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10 Feb 2009 : Column 1243

GP-led Health Centres (Battersea)

3. Martin Linton (Battersea) (Lab): What plans he has to introduce GP-led health centres in Battersea. [255397]

The Minister of State, Department of Health (Mr. Ben Bradshaw): My hon. Friend’s local NHS, like those in the rest of England, is planning a new GP-led health centre, open from 8 am to 8 pm, seven days a week. I understand that the proposal is to locate it near to Clapham Junction station.

Martin Linton: I thank my hon. Friend for recognising the health needs of Battersea in that new proposal, and in various other proposals to extend GP-led health centres. Will he assure my constituents that the range of facilities that can be offered in the new GP-led health centre will be far greater than can currently be provided in the Bolingbroke hospital, which is held in great affection, but is an old and impractical building?

Mr. Bradshaw: I can assure my hon. Friend that the range of services provided in the new health centres will be big, and will meet the needs of the local population, which is one of the criteria we have laid down. I can also tell him that plans for the expansion of health services in his area are not restricted to this particular GP-led health centre. I understand that there are also plans to expand services at Doddington, Bridge lane and St. John’s, including primary care services.

Mark Simmonds (Boston and Skegness) (Con): In Battersea, the provision of primary care is vital to the health of the community, but according to the Royal College of General Practitioners, seeing a doctor who knows the patient and their medical condition personally is important to more than 75 per cent. of patients. Yet the Secretary of State recently said that he “could not care less” which GP he sees. That is totally out of touch with patient needs both in Battersea and elsewhere. Can the Minister confirm that continuity of care is important to the vast majority of patients, particularly those with long-term conditions? If so, why are he and the Secretary of State centrally imposing polyclinics, against patients’ needs and wishes?

Mr. Bradshaw: Yes, I am happy to confirm what the hon. Gentleman asks me to confirm. However, what he says is another of the myths that were peddled by both the Opposition and the British Medical Association, at the time, in their opposition to new GP health centres. I do not know whether he has now abandoned the Conservative party’s opposition to the centres. I suspect that the Conservatives will quietly abandon that opposition, because where the new centres are opening, they are incredibly popular, not least with local Conservative councillors and Conservative MPs who want theirs to open as quickly as possible.

Of course continuity of care is important for many patients, particularly those with long-term conditions. However, many people, such as professionals who are otherwise healthy and who are juggling work and family life, find it very difficult to see their GP, because of opening times. They warmly welcome the opportunity to see a GP, and they do not particularly mind whether it is always the same GP.

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Influenza (2008-09)

4. Mr. Andrew Pelling (Croydon, Central) (Ind): What estimate he has made of the incidence of influenza in the winter of 2008-09. [255398]

The Minister of State, Department of Health (Dawn Primarolo): Information on the incidence of influenza-like illnesses is collected by the Royal College of General Practitioners. The rate of influenza-like illness started increasing in late November and peaked at 69 GP consultations per 100,000 people in mid-December. The rate of ILIs decreased to 13 consultations per 100,000 people by early February.

Mr. Pelling: I thank the Minister. Winter-prevalent diseases such as influenza and bronchitis lead to increased morbidity. I am told by two local undertakers in Croydon that that has led to a call on undertakers to take as many bodies as possible from south London mortuaries. I am told also that some south London hospitals have found it necessary to hire extra equipment for the cooling of deceased bodies. Is that a normal situation in the NHS, or is it peculiar to south London hospitals? Does it mean that additional support might be appropriate?

Dawn Primarolo: I do not know the exact details that the hon. Gentleman mentions, and I shall certainly examine the situation in his area specifically. The peak rate this year was a quarter of the level experienced in 1999-2000, which was the last severe flu season. The connection that he suggests between flu and early death is not showing up in the statistics at the moment, but I shall certainly give his points closer consideration and write to him.

Rob Marris (Wolverhampton, South-West) (Lab): Can my right hon. Friend tell me what steps her Department takes to encourage primary care trusts to contact all older people—those in the influenza bracket, at over 60—and ensure that they are told about the availability of an influenza jab that would increase their chances of surviving the winter?

Dawn Primarolo: I can assure my hon. Friend that all primary care trusts have active policies with their GPs and make information available to those over 65 and others who are entitled to the free flu jab. The rate of patients being immunised with the influenza vaccine is increasing, and it is currently 74.1 per cent. That clearly needs to continue to rise to the 75 per cent. level we aim at.

Foundation Hospitals

5. Mr. Peter Bone (Wellingborough) (Con): What criteria are used by NHS foundation hospitals when deciding on the location of their facilities. [255399]

The Minister of State, Department of Health (Mr. Ben Bradshaw): The criteria are the same as those used by non-foundation trust hospitals. Any changes to be made to services must be for the benefit of patients locally and led by doctors and health care professionals locally.

Mr. Bone: In Rushden, an out-patients facility is being closed. Some 6,000 constituents have written to me demanding that a replacement facility be built in Rushden. The NHS’s weighted criteria state that it
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should be built in Rushden, but in fact it is being built in an adjoining constituency, in a small town. That constituency already has a minor injuries unit and is getting a new hospital. What is the difference between the two constituencies? One is the Conservative marginal seat of Wellingborough, and the other is the Labour marginal seat of Corby. Are not this miserable Government making decisions about health facilities based not on need, but on political advantage?

Mr. Bradshaw: I am advised that no such decision has been made. The hon. Gentleman has been involved in detailed discussions with health care managers on the ground, who are considering the matter. I am sure that he recalls that we had an Adjournment debate on the subject. Kettering hospital and Northamptonshire primary care trust want to expand the out-patient provision in his constituency or for his constituents because they believe that the current provision in Rushden does not cover the numbers that they want to serve. Ultimately, what they are trying to achieve will mean that tens of thousands of people who must currently travel from the hon. Gentleman’s constituency to Kettering hospital for treatment will no longer have to travel so far. I therefore urge him to continue his discussions with his local health service managers. I understand that they have not ruled out alternative locations if one can be found that provides his constituents with the health care that they deserve in the 21st century.

Paddy Tipping (Sherwood) (Lab): Will the Minister be careful when he imposes criteria and regulations on foundation trusts? Clearly, local managers and professionals need to develop local solutions to local problems. That is important.

Mr. Bradshaw: My hon. Friend is right. People who should know better often misunderstand—I hope accidentally—how the system works. Any changes to services, whether to a foundation or a non-foundation trust, are matters for the local health service. If the proposals are sufficiently significant for local authorities’ democratically elected overview and scrutiny committees to think that they should be consulted, they must be consulted. If those committees remain unhappy, they can refer the proposals to the national independent reconfiguration panel. My right hon. Friend the Secretary of State has made it clear that he will respect and has respected all the IRP’s recommendations, which include two recent ones in Conservative areas, where the IRP recommended against the local health service’s proposals and its recommendations were upheld.

Acute Sector Staff (Assaults)

6. Anne Main (St. Albans) (Con): What progress his Department has made in reducing the number of assaults on NHS staff in the acute sector in the past 12 months. [255400]

The Parliamentary Under-Secretary of State for Health (Ann Keen): The NHS constitution recognises that staff have the right to work in a safe environment, free from violence. Staff are saying that they will not accept violence or abuse as part of the job, and they are demonstrating that by reporting violence. In 2007-08, the number of criminal sanctions following cases of assault in the acute sector increased by 13 per cent.

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Anne Main: I thank the Minister for her response. She referred to an increase of 13 per cent. What are the exact figures for the number of prosecutions made in the past five years? If she has not got those figures, will she supply them to me?

Ann Keen: The NHS security management service has signed a memorandum of understanding with the Association of Chief Police Officers. It encourages trusts to agree a protocol with their local police on how they can work together. The SMS has also signed a memorandum of understanding with the Crown Prosecution Service to ensure the effective prosecution of cases that involve violence and abuse against NHS staff. This is a matter for local management, but the hon. Lady shows great concern about the issue which I believe is felt across the House. I am happy to supply her with as much information as I can.

Mr. Kevin Barron (Rother Valley) (Lab): Does my hon. Friend have figures to show how many assaults on NHS staff are fuelled by alcohol? What are the costs of such assaults to the NHS as opposed to law enforcement agencies?

Ann Keen: We are aware of the concern that alcohol causes staff, especially in accident and emergency units, and of how it infringes on their management of other patients as well as of the patient who has the alcohol problem at the time. Continual work is being done on the matter with the SMS, which continues to consider figures on that troubling subject.

Mark Pritchard (The Wrekin) (Con): The number of violent attacks on Shropshire ambulance crews continues to increase, as does the number across the west midlands, so much so that Shropshire crews have had to resort to buying their own stab-proof vests. I have written to the chief executive of West Midlands Ambulance Service NHS Trust asking for the vests to be provided by the service. The reply is that the service is currently reviewing the situation. That review has been going on for some months. Is it not time that the Government spoke to West Midlands Ambulance Service NHS Trust and ensured that stab-proof vests are made available, in order that ambulance crews can do their duties and feel safe and their families know that they are safe?

Ann Keen: The hon. Gentleman raises a serious issue. It is up to the service to look at that, but I believe that the local and national standards that we, the police and all the agencies concerned are applying in respect of the worrying vulnerability of all our public sector workers will result in the correct policy, which will be managed locally, because that is how all such matters must be looked at in local decision making.

Mr. Jim Devine (Livingston) (Lab): As my hon. Friend knows, the Scottish Parliament introduced the Emergency Workers (Scotland) Act 2005, which offers legal protection to front-line health service staff such as doctors, ambulance personnel and A and E nurses. Do we have any thoughts about introducing similar legislation in this Parliament?

Ann Keen: A Ministry of Justice Bill addressed that issue last year, but I would be happy to discuss with my hon. Friend any areas that he has concerns about in relation to the serious issue of violence against staff.

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Mike Penning (Hemel Hempstead) (Con): I am sorry to say that the Minister was very selective in her comments about how many assaults on NHS staff there were in 2007-08. The truth is that 12,500 staff who had gone to work to care for the community in this country were assaulted by cowards, and that criminal sanctions—I stress that they were not prosecutions, but sanctions, including some that were just cautions—were applied in fewer than 700 cases. Where is the zero tolerance that this Government promised to protect our emergency services?

Ann Keen: The hon. Gentleman raises an issue that concerns the entire House. When increases in violence against our front-line staff continue, it is a matter for us all to address, in order to get the prosecutions, which is why we work with the Crown Prosecution Service and, in particular, with the Association of Chief Police Officers. That is an area for the Crown Prosecution Service, but it is not an area that we dismiss in any shape or form, and it would be wrong to give that impression. We are talking about serious measures for serious times, for our hard-working front-line staff.

Undergraduate Courses

7. Dr. Howard Stoate (Dartford) (Lab): What assessment he has made of the adequacy of provision for teaching of therapeutics and prescribing in medical undergraduate courses. [255401]

The Parliamentary Under-Secretary of State for Health (Ann Keen): The General Medical Council has the statutory responsibility to determine the extent of the knowledge and skill required for the granting of primary medical qualifications in the United Kingdom. The GMC’s document “Tomorrow’s doctors” sets the standards and outcomes for undergraduate medical education. The GMC is currently consulting on the draft of a third edition, which would include a strengthening of the requirements in this area and, consequently, provide the opportunity to address any areas of concern.

Dr. Stoate: Professor Webb of Edinburgh university recently told the Select Committee on Health inquiry into patient safety that the teaching of therapeutics and prescribing had all but disappeared from the undergraduate curriculum. A recent survey of medical students showed that 80 per cent. felt that they were either poorly or very poorly prepared for prescribing by the time they qualified. With drugs becoming more powerful and treatment regimes becoming ever more complex, surely it is important to ensure that medical students are properly equipped. Is there more that the Government can do to ensure that this valuable part of the curriculum is given the priority that it deserves?

Ann Keen: I thank my hon. Friend for that. The GMC is currently consulting on the draft of a third edition of “Tomorrow’s doctors”, which, as was noted on 22 January by the Health Committee, of which my hon. Friend is a hard-working member, enshrines the competences drawn up by the safe prescribing working group. Those competences are included in the draft. The consultation concludes on 27 March. The GMC will then consider all the representations received, before publishing the next edition in the summer of 2009. It will be the duty of us all to ensure that all our doctors’ education is safe in its practice.

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Mr. Robert Goodwill (Scarborough and Whitby) (Con): Does the Minister agree that doctors should look not only at the efficacy of the drugs that they prescribe, but at their cost-effectiveness? Should they perhaps be trained in how to resist the beguiling attentions of the pharmaceutical salesmen who so often visit our GPs’ surgeries?

Ann Keen: A strict code of practice governs this issue, as I am sure the hon. Gentleman is aware, and it is still a matter for the General Medical Council to look at all aspects of the training and practice of our medical practitioners.

Dr. Brian Iddon (Bolton, South-East) (Lab): May I draw my hon. Friend’s attention to the all-party group on drugs misuse’s report on physical dependence on, and addiction to, over-the-counter and prescription medicines? Does she agree with three of the report’s recommendations—that medical staff should be properly trained to recognise these problems; that they should follow the prescribing guidelines laid down by the Department of Health; and that they should be aware of the withdrawal protocols in cases where people have become physically addicted or dependent?

Ann Keen: My hon. Friend raises issues of concern, and I fully accept that we should study them carefully.

Lightning Process

8. Ms Celia Barlow (Hove) (Lab): What guidance his Department has issued to NHS trusts on the use of the lightning process in the treatment of people diagnosed with chronic fatigue syndrome. [255402]

The Minister of State, Department of Health (Phil Hope): The Department has issued no guidance on this process, because we expect decisions on clinical interventions, whether they involve complementary or alternative treatments, to be made by front-line clinicians. In making such decisions, clinicians will take into account evidence for the safety and clinical and cost-effectiveness of the treatment concerned.

Ms Barlow: I thank my hon. Friend for his reply. Sussex ME and Chronic Fatigue Society works tirelessly to assist the 6,000 adults and children across the county who suffer from the disease, and several of those people have been contacted about the success of the lightning treatment. Will he assess that treatment, in conjunction with the bodies that he has mentioned, and monitor how successful it is?

Phil Hope: It is not for the Department to undertake that activity. The National Institute for Health and Clinical Excellence, the independent body, issues guidance on the use of such treatments, and that guidance is the subject of a judicial review this week. It is to that independent body that those patients and organisations should make their representations, so that it can make the appropriate recommendations on the use of such treatments.

Mr. Graham Stuart (Beverley and Holderness) (Con): I agree with the Minister that treatments such as these should not be performed on the NHS until independent
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medical evidence has been obtained to show their efficacy. Will he tell the House how much is spent by the NHS on chronic fatigue syndrome?

Phil Hope: I am grateful for the hon. Gentleman’s support for a way of working in the national health service that has widespread support on both sides of the House and throughout the country. I do not have the figures that he requests to hand, but I will write to him in due course.

David Tredinnick (Bosworth) (Con): Is the Minister aware that herbal medicines—[Hon. Members: “Hear, hear!”] I have written to him about the fact that, if he does not introduce statutory regulation of herbal medicine practitioners by the time the herbal medicinal products directive is implemented in 2011, there will be no proper regulation whatever. What is he going to do about that?

Phil Hope: I thank the hon. Gentleman for his question. This is a serious issue that many people are concerned about. We will be undertaking a consultation on the future regulation of herbal medicines in the near future.

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