House of Commons
Tuesday 24 November 2009
The House met at half-past Two o'clock
Prayers
[Mr. Speaker in the Chair]
Oral Answers to Questions
Health
The Secretary of State was asked-
NHS Constitution
1. Mr. Mark Lancaster (North-East Milton Keynes) (Con): What recent assessment he has made of the effectiveness of the NHS constitution; and if he will make a statement. [300139]
The Secretary of State for Health (Andy Burnham): The NHS constitution was based on extensive consultation and has widespread support. It gives real power to patients by describing their rights. The Health Act 2009 gives the constitution its legal underpinning and requires a report on its effectiveness to be published every three years.
Mr. Lancaster: Last month Milton Keynes hospital acquiesced to the demands of a pregnant woman by providing an all-white staff for the delivery of her baby. Does the Secretary of State think that this was the correct decision by the hospital, or can we sometimes put patients' wishes too much to the fore in thinking of hospitals' actions?
Andy Burnham: I cannot be alone in finding uncomfortable the situation that the hon. Gentleman describes. I should have thought that it was so for the NHS staff who were on the receiving end of such a request. I know that the trust concerned is conducting an investigation into the request and its handling. I shall be happy to update him when further information is available.
Mr. Kevin Barron (Rother Valley) (Lab): Does my right hon. Friend expect that when the patient consultation on the new constitution has been completed, the wait of 18 weeks or less for a referral from a GP to a consultant or the two-week wait for GP referral for somebody suspected of having cancer will be one of the most popular things that has happened in the national health service in our lifetime? Will he make sure that that is reinforced so that people will expect it for many years to come?
Andy Burnham: My right hon. Friend the Chairman of the Select Committee is right to say that the outstanding progress the NHS has made on waiting times in the past decade should never be lost. We should lock in that progress and the NHS should not slip back below those standards. The patients charter published on 3 March 1995 gave an 18-month guaranteed waiting time for in-patient treatment. That is the measure of how far the national health service has come in recent times. I expect patients to endorse the proposal on that new right, but the NHS constitution will need to be updated in line with public expectations about the national health service.
Norman Lamb (North Norfolk) (LD): The draft NHS constitution includes a right to drugs approved by the National Institute for Health and Clinical Excellence, yet we are witnessing a growing crisis with patients unable to get hold of vital drugs for breast cancer, epilepsy and many other conditions. There is a long list of drugs that are currently unavailable because people are exporting them and profiting from the exchange rate. Is this not a despicable trade? What are the Government doing to stop it?
Andy Burnham: I understand the concerns that the hon. Gentleman expresses about parallel exports. The medicine supply chain is crucial and we are taking steps in the Department to guarantee the security of crucial medicines. He mentions the right in the constitution to
"treatments . . . recommended by NICE . . . if your doctor says they are clinically appropriate for you."
We believe that that is an important right for patients. Obviously NICE has a difficult job to do in judging the cost-effectiveness of treatments, but we think it is the right guarantee to make so that, just as we will not see waiting times slip back, there will never be a return, under this Government at least, to the postcode prescribing that we saw in the 1990s.
Norman Lamb: The right hon. Gentleman is right that there should be an entitlement, yet every day drug companies are reporting 300 to 500 calls from people who cannot get hold of vital medicines. I have a letter that has been circulating to community pharmacists; it includes a price list, with very attractive offers to pharmacists to buy their drugs for export, thereby denying patients in this country vital drugs. What are the Government doing to stop this unethical practice?
Andy Burnham: On Friday, the Minister of State, my right hon. and learned Friend the Member for North Warwickshire (Mr. O'Brien), published clear guidance to primary care trusts. The issues that the hon. Gentleman raises are crucial. It is vital that patients have access to the medicines that they need. We are taking a range of steps to secure the medicines supply chain, but I understand the points that he is raising. We have taken action and I will continue to work with him to ensure that there is no problem in the supply of medicines.
Keith Vaz (Leicester, East) (Lab): I declare an interest as someone who suffers from type-2 diabetes. Will my right hon. Friend assure the House that the NHS constitution will properly protect those who have diabetes by giving them an assessment to determine whether they have the illness? It is better to prevent than to treat once somebody has an illness.
Andy Burnham: I agree entirely that the challenge for the national health service is to become truly preventive-to become a national health service, with the word "health" underlined. My right hon. Friend will know that as well as consulting on the proposed maximum waiting times, we are asking the public whether people aged between 40 and 74 should have a right to an NHS health check every five years. That would take the NHS into new territory. It would take it squarely into preventive territory, and I look forward to hearing whether he and his constituents think that is the right step to take.
Mr. Andrew Lansley (South Cambridgeshire) (Con): The NHS constitution says that patients should have access to NICE-approved drugs. What does it offer a patient with primary liver cancer, for example, who has only one drug as an option for treatment and is told that the NHS will not provide it?
Andy Burnham: I described the right very clearly in my answer to the hon. Member for North Norfolk (Norman Lamb): it is a right to drugs as approved by NICE. The hon. Member for South Cambridgeshire (Mr. Lansley) should accept-indeed, I think I have heard him say before-that NICE has a very difficult job to do in judging the cost-effectiveness of new treatments. I do not want to return to a situation in which people have different access to drugs and treatments according to where they live. NICE brought order to the system, and has an international reputation for rigour in the assessment of new medicines. I am proud of the difficult job that it does, and when it has made its deliberations, that right carries its recommendations to patients throughout the country.
Mr. Lansley: The Secretary of State did not answer my question, but the answer that he should have given, according to his view, is that the constitution offers patients in those circumstances nothing-they will not have access to that drug. Why will he not follow the policy, which we pressed on him and his predecessors, of a value-based pricing system for new medicines, so that patients are provided with treatments that are clinically best for them, so that the reimbursement price through the NHS then reflects the value of the drug, and so that the Government, the national health service and the drug companies get together to ensure that patients have access to treatments that are clinically effective and best for them? Why will the Government not accept that they should have a policy that puts patients first?
Andy Burnham: Let me answer the direct point about NICE's provisional decision on treatments for liver cancer and Nexavar. It is a provisional decision, so every patient in the country has the opportunity to comment on it and the breadth and range of views can be heard. That is everybody's right-to make their views known. I do not think that the hon. Gentleman could sit in my position and basically say that every new treatment that comes along can be afforded. We have to have some rigour in the system, and in the way that decisions are made. Experts-I stress that word-should advise Ministers on how best to take forward those decisions, and that is what we have in NICE. It does an extremely important job for the Government and, I might add, for the taxpayer, and I should expect the hon. Gentleman to show it a little more support.
Derek Twigg (Halton) (Lab): About 10 or 12 years ago, I regularly had complaints from constituents who were waiting 18 months, two years and, in some cases, three years for an operation. On the patient guarantee, it is absolutely right that we reaffirm our commitment to waiting list times, and we should laud what we have done to reduce them, but will my right hon. Friend similarly guarantee that we will continue to press as hard as we can to get waiting lists down?
Andy Burnham: I agree entirely with my hon. Friend, and the whole thrust of the constitution is to translate those targets into permanent rights so that there is no slipping back. My father has just had a heart bypass operation, and he was treated within a matter of weeks. I looked at the patients charter that the Conservative party introduced in 1995, and there was a 12-month standard for an artery bypass graft. How many unlucky people died on those waiting lists for heart bypass operations? That is a world away, and I assure my hon. Friend that under this Labour Government we will never go back to such a situation in the national health service, with people dying waiting for hospital treatment.
NHS Dentistry
2. Michael Fabricant (Lichfield) (Con): What recent assessment he has made of the adequacy of NHS dental provision; and if he will make a statement. [300140]
6. Mr. Edward Vaizey (Wantage) (Con): What recent assessment he has made of the adequacy of NHS dental provision. [300144]
The Parliamentary Under-Secretary of State for Health (Ann Keen): More than 27.6 million people saw an NHS dentist in the 24 months ending June 2009. That is almost 750,000 more than in the same period ending June 2008.
Michael Fabricant: I thank the Minister for her answer. Paul Bason, a constituent of mine and a dentist, came to see me and told me that he has a major problem, because when someone needs a root canal operation on their teeth the current dental contract incentivises him to remove the tooth rather than to perform an operation. Does the Minister think that the contract is conducive to good dental practice?
Ann Keen: No, I do not. We have discussed that issue and root canal work many times in the House, and I suggest that the primary care trust in the hon. Gentleman's constituency speaks to the dentist concerned. Some root canal work is extremely complicated, so if the dentist cannot carry out the required clinical procedure, he can refer the patient to an NHS hospital, where a consultant will see them.
Mr. Vaizey: May I wish the Secretary of State's father a speedy recovery?
In 1999, Tony Blair promised access for all to an NHS dentist by 2001. Since the contract was rejigged, more than 1 million people now do not have access to an NHS dentist-an increase of half a million. When will Tony Blair's promise be fulfilled?
Ann Keen: I believe that the hon. Gentleman will be aware of the increase in dentistry and dental practice over the past two to three years, particularly in his own area. Oxfordshire has a contract with an existing practice to provide short-term provision, initially for 500 additional patients. In Oxfordshire, the number of dentists increased from 262 in March 2007 to 309 in March 2009. I hope that I am known in the House for my caring attitude to staff and to Members. Later this afternoon, I am opening a dental practice in Horseferry road in Westminster, which I am sure that residents and people who work in this area will be able to use.
Natascha Engel (North-East Derbyshire) (Lab): Will my hon. Friend agree to meet me to discuss the plight of lab technicians who make crowns and dentures for dentists? With dentists using cheaper foreign options, our domestic industry is dying on its feet.
Ann Keen: My hon. Friend raises with me an issue that I am happy to discuss with her at a later date.
Mike Penning (Hemel Hempstead) (Con): I am sure that the whole House would agree that when our armed forces come home on leave they need the best possible treatment from the NHS. Does the Minister therefore agree that it is abhorrent that when a serviceman comes home on leave and needs dental treatment he is turned away by the PCT because there is no funding stream for that treatment and sent back to barracks for treatment? Is that not wrong in the NHS in the 21st century?
Ann Keen: If the hon. Gentleman would like to give me evidence of that, I would be very interested to look at it.
Human Trafficking
3. Mr. Anthony Steen (Totnes) (Con): If he will issue guidance to health care practitioners on the likely health care problems experienced by trafficked persons which might not present immediately. [300141]
The Minister of State, Department of Health (Gillian Merron): Multi-agency guidance for all front-line practitioners on meeting the needs of trafficked people was issued last month. It includes a specific section on how front-line health practitioners should respond to the needs of trafficking victims, including those who might not present themselves immediately.
Mr. Steen: As many trafficked people have suffered from the most appalling mental and physical abuse requiring ongoing medical support and counselling, could I mention to the Minister the in-depth counselling service of the Helen Bamber Foundation in London, which gives wonderful ongoing counselling support to trafficked victims as well as to those who are found to have suffered torture? Will she consider extending that kind of in-depth counselling service to other parts of the country where more and more trafficked people are coming forward?
Gillian Merron:
May I pay tribute to the hon. Gentleman, who is a passionate advocate for people who rarely have a voice themselves? I, too, congratulate the Helen Bamber Foundation, whose work does indeed help to rebuild
the lives of those who have suffered the worst of violations. Provision of services is of course a matter for local health services. However, I will gladly draw the hon. Gentleman's comments to the attention of the taskforce that the Government have set up, whose work includes looking at the role and the response of health services in respect of trafficked people.
Fiona Mactaggart (Slough) (Lab): Talking therapies are very important for people who have been through the trauma and post-traumatic stress disorder that are too commonly the fate of those who have been trafficked. In our constituencies, many of us find that there is insufficient access to talking therapies for anyone. Will my hon. Friend talk to PCTs and mental health trusts around the country about ensuring that there is better access to counselling and talking therapies for people with such conditions?
Gillian Merron: I certainly share the views of my hon. Friend, who makes an absolutely valid point. That is exactly why we have set up the taskforce. It is chaired by Sir George Alberti, who will look specifically at where there are gaps and what role the NHS and health service workers can play in supporting those who have been traumatised in the way that has been described. I hope that will do a lot to plug any gaps such as those that my hon. Friend mentions.
Jim Sheridan (Paisley and Renfrewshire, North) (Lab): Most of the people who are trafficked into this country are young men and women who are exposed to terrible abuses. Will my hon. Friend have discussions with her counterpart in the Home Office to ensure that any criminal money that is recovered from the people responsible for this trafficking is confiscated and, better still, redirected to the NHS to pay for the health care of these young people?
Gillian Merron: Again, my hon. Friend makes a very important point. Indeed, the taskforce that I referred to was set up by the Home Secretary and the Health Secretary, and we want particularly to consider how we can support victims of trafficking, work better together across Government and help to bring to justice those who perpetrate this crime. We want to make the advances that my hon. Friend refers to.
Parking Charges (Offsetting)
4. Mr. Simon Burns (West Chelmsford) (Con): What guidance he has given to NHS trusts on the offsetting of receipts from parking charges against their deficits; and if he will make a statement. [300142]
The Minister of State, Department of Health (Mr. Mike O'Brien): NHS trusts manage finances locally, including how they eliminate deficits. Parking subsidies need to be approached with care, especially where the trust has a deficit.
Mr. Burns:
The Minister will remember that at the last Health questions, he told me that he did not expect trusts to make a profit out of car parking to pay off deficits. What is he going to do with the letter from the chief executive of Mid Essex Hospital Services NHS Trust that I sent him a month ago, which states that the
trust increased car park charges from 1 February 2007 for staff at Broomfield hospital from £40 a year to £200 a year as part of the turnaround scheme to reduce the deficit? That seems directly contrary to what the Minister said last month that trusts should do.
Mr. O'Brien: The hon. Gentleman did raise that with me, so I have looked into it. The increase in 2007 for staff was from 77p a week to £3.85 a week. At the moment, the trust apparently charges staff half the annual cost of operating the space. In other words, I am told that the trust subsidises those car parking spaces.
Today the shadow Chancellor has said how tough he wants to be on climate change and how he wants to discourage people from unnecessarily using vehicles and so on. Now, the hon. Member for West Chelmsford (Mr. Burns) wants to ensure that instead of money being put into patient care, it is put into greater subsidies for car parking-
Mr. Speaker: Order. I think we have got the gist of it. I am grateful.
Mr. Tom Watson (West Bromwich, East) (Lab): I believe my right hon. and learned Friend's guidelines suggest to acute trusts that they should provide some free parking to disabled badge holders. In cases where they do not do that, such as at my hospital at Sandwell, what recourse do we have to press them to change?
Mr. O'Brien: We have said that we want people with disabilities who are regular visitors to hospital to have access to permits that will enable them to have car parking spaces at a reduced charge. On what can be done, my hon. Friend must of course first approach the hospital, and if that is unsuccessful he should approach the primary care trust.
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