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House of Commons

Tuesday 23 June 2009

The House met at half-past Two o’clock


[Mr. Speaker in the Chair]

business before questions

Broads Authority Bill

Lords amendments considered and agreed to.

Mr. Speaker: Just before I call the opening question, I would like to ask hon. Members to keep their supplementaries to one question, and I would ask that Ministers’ replies are kept to a reasonable length. I am determined that we make good progress through the Order Paper.

Oral Answers to Questions


The Secretary of State was asked—

Cancer Awareness in Men

1. John Robertson (Glasgow, North-West) (Lab): What steps he plans to take to encourage men to seek medical assistance in the early stages of cancer. [281535]

The Parliamentary Under-Secretary of State for Health (Ann Keen): If I may be permitted, I should like to congratulate you on your first Question Time, Mr. Speaker.

The theme of last week’s men’s health week, which we supported, was men’s access to health care services. We are working to improve awareness of the signs and symptoms of cancer among men and women in England and to encourage those with symptoms to seek help earlier than they currently do so.

John Robertson: As the first Back Bencher to speak today, may I welcome you to the Chair, Mr. Speaker? I wish you all the good luck and good will that you deserve. I hope that you will receive a lot more luck and good will than some of your predecessors have received.

I thank my hon. Friend for her answer. Will she provide some detail and explain what she proposes to do to fill in the gaps that mean that men seem not to go to the doctor or take advice? How can we try to get them to the doctor to ensure that treatable cancer is treated very quickly? Hopefully we will not then have the deaths that we have at the moment.

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Ann Keen: From evidence, the reasons why men are more likely to develop and, sadly, die from cancer are complex. We do know that the earlier a cancer is diagnosed, the higher the chance that it will be treated successfully. Men are notoriously bad at taking care of themselves and tend to put off seeing their GP, which risks later diagnosis and treatment. To mark men’s health week, and with the help of the Football Foundation, of which men constantly take notice, NHS Choices has highlighted five important male health issues: testicular cancer, skin cancer, mental well-being, prostate cancer and sexual dysfunction.

Mr. Speaker: I was touched to receive the kind remarks of the hon. Member for Glasgow, North-West (John Robertson) and of the Minister. Perhaps I could just say—I hope that it is not presumptuous—that if any other Member was thinking of following suit, I ask him or her not to do so. We do want to make progress through the Order Paper.

Sir Nicholas Winterton (Macclesfield) (Con): Will the Minister indicate why the national health service is not always prepared to give people suffering from the early stages of cancer the most modern, up-to-date medication, even if it is the most costly? Why will it not prescribe the best drug to limit the advance of cancer?

Ann Keen: Our advancement in the treatment of cancer is well recognised in our cancer plan, but we still have to educate men and women in this country so that they go to their doctor earlier and diagnosis can be made much quicker and more effectively. That is what we are doing through many different initiatives.

Mr. Stephen Hepburn (Jarrow) (Lab): Does the Minister agree that although it is important that men go for early advice, it is also important that they get an early correct diagnosis? I am dealing with the case of a constituent who unfortunately died after being tret for 10 months in our local South Tyneside hospital for a urine infection. He was transferred to Sunderland, where he was diagnosed with prostate cancer, and he died—a tragic case. Will the Minister agree to meet me so that we can discuss the issue further, to find out how we got to this position?

Ann Keen: Yes. I am sorry about that particular tragedy of my hon. Friend’s constituent. The issue is so important, and I will be very happy to meet him.

Michael Fabricant (Lichfield) (Con): Testicular, prostate and skin cancers all have a good outcome, provided that they are diagnosed early. The hon. Lady is quite right that people must see their doctors quickly and that men do not look after themselves, but what steps can she take over a sustained period, not just a week, to ensure that there is a change of attitude and that men go to the doctor early for diagnosis?

Ann Keen: This is about education and schools getting through to young people about self-examination, which can still be done for some of the problems that affect men. Through the screening programme in the national awareness and early diagnosis initiative, we are bringing screening closer to those concerned in many imaginative ways. I am sure that if the hon. Gentleman looked on the NHS Choices website, he would see that.

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Ms Sally Keeble (Northampton, North) (Lab): Is my hon. Friend aware that my constituency has one of the highest death rates from prostate cancer in the country? Would she support primary care trusts in areas such as mine in understanding why the death rate is so high and, in particular, whether there is a high incidence or whether the problem is access to services and education?

Ann Keen: I was unaware of the problem in my hon. Friend’s constituency, although I would be happy to look at it with her. The Government are committed to introducing screening for prostate cancer; indeed, a ministerial statement on prostate cancer screening was made on 19 March. We have made great advancements in prostate cancer, which is good news for the men of our country. We now need to get that out to GPs and look at their skills and training needs.

Mark Simmonds (Boston and Skegness) (Con): May I press the Minister further on prostate cancer? It is the second most prevalent cancer in men in the country, with 35,000 new cases diagnosed every year, yet there are still wide inequalities in care and outcomes. Could the Minister say a little more about what specific actions and improvements she is planning in order to provide greater information about prostate care, to widen access to treatments such as hormone therapy and brachytherapy, to encourage greater provision of clinical nurse specialists and to ensure the full implementation of national guidelines?

Ann Keen: I am pleased that the House is giving this subject the importance that it deserves. The UK National Screening Committee is meeting today to discuss the new evidence and decide whether there is now enough information to make a decision on screening for prostate cancer. Should it decide that there is still insufficient information, it could commission further analysis. If that is the case, the committee will set a clear reporting timetable.

Mr. Lindsay Hoyle (Chorley) (Lab): The Minister is quite right in the way that she is addressing the issue. Testicular and prostate cancer are the silent killers, especially prostate cancer. The problem is that men seem to be too embarrassed to go to the doctor’s, but what about doctors calling men in earlier and regularly doing a full screening, rather than waiting for symptoms to appear? The problem is that most people do not even know that they have the symptoms. A regular call-in would be a way round that.

Ann Keen: I agree with my hon. Friend. Extending screening in different ways is important, which is why earlier I mentioned the good work that the Football Foundation does with us, because it helps in raising awareness where there tends to be more of a gathering of men.

Working Time Directive

2. James Brokenshire (Hornchurch) (Con): What his most recent assessment is of the effects of the European working time directive on acute hospital services in the future. [281536]

The Secretary of State for Health (Andy Burnham): Our aim is to ensure that, consistent with patient safety, the maximum number of services are supported to
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achieve compliance with the directive by 1 August. Two hundred and forty-seven trusts have now reported on 6,646 rotas. Following independent scrutiny, the proposed number of services for derogation is 200. I will shortly lay a statutory instrument before Parliament which will amend the working time regulations and set out the relevant information in detail.

James Brokenshire: What action will the Secretary of State take to deal with the significant concerns about the impact of the working time directive? Also, given the picture that he has painted of the action that he has taken, why has the British Medical Association suggested that there is insufficient preparation in some hospitals to deal with the fall in doctors’ working hours and that the funds needed for that are simply not getting to the front line?

Andy Burnham: We have taken great care to ensure that patient care is not disrupted by the implementation of the directive. That is precisely why the statutory instrument will set out those services which will need more time to prepare for the full adoption of the working time directive. However, the hon. Gentleman has to accept that the issue is fundamentally about patient care. Tired doctors make more mistakes—all the evidence points to that—and I do not think that we want to return to the past, when junior doctors worked up to 70 or 80 hours a week and made more mistakes than they might otherwise have made.

David Taylor (North-West Leicestershire) (Lab/Co-op): The figures suggest that in March 78 per cent. of NHS trusts were compliant with the European working time directive, but that that fell to 64 per cent. in April. Will the Secretary of State tell us what he expects the figure to be for May, which is due to be released soon, and are we really prepared for the significant reduction that we shall see from 1 August?

Andy Burnham: It is important to say that two thirds of junior doctors in the health service are now working to compliant rotas, and that all other NHS clinical and staff groups are already compliant with the directive. That means that a substantial part of the staff in the NHS are already compliant with the requirements of the directive. Of course we continue to keep a close watch on these matters, and we will take every possible step to ensure that there is no disruption to patient care after 1 August. The statutory instrument that I am bringing forward will provide extra flexibility for NHS management to ensure that the measures are introduced safely.

Dr. Richard Taylor (Wyre Forest) (Ind): Two of the serious casualties of the shift system are continuity of care for patients and continuity of learning for junior doctors. How can these matters be specifically addressed within the 48-hour week?

Andy Burnham: The hon. Gentleman raises an important point. He will know that my predecessor asked NHS Medical Education England to look again at junior doctors’ training, to ensure that, as part of their new working environment, they would get a grounding in all the necessary subjects. A review is under way into junior doctors’ training, and I hope that I can give the hon. Gentleman an assurance today that it will pick up precisely the point that he has raised.

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Rob Marris (Wolverhampton, South-West) (Lab): Since the Government do not believe that statutorily limiting an employee’s average working week to 48 hours helps a worker’s health, what hourly limit, if any, do they believe to be appropriate?

Andy Burnham: Obviously, individuals retain the ability to opt out of the requirements of the directive, but as I said earlier, this issue is fundamentally about patient safety. It is also about helping individuals to balance their work and home lives, and about ensuring that, when they are at work, they perform to the very best of their ability. We believe that we can safely introduce the working time directive across the NHS and that, overall, the outcome will be staff working to the highest of their potential while ensuring that patient safety is the absolute priority for the NHS.

Norman Lamb (North Norfolk) (LD): If I am not allowed to welcome you to your Chair, Mr. Speaker, may I at least welcome the Secretary of State back to the Department of Health, and the two Ministers to their posts?

The Secretary of State will be aware that one of the key findings of the Healthcare Commission in regard to Staffordshire hospital was the concern about low staff surgical rotas. The president of the Royal College of Surgeons has warned of the potentially “catastrophic” impact on hospitals of the new rules, saying that patients could be put at risk and that some could die. He also said that training could suffer, and that there was a risk of hospitals closing for emergencies. Given that we are now six weeks away from the implementation of the rules, will the Secretary of State agree to initiate a full risk assessment of their impact on patients, and to act in accordance with its findings?

Andy Burnham: I hope that when the hon. Gentleman sees the statutory instrument he will be reassured that it will provide the necessary flexibility in the specialties that it lists to ensure that the requirements can be safely introduced. I would also point him towards the evidence that early adopters of the directive, such as Homerton hospital, have shown a reduction in adverse incidents on the wards. Also, research by Warwick university medical school on trainees working in Coventry and Warwickshire university hospitals compared the number of errors made by junior doctors working no more than 48 hours with the number made by those working no more than 56 hours a week. It showed that fewer clinical errors were made by those working fewer hours. There is therefore good evidence to show that this move will improve patient safety in the national health service, although we of course take seriously the concerns that the hon. Gentleman has raised, and we will proceed cautiously at all times.

Mr. Stephen O'Brien (Eddisbury) (Con): May I from the Opposition Benches welcome the Secretary of State to his new post and to his first questions?

Mr. Speaker, as you will know, and as I discovered through a recent freedom of information request, Buckinghamshire hospitals need to lose 1,360 hours of doctors’ training time to meet the requirements of the European working time directive. Will the Secretary of State confirm that patients will face cuts in care and
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that doctors will face worrying cuts in training because his Labour MEPs failed to oppose this European imposition?

Andy Burnham: I do not wish, at your first parliamentary questions, Mr. Speaker, to inject a note of political discord, but let us get some facts on the record. The last NHS work force census recorded that 34,910 consultants were working in the NHS—a 56 per cent. increase on 1998. It also showed that the overall number of doctors in training is 49,178—a 60 per cent. increase on 10 years ago. This Government have invested in putting more staff on the wards and they have not run junior doctors into the ground so that they were unable to do a proper job of caring for this country’s patients.

Influenza Pandemic

3. Mr. Andrew Mackay (Bracknell) (Con): What progress his Department has made in its preparations for an influenza pandemic. [281537]

The Secretary of State for Health (Andy Burnham): The cumulative total laboratory-confirmed UK cases as of 22 June is 2,905. Globally, the total number of cases confirmed by the World Health Organisation is 52,160. The Health Protection Agency, in conjunction with the NHS, is doing an excellent job, working to minimise the spread of the virus. An interim national pandemic flu service has been tested and could be mobilised within a week; primary care trusts have put in place a support structure for this service. Discussions with manufacturers about our purchase of vaccine are at an advanced stage.

Mr. Mackay: With the real possibility of a national and full-scale pandemic of this flu, is the Secretary of State worried that his own national influenza helpline is not yet up and running? In those circumstances, does he think that NHS Direct will be able to cope?

Andy Burnham: The pandemic has been declared by the World Health Organisation, but it is important for the right hon. Gentleman to recognise, as does the World Health Organisation, that the UK is at the vanguard of countries around the world in its preparedness for dealing with the situation in which we find ourselves. I said in my reply that an interim flu line service is available and could be up and running within a week. We have also made preparations to ensure that the full national pandemic flu service will be available to be switched on in the autumn if it is needed. Our preparations are good and we remain in a position to ensure that patients are not put at risk. I hope that the right hon. Gentleman recognises the good progress made to date.

Andrew Miller (Ellesmere Port and Neston) (Lab): We are clearly in a strong position when it comes to world comparators in preparedness, but will my right hon. Friend assure the House that we are also in a strong position to learn lessons? Are preparations in place for proper mapping and modelling of the way in which the pandemic spreads throughout the UK, so that we can learn lessons that can be applied to the future?

Andy Burnham: Yes, we are. The Health Protection Agency has been doing a superb job in the early stages of this virus in monitoring, tracking and containing the
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spread of the disease at a local level. Much research is going on, based on information from GP practices and other sources, to monitor how the NHS is also coping with the extra pressure on the system. I can give my hon. Friend a full assurance that every possible step is being taken to handle the current situation and learn and provide a resource for future use.

Mr. Crispin Blunt (Reigate) (Con): Ten days ago, a letter from a retired immunologist, Dr. Eva Kasp, was published in The Times. It said:

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