion made, and Question put forthwith (Standing Order No. 118(6)),

Betting, Gaming And Lotteries

Question agreed to.

European Union Documents

Motion made, and Question put forthwith (Standing Order No. 119(11)),

Food Distribution to the Most Deprived Persons in the Community

Question agreed to.


Northern Rock

7.32 pm

Mr. Peter Atkinson (Hexham) (Con): The petition, which is signed by 86 of my constituents, states:


7.34 pm

Mrs. Sharon Hodgson (Gateshead, East and Washington, West) (Lab): I have a petition in a similar vein, which I would like to present to the House on behalf of my constituent Mr. James Pagan and 87 other constituents.

The petition states:


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Coronary Heart Disease

Motion made, and Question proposed, That this House do now adjourn. —(Ian Lucas.)

7.35 pm

Janet Anderson (Rossendale and Darwen) (Lab): I thank you, Mr. Deputy Speaker, and Mr. Speaker for giving me the opportunity this evening to raise this issue, which is of great importance to my constituents.

In the 19th and early 20th centuries, before the advent of vaccination, the most common causes of death and disability in this country were infectious diseases such as smallpox, diphtheria, tetanus, whooping cough, measles and polio. The average life expectancy of a male baby born in 1900 was 45. Edwardian men considered themselves old in their early 40s. Our pursuit of the maxim that prevention is better than cure has been successful: it has changed the structure and quality of our lives, but much more remains to be done. Often, if we solve one set of public health problems, the next challenge looms clearer.

The main cause of death in the UK now is cardiovascular disease and coronary heart disease, with nearly half the deaths caused by the latter. Based on 2005 data, there are some 227,000 heart attacks each year. The British Heart Foundation estimates that 1.5 million men and 1.1 million women are living with CHD. That is an immense residual quantum of personal suffering, but also a burden on the economy. It is reckoned that coronary heart disease costs the UK economy nearly £9 billion a year, and £5.7 billion of it is a result of days lost owing to death and illness and to informal care costs.

What is the best medical handle to bear down on this? Well, we know that high blood cholesterol is the single biggest risk factor. It was from that finding that a strategy began to be put in place to address the problem. In April this year, the Department of Health launched “Putting Prevention First”—a national programme of vascular checks for 40 to 74-year-olds, including risk assessment and management. It is thought that that programme has the potential to prevent up to 9,500 heart attacks and strokes every year and to save no fewer than 2,000 lives.

Running in tandem with that is the key part of the mechanism: the annual reward and incentive programme based on GP practice achievement results. That is the quality and outcomes framework, which began in 2004 and is known as the QOF. The current QOF target is to get 60 per cent. of all identified patients to a target cholesterol level. However, there are elements within the overall control strategy that are not operating optimally—at least not yet. A report by the university of York of June 2007, which I commend to hon. Members, dealt with

and reads:

but we do not make full use of them. Our death rates from cardiovascular disease remain among the highest in western Europe. Tony Hockley, director of the Policy Analysis Centre, reckons that in England alone there are more than 7,000 unnecessary heart attacks a year because we do not diagnose and treat enough people with raised cholesterol levels.

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I understand that cholesterol testing in the US is recommended for all adults over 20 every five years, that US targets for cholesterol reduction are significantly more ambitious than in the UK and that, broadly speaking, the hard-headed medical insurance companies in the US are prepared to pay for cholesterol-reducing medications on a preventive basis for those in high-risk groups. What makes sense to commercial ventures in the USA should make sense to a value-for-money-minded Treasury in the UK, too.

The big problem with QOF is that it has not moved with the times. The 2004 measure was based on recommendations made in 2000. There are inconsistencies with the National Institute for Health and Clinical Excellence guidelines of 2008 and the Joint British Societies professional guidelines. The 2008 NICE guidelines on lipid modification and type 2 diabetes recommend a level of cholesterol in the blood 20 per cent. lower than the QOF provides for, but, as yet, the target remains static. That means that the way in which we pay GPs is not incentivising them adequately to treat patients down to ideal serum cholesterol levels. That represents a missed opportunity, and lives lost or blighted.

There is an additional anomaly. GPs can still qualify for their QOF incentives even if significant numbers of patients are excluded from the calculations under the exception reporting rules. That is fair up to a point. Practices should not necessarily be penalised if, for example, patients do not attend for review, or if a medication cannot be prescribed because of contra-indications. However, the exception reporting rate for cholesterol control varies widely in primary care trusts, from 5 to 15 per cent. Worse, 14 of the 40 PCTs with exception reporting rates above 10 per cent. are also meant to be “spearhead PCTs”, and therefore to be leading a drive to tackle public health problems such as smoking, obesity and poor diet in some of England’s most deprived areas. My own PCTs, Blackburn with Darwen and East Lancashire Teaching, have an exception reporting rate of 12.8 per cent. and 11 per cent. respectively. We are left with more than a suspicion that the exception reporting rules are being used in a way that preserves GP income but does not maximise health service delivery, not least in the most deprived areas of the country.

The message is clear: the mechanism by which we incentivise GPs to deliver health improvement is outdated. It needs review, not least in bearing down on high exception reporting rates. As a nation, we invest a great deal in the NHS and we have a right to expect value for money and achievable goals in driving down rates of the main killer disease in Britain today.

I thank the Minister for attending today. She has previously expressed an interest in this topic in answer to parliamentary questions, and I look forward to hearing her response.

7.42 pm

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