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Andy Burnham: I do not think that it is possible for the shadow Secretary of State for Health to accuse the Government of not investing in cancer services. This Government made the change on day one of taking office, and we have invested in cancer services throughout our period in office. The facts are as follows. Cancer mortality among under-75s fell by almost 18 per cent. between 1996 and 2006. That is a record of which we
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are very proud. However, we must continue to invest in the equipment and capacity to give people as rapid access to tests as possible. As I said earlier, we want to give GPs the ability to refer people for non-obstetric ultrasound, for flexible sigmoidoscopy and other such tests, so that we can give people ready access to tests in the community, help to get early diagnosis and, in the vast majority of cases, put their minds at rest.

Mr. Lansley: I regret that I did not really get an answer to my question. Since the Secretary of State wants to talk about cancer mortality, will he explain why, in the decade after Labour came to office, the gap in cancer mortality between this country and the European average widened? On the other point that he made, surely he must know that the issue in the NHS now is not primarily about the capital resources for additional diagnostics, but the staffing to support them. Diagnostic equipment could be better used if there were more radiographers and sonographers.

Andy Burnham: I can answer the hon. Gentleman on both points. As I said, cancer mortality fell over the decade in question. Cancer survival rates have been steadily improving. We accept that there is more to be done to close the gap between us and comparable countries, but that is precisely why I have taken steps on early diagnosis, which is the new frontier in taking on the battle against cancer.

The hon. Gentleman mentioned the work force. The cancer work force has increased considerably in that period. We have been investing not just in equipment, but in people. He mentioned radiographers. There were some 12,500 radiographers in 2000. In 2006 there were 14,500, and the plan is to have 17,500 by 2012. That is a genuine commitment to invest in the work force and the equipment that gives people in this country the best possible chance of surviving cancer. He cannot look me in the eye and say that his party in government did the same thing.

Mr. Speaker: Order. I appeal to the Secretary of State and the other Ministers on the Treasury Bench: we must have shorter answers. We need to make progress.

Mr. Dennis Skinner (Bolsover) (Lab): Does my right hon. Friend agree that he cannot say often enough that the real reason why we have been able to reduce the problems with cancer and many other illnesses, particularly heart disease, is the money that we invested in 2001 and the 1 per cent. increase in national insurance contributions, every penny of which went straight to the NHS? That had never been done before in any Budget. Conservative Members walked into the No Lobby and voted against that money. As someone who has had cancer and open-heart surgery, I cannot thank the NHS enough. I thank my colleagues for walking through the Aye Lobby and providing the extra money to find the people to do the job.

Andy Burnham: I could not have put it better. The Conservatives had the nerve to stand up in Manchester last week and proclaim themselves the party of the NHS. But as my hon. Friend rightly says, a few years before that they walked though the No Lobby to vote against the money that Wanless said was crucial to put
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our NHS back on its feet. That money has paid for the figures that I have been reading out in the House this afternoon.

Sandra Gidley (Romsey) (LD): In 2007, the National Radiotherapy Advisory Group highlighted the 63 per cent. gap between current activity levels and optimal treatment levels. That position will worsen as cancer increases in an ageing population. The Secretary of State has mentioned the projected staff increases, but what will he do about the equipment which, although it was replaced under this Government, is coming to the end of its useful life? What plans are there to ensure that the equipment and staff are there in the future?

Andy Burnham: The hon. Lady is right to say that this is not a case of one or the other: we need both together. As well as radiographers, some 1,800 extra cancer consultants have joined the NHS since 1997. We need both, and I recognise that we have to invest in the most up-to-date equipment to give people the very best cancer care. That is our commitment, and that is what we are doing by reprioritising our spending plans to get the funding into that equipment, switching away from the hospital-building programme.

"Shaping the future of care together"

5. Mr. Mark Harper (Forest of Dean) (Con): What discussions he has had with the devolved Administrations in relation to the implementation of the proposals in his Department's Green Paper, "Shaping the future of care together". [292232]

The Minister of State, Department of Health (Phil Hope): The Secretary of State wrote to Ministers in Wales, Scotland and Northern Ireland with the full text of the Green Paper before publication. Officials have been in regular contact with their counterparts in the devolved Administrations, and a further series of meetings is planned.

Mr. Harper: I am grateful to the Minister for that reply. In border constituencies such as mine, many constituents-such as those who live in Sedbury and Beachley in my constituency, whose nearest town is Chepstow in Wales-will be very concerned about how this plan would work across borders. In May 2008 Ministers said in the forerunner to this document that they were thinking very carefully about how it would work across devolved borders, so can the Minister give us any idea about any proposals he has come up with-or has the last year and half just passed with no concrete action at all?

Phil Hope: The hon. Gentleman is right to say that the system of care and support that we want to create-it will be the first ever national care service of its kind-covers a mix of devolved and reserved policy areas, because care is devolved and the benefit system is reserved. We are therefore working closely with the devolved Administrations to ensure that any changes we make to any of the systems provide the best possible outcomes for people in the UK. I cannot pre-empt the consultation in which we are currently engaged to achieve that outcome, but I can assure the hon. Gentleman that we are working closely with the devolved Administrations to get the best possible outcome for everyone's constituents.

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Mark Lazarowicz (Edinburgh, North and Leith) (Lab/Co-op): Will the Minister think about how to get agreement with devolved Administrations so that the portability of benefits can extend beyond England, and can in due course, by agreement, be extended to people from England moving to Scotland or Wales, or vice versa, at some future stage?

Phil Hope: My hon. Friend has highlighted a key feature of the new national care service that we want to develop: the idea that people's care assessments should be portable. At present in England different people get different assessments depending on where they live. The proposals in the national care service will ensure that there is a single care assessment, so that people are not identified with different needs according to where in the country they happen to live. That is the kind of discussion about how the system would operate that we are having with counterparts in the devolved Administrations, including Scotland. If there are features of the national care service that have particular merit and benefits, and which the devolved Administrations, for whom this is a devolved matter, wish to replicate, I will be more than happy to enter into discussions with colleagues in those devolved Administrations.

Mr. Stephen O'Brien (Eddisbury) (Con): As a prelude to the Green Paper, on 11 June the Minister said here that each MP had to ensure that the money from the carers strategy announced by the Prime Minister actually went to carers. The Princess Royal Trust for Carers reports that of this year's £50 million, £40 million has gone missing, including in the Minister's own Northamptonshire primary care trust. Where has the money gone? Does it surprise him that carers feel so let down?

Phil Hope: I guess that carers will feel most let down when they hear that the Conservatives are opposing a national care service that will provide a fair, affordable and simple system. [Interruption.] I am talking about the question that the hon. Member for Forest of Dean (Mr. Harper) asked me earlier, about the national care service. That national care service will provide much more help for people both in their own homes and in residential care, unlike any of the proposals that have come forward from the Conservative party. In terms of the allocation of the carers money, I am delighted that the Government-again, the Conservatives voted against this-committed a sum of £150 million to be paid in to the national health service, to be provided by local primary care trusts. It is for PCTs to identify the priorities in their area. We are encouraging organisations, and we will be issuing guidance on how that carers' support money can be provided, but it is this-

Mr. Speaker: Order. I am grateful to the Minister. I call Sir Alan Beith.

Alcohol-related Mental Health Services

6. Sir Alan Beith (Berwick-upon-Tweed) (LD): What assessment he has made of the availability of services for patients in north Northumberland with mental health problems related to alcohol. [292233]

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The Minister of State, Department of Health (Gillian Merron): The North East strategic health authority has advised me that NHS North of Tyne undertook an assessment during 2007 to map the service provision against best practice guidance. Following that, the trust is now working with local partners on developing services in the local community for people with alcohol and mental health problems.

Sir Alan Beith: I welcome the flurry of activity since I tabled that question some time ago, but will the Minister take a personal interest in a matter that is worrying general practitioners throughout north Northumberland: the fact that there is no facility to which they can refer people with alcohol problems and alcohol-related mental health problems? Will she help and encourage all the relevant NHS trusts to fill that gap urgently?

Gillian Merron: I can indeed confirm a personal interest, as I spoke with the primary care trust this morning. It is aware of the challenge to provide better services and is in the process of completing a review of all alcohol services, including those for people who also have mental illness. I have asked the local director of public health to meet the right hon. Gentleman to discuss the review's findings and he is happy to do so. I am also assured that the PCT is prioritising alcohol reduction services and, within that, has identified new investment for community-based alcohol services, which is particularly important for those with a lower-level mental health problem.

Mr. Barry Sheerman (Huddersfield) (Lab/Co-op) rose-

Mr. Speaker: Order. I know that the hon. Member for Huddersfield (Mr. Sheerman) will stick to the subject of north Northumberland.

Mr. Sheerman: Can the Minister tell me whether the relaxation of product placement rules would help the people of north Northumberland in coping with alcohol problems?

Gillian Merron: I am happy to refer that question to colleagues in the Department for Culture, Media and Sport.

Anne Milton (Guildford) (Con): The Department of Health's policy guideline on dual diagnosis talks of teams with specific expertise in dual diagnosis being developed and better co-ordinated. That was produced seven years ago, but anecdotal evidence from Northumberland and elsewhere suggests that little improvement has been made; indeed, people with schizophrenia have a 10 per cent. higher than average risk of having an alcohol problem. What action is the Minister taking to ensure that people with a dual diagnosis receive the right support?

Gillian Merron: We all know that providing the services for those who have both mental illness and an alcohol problem is an increasing challenge. There are many examples of good practice, but the truth is that, of course, we can do better. That is why we will publish, before the end of the year, good practice guidance on the development of integrated care pathways. That will give specific guidance for those who are working with people with co-existing alcohol and mental health problems. In other words, we seek to get the right people doing the right thing at the right time in the right way.

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Better Healthcare Closer to Home

7. Tom Brake (Carshalton and Wallington) (LD): What his most recent assessment is of the effectiveness of the Better Healthcare Closer to Home programme in achieving its objectives. [292234]

The Minister of State, Department of Health (Mr. Mike O'Brien): South-west London's NHS tells me that good progress is being made on the Better Healthcare Closer to Home programme.

Tom Brake: I thank the Minister for his reply. He may be interested to know that more than 800 people wrote to Sir Richard Sykes, the chairman of NHS London, asking that there be no further undue delays in the Better Healthcare Closer to Home programme. We have received reassurances from Sir Richard that there will be no such delays from his end, so I now seek the Minister's reassurances. Can he confirm that no block on that programme will be caused either by a south-west London review or by a pan-London review that is under way? Will he confirm when the Department-

Mr. Speaker: Order. One question will do; I hope that people will get that message.

Mr. O'Brien: First, I can confirm that the case in respect of St. Helier looks to be good, and we hope to be able to announce some progress on that in the near future. On the Better Healthcare Closer to Home programme, the primary care trust has already developed the Shotfield health centre-a new £13 million centre-in Wallington; the Robin Hood Lane health centre in Sutton officially opened in May 2008; and the PCT is also developing a GP-led health centre on the Wilson site in Mitcham, which will open in spring 2010. That is good progress.

Mr. Nicholas Soames (Mid-Sussex) (Con): Given the great importance of these services, will the Minister confirm that the working time directive has not had an adverse effect on the service provided?

Mr. O'Brien: It is important that we ensure that the quality of delivery of care in the NHS is not compromised by staff who are overtired and unable to make the difficult judgments that we often call on them to make. We have to ensure that the working time directive is delivered appropriately and that staff comply with it.

Social Care

8. Paul Holmes (Chesterfield) (LD): What recent representations he has received on his Department's Green Paper on social care. [292235]

The Secretary of State for Health (Andy Burnham): We have held 28 "Big Care Debate" events in nine regions in England, which were attended by about 1,000 people. In addition, there have been more than 10,000 responses to the public consultation. I have also received 29 written parliamentary questions and 141 letters and e-mails about the care and support Green Paper.

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Paul Holmes: I thank the Secretary of State for that response. A number of my constituents have contacted me about the Green Paper. Typical of their responses was one from a lady who said:

Will the Secretary of State take this opportunity to reassure my constituent that the Government will not take away awards such as the disability living allowance and the carer's allowance, which allow people to live independently and with dignity?

Andy Burnham: We think that there is an argument for combining some disability benefits with the funding that goes towards social care to create a better system for care and support. I also want to reassure the hon. Gentleman's constituent that no decisions have been taken on this matter. Obviously, we are consulting on it through the Green Paper. The main point that I want to put across is that whatever changes we make, we want to ensure that under a new and better care system people can still get an equivalent level of support to that which they are used to. We would want to replicate the level of control that his constituent describes under the new national care service that was described by the Minister of State, my hon. Friend the Member for Corby (Phil Hope).

Mr. Kevin Barron (Rother Valley) (Lab): If we are going to introduce a national care service, why should it not be funded in the same way as our national health service is?

Andy Burnham: I would say to the Chairman of the Select Committee on Health that we have to be careful to ensure that it is fair across the generations. To say that the cost of social care should be fully funded by the taxpayer raises a genuine question about whether that is fair to today's working-age population, who obviously face their own pressures. The proposal at the heart of the Green Paper, in all the scenarios, is a partnership between the state and the individual. We think that that will be the fairest way to proceed, but obviously there are different ways in which that partnership could be constructed.

Allergy Services

9. Jo Swinson (East Dunbartonshire) (LD): What assessment he has made of the effectiveness of the specialist allergy service pilot in the north-west. [292236]

The Parliamentary Under-Secretary of State for Health (Ann Keen): The pilot allergy network in NHS North West started in February 2009. The project team is beginning to work with the clinical evaluation unit at the university of Liverpool on "An Analysis of North West Services" to review data about current activity and measure improvements and outcomes.

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