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Of course, transparency is an essential part of how a good national health service will work locally-being accountable to local people. Many things have been put in place to ensure that commissioners are given guidance on how to carry out good commissioning for services for carers, including respite care. Those local groups can take that guidance to their PCTs and discuss it with them and ensure that the local PCT is commissioning to the best quality practice that we can make available. A number of steps are in place. I can
give the hon. Gentleman the assurances he requires, so that the Liberal Democrat policy is as consistent as we all would like it to be.
The hon. Member for Eddisbury mentioned malnutrition. He is right. We established a working group that produced a report earlier this year. We are preparing our response to that-he will just have to wait a little longer until we can make clear how we wish to take matters forward. I agree that practical steps can happen now to deal with issues relating to malnutrition. The hon. Gentleman mentioned a couple of good examples-red trays, and so on. I have visited hospitals where picture menus are used. Asking people to look at a picture of food rather than a description of it on a menu is a practical way of getting them to choose the food they really want. When the food arrives, it matches the picture. The cooks have to ensure that it actually matches the picture that is chosen, which raises the quality of the food provided.
What will the future be of the board that was set up to write the report on malnutrition to which he is considering a response? Writing a report is one thing, but there is a need to see its recommendations implemented. Will that board be in place afterwards?
Phil Hope: The hon. Gentleman will have to wait just a little longer. I am generous in giving him answers in these debates, but on this occasion he will have to wait for my analysis of the recommendations regarding what needs to happen and how that might be pursued, so that action happens on the ground. It is not a question of our not knowing what to do; what matters is making things happen on the ground, and that is what I am bending my mind to as I take my considerations forward.
The hon. Members for Leeds, North-West and for Eddisbury mentioned cancer treatment. There is more to do here. I am pleased to say that cancer death rates across all age groups have declined over the last decade, although the decline among older people has been much less significant than for other ages, as hon. Members have mentioned in detail. That is why we have established a national cancer equality initiative to tackle all inequalities in cancer care, including improving the treatment and services offered to older people. Early next year, there will be a new practical guide on reducing inequality, including detailed analysis from the national cancer intelligence network of data by cancer type, age and geography, so we can show where our efforts need to be focused in future. We are also looking at pilots to improve the way that older people are assessed for cancer treatment, to ensure that that is always done on the basis of clinical safety and effectiveness and never on the basis of age alone.
Other questions were raised about cancer screening. Our screening programmes are well respected internationally, with high-quality services and high levels
of coverage. It is vital that we base all our screening programmes on the best international evidence. We must weigh up the effectiveness of screening certain age groups against the harm that may be caused-the possibility of false positives and false negatives-and the stress and anxiety that screening can lead to. It is not for Ministers to make any decision on the age range for screening; it is, rightly, a decision for the clinical experts. As the age equality review recommended, we will commission a programme of research into the upper age limits on breast screening.
I want to put hon. Members right on something that has been mentioned today. We are now extending our routine screening programmes for breast cancer to include women aged up to 73, and extending the programme for bowel cancer for men and women to those aged up to 75. It is important to get those facts on the record. I remind hon. Members that people beyond those age ranges can still self-refer to these screening programmes, and I strongly encourage them to do so if they have a history of cancer in the family.
The hon. Member for Sutton and Cheam began with mental health, and that is where I should like to conclude. I am grateful to hon. Members for mentioning that we have launched "New Horizons", our new national strategy for mental health. However, before I get into that, I should like to say something about the national operating framework, which the hon. Gentleman mentioned.
I am at a loss to know what the hon. Gentleman is referring to that suggests there has been some kind of change. Perhaps he and I can correspond on this issue afterwards. Mental health is explicitly mentioned a number of times in the national operating framework, and is specifically mentioned in "New Horizons". In the framework we highlight the importance of intervening earlier in mental health problems so that we get better outcomes and better value for money. There are five explicit references to mental health in "New Horizons", although I will not read them out, and two explicit references to dementia. The whole of the "New Horizons" strategy is a lifespan approach. I do not think there has been a change of the kind the hon. Gentleman mentioned. Perhaps afterwards, through correspondence, we can confirm what I know to be true: that we have not changed the priorities in the way he suggested.
Mr. Burstow: I was trying to clarify whether mental health has become a "must do" in the operating framework. I understand that it has tiers, and that there are some things that are nice to do but which are not mandatory for local NHS organisations to deliver on. Has mental health been elevated to a "must do"?
That is a different question from the one the hon. Gentleman raised in the debate. I thought he asked whether it had been downgraded in some way-[Interruption.] I understand now. With that in mind mental health services and the operating framework are not where they were before, with vital signs listed and five references made. We have moved on from the 10-year mental health service framework, which is now over-this is its last year-to "New Horizons", which went out to consultation and has now been published. That supersedes the old national service framework for mental health and will tackle the historic differences,
which hon. Members were right to highlight, in the way some older people are treated compared with working-age adults.
The new strategy will build on firm foundations. Spending is up by £2 billion over the past decade. We have two thirds more psychiatrists, a fifth more psychiatric nurses and more than 700 new community mental health teams, giving us a firm foundation and meaning that we can help people of all ages to access the services they are going to need.
For the avoidance of doubt, I have brought a copy of "New Horizons" with me. I shall mention annexe A particularly for the benefit of the hon. Member for Leeds, North-West, whom I do not think has read the detail. Annexe A is entitled,
"community mental health teams",
"Crisis Resolution and Home Treatment services, assertive outreach services, Improving Access to Psychological Therapies (IAPT) and psychological services",
and so on. All older people should have the same access to these services that we have been building up over the past few years. I hope that that gives the hon. Gentleman the assurances that he and the hon. Member for Sutton and Cheam want about older people, who feature large in the strategy and are an important part of the future of mental health services. It is not only about mental health services; it is also about preventing mental ill health in the first place, through a cross-government strategy.
Let me provide some specifics. I will be doing a lot of work over the next few years, chairing a new ministerial advisory group on mental health inequalities to lead this agenda. We will work with the Royal College of Psychiatrists and other professional bodies to help providers re-design these services and tackle some of the cultural issues that mean that older people sometimes lose out. Training programmes for general practitioners and practice nurses, for example, will be developed, helping them become more sensitive to signs of depression among older people. This may also mean longer consultations by GPs, so they have more time to check on an older person's mental well-being and on the physical health reason about which they may have attended the surgery in the first place; and strengthening the availability of services for older people living in residential care homes, as was mentioned earlier, where depression issues can be strong.
For clarification, the 18-week wait to which reference was made applies to consultant-led mental health services, so there is an element of this in the present system. I believe that there are signs that mental health services are changing for the better. We have seen some great examples of GPs, therapists, social workers and care providers working together to provide the integrated personal support that we need.
I am delighted that this debate on the last day before the House rises for the Christmas recess has provided an opportunity to air the matter of support for older
people and of tackling age discrimination in health care. It has given me the rare opportunity to spell out at length the Government's high and strong track record on such matters, which is all about quality and consistency. Age discrimination, like any form of discrimination, is unacceptable. We have taken some important steps to remove it from health and social care, but there is of course more to do. I look forward in the months and years ahead to addressing the many issues that I have set out today as we move closer to what everyone supports-a full ban on age discrimination across all services.
Dr. Ashok Kumar (Middlesbrough, South and East Cleveland) (Lab): It is a pleasure to see you presiding over this important debate, Mr. Cook. Had you not been presiding, I am sure you would have joined in the debate, as I know that this subject is close to your heart.
First, I thank Mr. Speaker for granting me this debate on what is an important subject for my area-steel is the lifeblood of our economy. Nearly a fortnight ago, Teesside was rocked by the disastrous news about the mothballing of the integrated iron and steel plants of Redcar and Lackenby. That news has destroyed the festive spirit of thousands of families across Teesside. The plants are in constituency of my hon. and learned Friend the Member for Redcar (Vera Baird), who is taking a lead on this matter and has been fighting hard. However, many of the job losses are in my constituency.
I was once one of the many thousands of people who worked at that plant. As a young graduate engineer, I worked on bringing the Redcar blast furnace-the biggest blast furnace in western Europe-online in 1978-79. I worked on that furnace for eight months, and many years later I remember my many trials and experiences with it. Therefore, I have a deep, emotional attachment to this matter.
I shall talk generally about the steel industry on Teesside, including the importance of research and development. Then I shall say a few words about the steel industry in my own constituency, in particular the Skinningrove works. Then I shall raise the big issue that I mentioned earlier-the mothballing of the integrated plants in Redcar and Lackenby.
The importance of the manufacturing industry for our economy has been underestimated. We cannot survive as a nation on an economy that seems to range from pizza parlours to DVDs or sportswear retail warehousing. Manufacturing accounted for more than 20 per cent. of the economy in 1997 when Labour came to power and criticised the country for having too narrow an industrial base. However, by 2007, that share had declined to 12.4 per cent. Why is manufacturing important? Quite simply, it acts as a multiplier across all boundaries of the economy. It encourages the development of human skills, and the development of an infrastructure to support those skills. It also encourages research and development and the spread of innovation.
I will say a few words about steelmaking on Teesside. Steelmaking has been central to our economy since the mid-Victorian age, and has evolved over the decades to the position that it is now in. The main works line the River Tees and the core of those works is found in the Teesside Cast Products iron and steelmaking complex, whose mothballing has been announced.
At Grangetown, we have a fully functioning and impressive steel technology centre. That centre has an international reputation with an outstanding pilot plan, and many brilliant metallurgists, engineers, technologists and scientists work there. I must declare an interest, as I am a former employee of the research centre, and I had 14 happy years working there. Some of the work that I undertook at the Teesside technology centre was connected with the completion of what was then the British Steel Redcar works, and the commissioning of
the new blast furnace. At that time, the furnace was considered the biggest in the UK; I seem to recall that it was the biggest in Europe.
The furnace in Redcar was a great British achievement. It was to make iron for feeding to the Lackenby basic oxygen steel plant, and the associated continuous casting plant. Both were then state-of-the-art steelmaking and processing plants and, due to regular upgrading, they are still world-class plants today. They deserve more than merely being consigned to the scrap heap of past manufacturing glories, left to be of interest only to the industrial archaeologists of the future.
Mr. David Anderson (Blaydon) (Lab): It is an honour to be here with you today, Mr. Cook, and I congratulate my hon. Friend and praise him for the great work that he and other Teesside MPs have done on this issue.
The reality is that we need to keep this plant going. If we are ever to deliver the low-carbon economy that we have promised for the north-east, and develop things such as underground gasification of coal, carbon capture and storage, and sequestration of CO2, we need to develop skills, not lose them. We should not consign them to history as has happened to so much of our industry in the north.
Greg Clark (Tunbridge Wells) (Con): I must declare an interest because members of my family work at Corus on Teesside. The Copenhagen summit is taking place as we speak, and a low-carbon future for the world is being discussed. Does the hon. Gentleman agree that there is no better place than Teesside, with the skills, industrial heritage and facilities that it has available, to lead the world in that? Is this news not a bitter blow that must be overcome so that we can use that fantastic potential on Teesside?
Dr. Kumar: I agree with every word that the hon. Gentleman has said. I hope he is saying that we have to keep the works open. If he is, I am wholeheartedly with him all the way. The sentiments he expresses are similar to those expressed by my hon. Friend the Member for Blaydon (Mr. Anderson).
In my constituency, we have the world-class Skinningrove rolling mills, which until now have concentrated on small sections for the construction machinery sector. They have recently moved into supplying sections for the wind farm industry, which is seen as a sector where exponential growth can be expected. The mills have a vigorous and dynamic management and a committed work force who want the plant to grow and prosper.
I have helped the mills over recent months by brokering an offer from the local authority, Redcar and Cleveland borough council, for business rate relief. That offer is substantial, and I hope the Minister will join me in praising the dynamic management and the work force of Skinningrove works for their hard work and commitment.
I come to the subject of Teesside Cast Products and the disastrous news about the mothballing of the integrated iron and steel plants of Redcar and Lackenby. There is also the sad news that 1,700 steelworkers might be made unemployed. Furthermore, it is estimated that 8,000 people down the supply chain will lose their livelihoods.
The autonomous complex within Corus called Teesside Cast Products was once seen as the future of steelmaking-not just in the north-east, but in the whole country. The future of Teesside Cast Products was secured by a deal with a consortium that agreed to purchase almost 80 per cent. of the plant's output until 2014. That consortium included steel traders from Korea, Mexico and Italy. However, when the demand for steel across the world dried up, the partners, led by the Italians, tore up the agreement and announced that they would not buy any more steel.
I place on the record my great praise for all the efforts made by my hon. and learned Friend the Member for Redcar to reach commercial solutions with the consortium to preserve production at Teesside Cast Products. In fact, she went to Italy to try to persuade the Italians to come back to the table. She displayed great courage.
On Teesside, all is not lost. After all, the Teesside Cast Products plant has not been closed completely and, according to Corus, will be kept in a state of total readiness for any possible restart. A full maintenance team will be kept in employment purely for such an eventuality. I need to stress the fact that bringing a blast furnace back online can be done. It was recently done at Port Talbot, after a year's shutdown. It was also done at the associated Corus plant at IJmuiden in the Netherlands.
I recognise that the Government have said that they are prepared to help Corus on Teesside, but that seems to be limited to the same recipe of cash for training and retraining. That support is important and helps those displaced by the Corus announcement to find other employment in the local labour market. Positive action in finding other industrial uses for the Redcar and Lackenby site is also welcome. That could be one of the new generation of carbon capture power stations recently given the go-ahead by Government, or used for other low-carbon applications. However, I still believe that that is not enough.
Ms Dari Taylor (Stockton, South) (Lab): I am delighted that my hon. Friend has secured the debate; I am only sad that it lasts just 30 minutes. References have been made, and he is now making them, to the amounts of money that we require to ensure that we keep steel making on the Tees. Reference has also been made to the European globalisation adjustment fund, which we could tap into. That is a seriously large sum of money. In his opinion, will that be the next step that we take to ensure that we retain and maintain steel making on the Tees?
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