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The Parliamentary Under-Secretary of State for Health (Ann Keen): All NHS staff, with the exception of doctors in training, have been compliant since 1998. In 2004, working time provisions were extended to doctors in training whose maximum hours were reduced to 56 hours by August 2007 and 48 hours by August 2009.
The Royal College of Surgeons said in January this year that we simply do not have the surgeons in the UK to fill the gaps created by the working time directive. Does the Minister agree that it is wrong to put at risk the work of local trusts, including the Norfolk and Norwich University Hospitals NHS Foundation Trust, the safety of patients and the career aspirations
of those who wish to become surgeons by her Department's lack of proper planning for the implementation of the working time directive?
Ann Keen: I am sorry to disagree with the hon. Lady. The working time directive is health and safety legislation, and there is strong evidence that tired doctors make mistakes, so reducing working hours to 48 will of course improve patient safety. I know that the Norfolk and Norwich university hospital is looking at its anaesthetic rota and coming to an agreement on it. There has always been a tradition in surgical training that needed to be addressed. The most recent survey of medical education for those in training has shown that this training is now better and safer.
Mr. Stephen O'Brien (Eddisbury) (Con): Given that at the last count, only two thirds of junior doctors were compliant with the European working time directive and 77 trusts have had to request a derogation from the directive, and in the light of the fact that the Secretary of State himself does not have to comply with the directive that his own party has forced on our doctors, what action are the Minister and the Secretary of State taking to bring forward the long-delayed review of junior doctors' training to ensure that doctors' skills and training-and, ultimately, patient care-do not suffer as a result of the Government's failure to negotiate an opt-out?
Ann Keen: I can certainly tell the hon. Gentleman one thing-this Labour Government and this Minister have no intention ever of returning to the long and dangerous hours that all our doctors and surgeons used to have to work, because I actually worked with those doctors at the time. Any one of them would tell the hon. Gentleman how serious that practice was, as mistakes were made. Along with the medical education authorities, the British Medical Association and all the Royal Colleges, we take patient safety very seriously. The report that the hon. Gentleman mentioned will be looked at and we will report back on it, I believe, early next year.
The Parliamentary Under-Secretary of State for Health (Ann Keen): In the last decade, child health services have developed based on research and the healthy child programme. In the London strategic health authority region, 1,876 health visitors were employed in 1997. Following the change and the extensive child health programmes, we now deliver child health by a range of practitioners. The latest figures show that at 30 September 2008 there were 1,577 health visitors.
Does the Minister accept that after 12 and a half years in office, we are losing nationally one health visitor on average every 30 hours, that the professions reckon that we need another 8,000 to plug the gaps and that there are some places where there are
two and a half as many people on a health visitor's case load as was recommended as safe by the inquiry into baby Peter's death?
Ann Keen: We recognise that there is a shortage of health visitors, but, as I said in my earlier answer, we are delivering the child health strategy in a different way. Health visitors now lead teams. The 21 Sure Start centres in Southwark, part of the hon. Gentleman's constituency, serve as a focal point for local families, and have excellent links with health visitors, nurseries and infant schools.
Unite/CPHVA and the national health service have launched an action on health visiting programme. They are working closely together, especially in London, evaluating return to practice schemes. We value our health visitors greatly. As for their case load, the Secretary of State recently announced that such issues were to be reviewed.
The Parliamentary Under-Secretary of State for Health (Ann Keen): This is a matter for local organisations. They make budgetary decisions based on the needs and priorities of the local populations to deliver effective local services.
Tony Baldry: Three consultants used to provide 24/7 consultant-led paediatrics at Horton general hospital, but it is estimated that it will take between nine and 13 to deliver the service in future. That has implications not only for the trust's budget, but for the future recruitment of consultants. What plans are the Government making in relation to recruitment as a consequence of the working time directive?
Ann Keen: We are in constant discussion with Medical Education England, along with the strategic health authorities, which have strategic responsibility for the planning of their consultants. Money has been made available to assist them in that process.
The Secretary of State for Health (Andy Burnham): Tomorrow the Government will publish the personal care at home Bill, which will benefit about 400,000 of the most vulnerable people in our society. On the same day, I will address a conference at the London School of Hygiene and Tropical Medicine to raise awareness of the human health costs of inaction on climate change in the lead-up to the Copenhagen summit.
The people of Cumbria have been in all our thoughts over recent days. Today my hon. Friend the Under-Secretary of State for Health spoke to Sue Page, chief executive of NHS Cumbria, and passed our thanks-the thanks of the whole House, I am sure-to the NHS staff and
health professionals who have done so much to help local people to pull through during some very dark hours.
I am assured that emergency measures are in operation, including the use of Cockermouth community hospital as a general practice. In Workington, emergency measures are providing the full range of primary care services for people in the north of the town. My hon. Friend the Under-Secretary will visit the affected areas on Friday, and any further steps that are necessary will be taken.
James Duddridge: Following concerns raised about the generic substitution of epilepsy medicine, what decisions has the Secretary of State made on whether such medicines should be excluded from the pharmaceutical price regulation scheme?
The Minister of State, Department of Health (Mr. Mike O'Brien): We intend to launch a 12-week consultation, which I hope will begin before Christmas. We therefore do not expect to be in a position to implement generic substitution until next year. However, we will wish to examine those issues as part of our wider consultation.
T5.  Martin Linton (Battersea) (Lab): Cans of super-strength lager carry the message "Enjoy responsibly" or "Please drink responsibly", yet they contain four and a half units, which is more than the maximum recommended daily intake. Given that super-strength drinks are a major killer of vulnerable homeless people, would it not be more responsible for the Department to ban half-litre cans and to introduce a super-strength tax on beers and ciders containing more than, say, 6 per cent. of alcohol per volume, as recommended by the Thames Reach charity in my constituency?
The Minister of State, Department of Health (Gillian Merron): I note the clear recommendation from that organisation in my hon. Friend's constituency. Whatever the strength of the lager or other alcohol that people drink, they should understand how strong the drink is, how much they are drinking and the health risks involved. As my hon. Friend knows, tax is a matter for the Chancellor, but I will ensure that his comments are drawn to the Chancellor's attention.
T2.  Mr. Philip Hollobone (Kettering) (Con): According to the Jeanette Crizzle trust, of which I have the honour to be a trustee, fewer than 7 per cent. of secondary schools have taken part in the Department's Give and Let Live organ donor education programme. What is the Secretary of State going to do to improve participation rates?
Andy Burnham: This is obviously a very important issue. There were reports in the news again today that not enough good organs were available for donation. I think that we can reach across the House and agree that the matter is crucially important. There is more that we can do to encourage people voluntarily to join the organ donation register. Progress has been made recently, but there can be no let-up. I hope that the hon. Gentleman will work with us, and will support all our efforts to boost awareness and the number of people joining the register.
Jane Kennedy (Liverpool, Wavertree) (Lab): Will my right hon. Friend take a personal interest in the two capital building projects, part of the £1.2 billion committed to Liverpool hospitals by the Government, the Liverpool university hospital and the Royal Liverpool children's hospital, both of which are critical to the future delivery of hospital services to Liverpool?
Andy Burnham: I visited Liverpool yesterday and spoke to the chief executive and chair of the Royal Liverpool and Broadgreen University Hospitals NHS Trust. The scheme has important health benefits for the city and region, but also has wider economic benefits. I can assure my right hon. Friend that I am paying close attention to both of the schemes that she mentions. Obviously there is pressure on capital budgets in the current climate but I recognise that these are important schemes.
T3.  Bob Russell (Colchester) (LD): Is the Secretary of State aware that the future of the nation's community dental practices has been put at serious risk because of guidance HTM 01-05? Will he agree to meet me and some dentists from my constituency so that they can explain what are clearly the unintended consequences of this guidance note?
Mr. Lindsay Hoyle (Chorley) (Lab): There is a new village near Chorley called Buckshaw, and thousands of new homes are being developed in Chorley. My concern is that there is a drag factor between the population and the funding given to primary care trusts. What can we do to ensure that Chorley gets the right amount of funding for its primary care trust?
Mr. Mike O'Brien: The NHS is constantly looking to ensure that we keep up to date with the way in which populations change in particular areas. PCTs must ensure that those data go to the Department so that the appropriate decisions on finances can be made.
T4.  Greg Mulholland (Leeds, North-West) (LD): At a recent surgery, a constituent raised the problem of having an above-inflation increase at a private care home for his mother. It can be difficult to move people from those homes, so there is no competition with other businesses. What tools are at the Government's disposal to deal with this and to regulate private care homes so that they cannot simply charge anything willy-nilly, knowing that people cannot access another care home?
The Minister of State, Department of Health (Phil Hope): The quality of care provided by private care homes is subject to regulatory control by the Care Quality Commission. They are independent and fee levels negotiated with local authorities are a matter for local authorities. If the hon. Gentleman has a particular issue on that, he should first discuss it with the local authority, but recent legislation means that an individual may be able to complain to the local authority ombudsman.
Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab): Further to the incident at Milton Keynes general hospital when a maternity patient demanded all-white staff, may I clarify to the Minister that I spoke directly to the chair of the hospital trust, who assured me that the patient's request had not been acceded to and that she was treated by the duty team-a mixed team-for her caesarean? It would appear that the hospital did follow the NHS code in dealing with what was clearly a difficult and sensitive incident. I would be grateful if the Minister made sure that the accurate account of what happened is accentuated and that the hospital is congratulated.
Andy Burnham: I am grateful to my hon. Friend for that important clarification. We would want to ensure that no unfair suggestion is made about NHS staff who do their best for all of her constituents at all times. There is of course no place for racism in the NHS, nor for any discriminatory behaviour towards NHS staff. On that there can never be a compromise, but we have heard the clarification given by my hon. Friend today.
T6.  Mr. Andrew Pelling (Croydon, Central) (Ind): A Bethlem Royal hospital in-patient who had previously been convicted of murder absconded while on a shopping trip to West Wickham. As we would expect of one of the best trusts in the country, Bethlem reacted very professionally in giving reassurance to the public about its procedures for such circumstances, but would it be worth checking whether there are sufficient resources to support such activities for in-patients outside hospital?
Phil Hope: I am grateful to the hon. Gentleman for bringing this case to my attention. Whether a patient who has been detained under the Mental Health Acts can leave a hospital or unit under escort on a visit is always a clinical decision. The hon. Gentleman described the mental health trust involved in this case as one of the best in the country, and it is the responsibility of individual trusts to ensure that patients in their care do not abscond from secure services.
The hon. Gentleman referred to resources. As I said earlier, investment in mental health services has increased for nine consecutive years, and by some 50 per cent. or £2 billion in real terms. I understand that the South London and Maudsley NHS Foundation Trust will be carefully reviewing the incident the hon. Gentleman raised and that it will change policies and procedures for escorting patients if that is found to be necessary.
Joan Walley (Stoke-on-Trent, North) (Lab): May I mention how proud my constituents are of the new Haywood hospital alongside the University Hospital of North Staffordshire NHS Trust's new hospital? Will my hon. Friend the Minister take a very close look at investment and capital funding, however, and will he in particular look at the pace of change, as our area is still distant from the target, and at the importance of the market forces factor, so that we can make sure we get our full allocation of capital funding across north Staffordshire?
Mr. Mike O'Brien: My hon. Friend is a doughty fighter for Staffordshire and for ensuring that funding goes in the direction of her constituents. I will, of course, look at the issues she raises and see if I can be helpful.
T7.  Michael Fabricant (Lichfield) (Con): Paul Bason, a Lichfield-Staffordshire dentist who came to see me, raised, among other issues, the question of training. He says that after graduating in dentistry people have to have a year in vocational training, which is a good thing, but he asks whether there will be enough vocational trainers for the next batch of graduate dentists, and he thinks that perhaps there will not be.
Ann Keen: We have to accept that there is competition for training places in some areas and that it is necessary for some new graduates to move out of their home area. Over the country as a whole, however, we make sufficient training places available for training new graduates.
Andrew Mackinlay (Thurrock) (Lab): The roll-out programme for ultrasound screening against aneurysms of the aortic artery is inadequate. How and when will this treatment, which will save up to 6,000 lives a year among men aged over 60, be available? It is desperately needed, especially in working-class areas where the greatest indices of health poverty exist, such as my area.
Ann Keen: When rolling out any new technique within the national health service, we have to prepare the work force. This screening has been in progress. It has taken off better in some areas than in others, but we are looking at this and we are particularly concerned that we get it right because of the number of lives that will be saved.
T8.  Sandra Gidley (Romsey) (LD): Constituents are being told that GP surgeries have to use up their initial allocation of 500 flu vaccines before they can order further supplies, even if the surgery knows there are a further 1,500 or so patients still to be vaccinated. What is the Secretary of State doing to ensure that surgeries have adequate and timely supplies of vaccines so that all vulnerable people can be vaccinated as soon as possible?
Andy Burnham: It is very important that surgeries have a ready supply of vaccines so they continue with the programme of vaccinating priority groups. We were aware that some surgeries may be coming to the end of the vaccination of priority groups at around this time, which is why we took the decision to extend the vaccination campaign to children aged between six months and five years. I take the point the hon. Lady raises very seriously. We want to ensure continuity of supply of vaccines to all surgeries around the country. We are confident that all GP surgeries have had a supply of vaccine, but we will continue to take a close look around the country to ensure that all surgeries have enough vaccine to be able to continue vaccinating in the priority groups.
David Taylor (North-West Leicestershire) (Lab/Co-op): Having five years ago been given exclusive rights to dip its corporate snout into the private finance initiative hospital trough, Laing O'Rourke must have industrial-strength chutzpah now to sue the Secretary of State for Health for abortive costs on that collapsed project. Does that not lay to rest, once and for all, the illusion that PFI transfers risk to the private sector?
Mr. Mike O'Brien: PFI has produced a large number of hospitals and clinical facilities for the NHS; it has, in many areas, been an enormous success. What I would say is that sometimes difficulties arise and we must deal with them.
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