| Previous Section | Index | Home Page |
22 Apr 2009 : Column 122WH—continued
I need to tackle a few things that have come out in this debate. Perhaps we should start with screening. Triple A screening is essential. The Prime Minister announced our strategy in 2008, but those who understand how the health service works will know that one cannot make an announcement and press a button and get everyone to start such important screening. Triple A screening is very complex and any programme would need careful development, involving cardiologists and specialists.
There are important patient safety considerations, too. We must be sure that we can provide the correct treatment at the highest standard. It is essential that we put it on the record that the health service, the clinicians and others concerned with this screening have to have the right training to ensure that the right standard of safety care is always in place. The same applies to vascular screening. The next steps guidance was issued in November 2008 and was accompanied by a primary care service framework. Best practice guidance was issued in April 2009. Both guidance documents have drawn on input from not only the NHS, but PCTs, pharmacists, all the other groups that have been mentioned in the debate, and especially the learning network that has been operating since 2008.
The hon. Members for Romsey (Sandra Gidley) and for North-East Cambridgeshire mentioned targets on a few occasions in their contributions. Of course targets make a difference. I am pleased to see two—if not three—converts to targets today.
The hon. Member for Croydon, Central (Mr. Pelling) talked about congenital heart defects. We recognise that services for people with congenital heart disease need to be different from those for acquired heart disease. I will be happy to write to him with a more detailed response—I am not able to deal with it in the time available in this debate. However, on his final point on any proposed reconfiguration, I urge and encourage him to engage with his constituents. The NHS in London is currently consulting on its proposals for the future of stroke and trauma services, which is exceptionally important. I understand that he met the Secretary of State recently; such consultation should continue.
I should also like to address the call for a further strategy document. I understand where Members from within the coalition of all-party groups are coming from, but we believe that our NSFs have stood the test of time. Some elements of the guidance have been updated over the years by NICE, as we envisioned from the outset. However, the hon. Member for North-East Cambridgeshire would find the standards in the NSF and the markers of quality element of the stroke strategy hard to improve upon.
I was overwhelmed with invitations at the beginning of the debate—my hon. Friend the Member for North-West Leicestershire (David Taylor) was exceptionally complimentary. I am happy to commit to discussing the way forward. The hon. Member for North-East Cambridgeshire will also find that the Government have never said that the NSF will not run after its 10th birthday. We tend to talk in terms of those horizons, saying things like “Over the 10 years” and the like. It is a convenient round number and people can consider what will happen when the 10 years are up. I accept hon. Members’ concerns, but I think we can put them to bed.
Mr. Moss: Will the Minister explain the fundamental difference between the renewal of the mental health strategy and the renewal of the cardiac and vascular health strategy?
Ann Keen: The hon. Gentleman makes an interesting point. Mental health is not within my portfolio, so it would be unfair to the Minister with responsibility for it if I were to comment on it. As I said, I can see why people have the 10 years figure in their heads. Our recently published 2008 progress report for the CHD NSF stated that we must continue not only to build on the success that we have realised so far, but to consider where we need to do better. There is no doubt that we need to focus relentlessly on improvement and on making quality the organising principle of the NHS.
I should now like to reflect on the successes of our NSFs and the progress that has been made on the implementation of our national stroke strategy. Our greatest achievement in cardiac services has been getting waiting times down. That has been acknowledged by hon. Members today, for which I thank them. That was achieved with a massive increase in cardiologists and other key staff and a 50 per cent. increase in capacity thanks to a £735 million capital investment programme.
The improvements in recent years could not have happened without the hard work and commitment of NHS staff. Cardiologists, cardiothoracic surgeons, cardiac nurses, technicians and rehabilitation specialists have all played their part. I have the great good fortune to meet front-line workers in the health service frequently. I visited St. Peter’s hospital in Chertsey, where I saw the angiography suite, which is a very impressive nurse-led unit, and in November last year I was able to accompany the Prime Minister on a visit to Harefield Heart Science Centre, which is led by the eminent cardiologist, Professor Sir Magdi Yacoub. I saw the energy of the young scientists in the centre. They look at stem cell research and other things to research the causes and nature of heart disease and, of course, they consider the importance of its prevention and treatment. I also visited the cardiac catheter laboratory and the walk-in emergency centre at Harefield, which is led by another eminent cardiologist, Dr. Charles Ilsley, and I witnessed a cardiac catheter angioplasty being performed at King’s college. I pay tribute to all those people.
We have tried very hard not to have a party political, partisan debate, but I should like to give the hon. Member for Boston and Skegness the opportunity to dissociate himself totally from the remarks made by Daniel Hannan, a Member of the European Parliament, to Fox News. He told those he called his “friends in America” not to go down the same route as us. He said that the NHS was “a mistake” that
“we have lived through for 60 years”
“has made people iller”.
Would the hon. Gentleman like to dissociate himself from those remarks?
Mark Simmonds: I am grateful to the Minister for giving me the opportunity to do so. It is clear that we do not agree with those remarks. The NHS has just had its 60th birthday and we were keen to celebrate it. Since I have the opportunity, I, too, should like to thank and congratulate the hard-working NHS staff, who do such an excellent job every day of the year.
Ann Keen: I hope the hon. Gentleman will ask his party leader to do as he has just done and dissociate himself from the MEP who made such scurrilous remarks about our NHS.
We are planning two pieces of work for the CHD NSF. First, we are commissioning an external review of its implementation and delivery to understand better what has gone well and, more importantly, what has not gone well and, more importantly still, why. Secondly, we will undertake an analysis of the trends in the burden of heart disease and how they, combined with changing patient and public expectations, and technological and medical advances, are likely to affect future demand and patterns of service provision. We aim to make that analysis available alongside the external review.
The CVC report offers the most helpful contribution to our thinking about future burdens. We are happy to continue to discuss the matter and to work with our third sector partners to ensure that the development of heart services continues to improve and that the momentum we have generated in the past 10 years is not lost. One direction that we are keen to pursue is a more integrated cross-vascular approach. There are close links between the risk factors for heart disease, stroke, diabetes and kidney problems. Our recently launched NHS health checks programme demonstrates our desire to pursue such an approach and our commitment to focus increasingly on prevention.
Mark Simmonds: In the brief time remaining to the Minister, will she address the key points that several hon. Members made on the significant role that pharmacies could play in improving and delivering care and prevention for those with cardiovascular problems?
Ann Keen: I mentioned that. I said that we have consulted pharmacies particularly on vascular checks. They are aware of their important role.
We can also look at healthy lifestyles and address the inequalities in health. Those words were not allowed to be used in the Department of Health prior to 1997, so I am pleased that that has changed. A wide range of the Department’s health promotion initiatives contribute to vascular health. As was mentioned in the debate, obesity is the common risk factor across the range of vascular diseases, which is why our healthy weight, healthy lives strategy is focusing on helping people to maintain a healthy weight by promoting healthier food choices and physical activity. Eat less, move more, live longer is the message.
The combination offers a really powerful mechanism for embedding quality as the organising principle of the NHS, whether it is through prevention or looking at the science of the disease. It is important because it affects us all, especially our constituents in more deprived areas. We have much more work to do, and I look forward to working with the coalition.
Motorcycle Testing (Wales)
3.59 pm
Mark Williams (Ceredigion) (LD): I am delighted to have the opportunity to raise this issue, and it is a particular pleasure to serve under your chairmanship, Mr. Pope.
It is customary to describe Westminster Hall debates as timely, but this debate is particularly timely, as from next Monday, motorcyclists who want to earn their licence will be subject to a new two-module test. The new test stems from the European Union’s second driving licence directive, which introduced a requirement to test emergency stops at 50 kph, or somewhere between 31 and 32 mph. I should say at the outset that it is disappointing that the Government did not seek a derogation allowing the emergency stops to be tested on roads, as they were previously. I hope that those in Europe with responsibility for the decision would look favourably on a measure that would suit us better and that, after all, involves a difference of little more than 1 mph, although perhaps the Minister can tell us differently. However, I will not dwell further on the decision in Europe. We are where we are, awaiting Monday’s looming farce.
We face more immediate concerns, although it is worth pointing out where failures have occurred. I hope that this debate will reinforce the view that the Department for Transport and the Driving Standards Agency have an important duty to ensure that people can access the test. The practicalities of the new modular test have led to the Government’s creation of a series of new facilities, to be known as multi-purpose test centres, to provide for the test. The original intention was to have 90 sites across the United Kingdom. Some 66 were planned, but when the test comes into effect on Monday, only 44 centres will be operational.
In October, when the new testing regime began, 39 testing centres were ready for action. The new testing regime was then delayed for six months, owing to the lack of facilities. Only five more centres are in place now than were then, so I do not understand why, if a delay was appropriate in October, it is not appropriate now. There has been no significant increase in the number of facilities open. I encourage the Minister—perhaps rather optimistically, at this late stage—to think again.
I should place on record the DSA’s much appreciated strenuous efforts to locate additional sites. However, even if the 66 sites were up and running for next week, serious concerns remain about the new test’s implications for some in rural areas. The map of the United Kingdom highlighting the location of the centres makes for gloomy reading. There are huge voids across mid and west Wales, parts of Scotland and the west country. However, as I am flanked by my colleagues from mid and west Wales, the Minister will appreciate that Wales is the issue of the day.
In Ceredigion, my constituency, riders face the choice of undertaking the first module in Shrewsbury or Swansea. That will lead to potential round trips of up to 140 miles, which raises significant issues of both convenience and safety. Many motorcyclists have expressed to me their fear that riders might have to negotiate treacherous conditions over long distances. It is deeply worrying
that a test introduced to improve safety could have the opposite effect. The sun is shining here today, as I dare say it is in mid-Wales. It would be a pleasure to travel the roads of mid-Wales today, but that is not always the case. A few months ago, the roads were dark, wet and icy. It is worrying.
Mr. Roger Williams (Brecon and Radnorshire) (LD): My hon. Friend is spelling out the situation in Ceredigion. In my constituency, the Harley-Davidson academy of motorcycling operates a centre where people can learn to ride motorcycles safely and with skill, but those taking phase 1 of the test will have to travel at least 50 miles to Shrewsbury, Swansea or Newport. As he says, returning from the test, particularly if they had failed it, would be an ordeal for somebody just learning how to ride their motorbike.
Mark Williams: My hon. Friend represents a constituency that is arguably even more rural than mine. The practical difficulties facing constituents trying to take the test present a huge challenge. However, he will forgive me if most of my speech concentrates on Ceredigion.
To put the issue into context, it is not just mid and west Wales that have been affected. The original proposals have created particular difficulties for those in rural areas of Scotland, particularly some island communities. The Isle of Wight has not been included in the list of MPTCs, so riders from the island will have to travel to the mainland. Also, my hon. Friend the Member for Mid-Dorset and North Poole (Annette Brooke) has told me of her constituents’ concerns. I am sure that the search for casual testing sites is ongoing in such areas, as it is in mine. Any positive news that the Minister can give us will be most welcome.
I mention those areas—they are far from being isolated cases—to illustrate the fact that although mid-Wales is certainly among the worst affected areas, the infrastructure put in place for Monday is far from adequate. I am an optimist by nature. I do not intend to be a doom merchant, but I am worried about the operation of the test as of Monday.
I emphasise that I do not blame the DSA for the situation. I was privileged to meet some of its representatives in my constituency last Friday. It has been given a budget and been charged with using it as best it can to reach as many people as possible. It is incumbent on Government to provide the DSA with adequate resources, so that it can provide adequate testing facilities to meet the challenges of rurality and geography that some of us face.
Lembit Öpik (Montgomeryshire) (LD): I congratulate my hon. Friend on this debate and echo his concerns. Car driving instructors in Newtown and the surrounding area feel the same way. Does he agree that, apart from the basic stupidity, eco-unfriendliness and additional danger of the change being forced upon us, it is the Government’s responsibility to ensure that people can learn to ride bikes and pass their driving test without bearing an inordinate additional burden as punishment for the fact that they happen to live in mid-Wales or Montgomeryshire?
Mark Williams: I am grateful to my hon. Friend for making that point. Like my hon. Friend the Member for Brecon and Radnorshire (Mr. Williams) and me, he is acutely aware of our constituents’ sensitivity to the loss of public services from rural communities.
As I mentioned, the DSA has been helpful in trying to identify casual testing sites where module 1 can take place. We are still trying to find a suitable site in my constituency. I am hopeful, not least because of the determination of the Motorcycle Action Group and of some of my constituents—particularly Rory Wilson and Ken Huntley—that we will be able to find somewhere. However, no site will be ready by Monday, which is why I still hope, optimistically, for some reassurance from the Government about the arrangements as well as about a delay.
Without those assurances, the effects of the new test will be felt immediately. The worst-case scenario is that the new test will reduce demand for module 2, causing problems for the businesses that offer that part of the test. Module 1 must be completed before module 2 can be taken, and there has already been worrying evidence of what lies ahead. Ian Plover of Rider’s Edge, which operates from the Royal Welsh showground in Builth Wells in the constituency of my hon. Friend the Member for Brecon and Radnorshire, contacted me about his concerns. When he bought the business in November 2008, it was on the understanding that there would be a casual testing site in the town of Llandrindod Wells. Unfortunately, that does not appear to be the case at the moment and, as a consequence, Rider’s Edge finds itself in some difficulty. As of last week, not a single test had been booked after the start date of the new test.
Mr. Plover made the point strongly that the DSA was helpful and did everything it could to assist him in making testing as accessible as possible, but his example demonstrates clearly what might happen when the new test is in place. A reduction in demand for the first module could cause some businesses to become unsustainable. In a few months, we might find not only that some in rural areas do not have access to module 1 at an MPTC, but that no one offers the second module locally either.
Mr. Roger Williams: I emphasise that the facility in Llandrindod Wells was supported by the local authority and the Welsh Assembly Government. With those supporters, I do not understand why that facility could not be provided.
Mark Williams: My hon. Friend makes an important point. I have a vast list of sites that have been explored as potential casual sites but have been rejected. Perhaps the Minister will explain why the Llandrindod site was not pursued.
If my hon. Friends will forgive me, I will now migrate to the west coast. West Wales has been hit further by the lack of an available MPTC site in Haverfordwest in Pembrokeshire. That was explained to me in some detail by the DSA last week. It fought hard to ensure that there was a site in north Pembrokeshire, which would have alleviated some of the concerns in the south of my constituency. It appealed through the planning process to get a site up and running and spent a lot of money from its budget on doing so. It was not the fault of Government, the DSA or the local community. Blame may lie elsewhere.
| Next Section | Index | Home Page |