The Parliamentary Under-Secretary of State for Health (Ann Keen): As of September 2008, there were 143 qualified midwives at the Kettering general hospital foundation trust and 161 qualified midwives at the Northampton general hospital NHS trust. It is, of course, the responsibility of trusts locally to ensure that appropriate midwifery services are provided. There are more than 25,600 midwives in the NHS. Trusts met the Government's commitment to recruit an additional 1,000 midwives a year early and are on target to recruit 4,000 extra midwives by 2012.
Mr. Hollobone: There is a shortage of seven midwives at Kettering general hospital, which is actually very good compared with the shortage nationally. However, the real problem is the shortage of band 6 midwives-the more experienced midwives. As a result of the shortage, newly qualified trainees entering the system are not undergoing the preceptorship that they are meant to receive. What will the Minister do to address that problem?
Ann Keen: The hon. Gentleman asks a very important question. At the same time as recruiting and retaining midwives, we are also looking at how we can retain experienced midwives by offering a more flexible approach to work and through working in teams. That is the way forward, and I am pleased to say that the vacancies at Kettering should be filled-I am led to believe that 12 candidates are now ready to be interviewed for the remaining six positions. We are also working closely with the Royal College of Midwives on the preceptorship.
Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab):
Maternity services in Milton Keynes are currently being monitored by the Care Quality Commission following a second damning coroner's report on a neonatal death in Milton Keynes. There seems to be a particular problem with recruiting midwives. Can the Minister point Milton
Keynes to good practice elsewhere, to enable it to be more effective at recruiting the midwives for whom it does have funding?
Ann Keen: My hon. Friend points out that the funding for the posts exists. In fact, nationally there has been a 38 per cent. increase in the number of student midwives, so we are hopeful that we will reach our target. However, I would ask her to work with the trust and the Royal College of Midwives, and I would be happy to meet her and explain in more detail our programme of events for retaining midwives.
Anne Milton (Guildford) (Con): The Minister has not really explained where the extra 4,000 midwives will come from. The Government's own projections show that there will be an increase of only 1,000, but a 2009 memorandum on public expenditure states that between 2008 and 2012 an extra 1,500 will graduate each year. Yet the same memorandum projects about 1,800 new graduates a year. On my reckoning, that leaves us 3,000 short. Perhaps she can explain exactly where those 3,000 will come from.
Ann Keen: I am glad to explain that to the hon. Lady. As mentioned in previous answers, we have been working most successfully with the Royal College of Midwives on a recruitment returners project. Actually, we are led to believe that a 38 per cent. increase in the number of students will deliver the target of an extra 4,000 midwives by 2012, and we are on schedule to achieve that. The extra money that has gone into midwifery has proved to be very successful, and of course we have made maternity services a priority, which is reflected in the latest NHS operating framework.
Ms Sally Keeble (Northampton, North) (Lab): Is my hon. Friend aware that in Northampton there has been a particular increase in the number of babies born with special needs and that case conferences are needed because of child protection issues? Will she recognise that that is putting pressure on maternity services and will she support the primary care trust in looking into the reasons for that and in providing the support for the care needed for those babies with complex needs?
Ann Keen: My hon. Friend asks about neonatal intensive care and the care of high-dependency babies. In the latter part of last year, we issued a new toolkit to enable PCTs to manage staff and situations better. Again, this is about retaining staff in a highly stressful area.
The Secretary of State for Health (Andy Burnham): The Government decided to end their bilateral health care agreement with the Isle of Man on 31 March 2010, because it no longer represents value for money. Tourists will continue to receive free accident and emergency treatment but will now be expected to have insurance to cover the cost of further treatment.
Sir Nicholas Winterton: I am obviously grateful to the Secretary of State for that factual response. However, clearly he will be aware that the Isle of Man is a Crown dependency, that the reciprocal health care agreement has been in place since 1948 and that the Government's decision to end it at the end of next month was an arbitrary one without consultation. Has he given any thought to the impact on hospitals in the north-west of England, which could be affected by the decision, and to the position, in particular, of elderly people who go in their retirement to the Isle of Man and will be placed in financial difficulty when it comes to their health care?
Andy Burnham: I am aware that we are talking about a long-standing agreement, but I hope that the hon. Gentleman would accept that it relates to a different time, when lots of people from the north-west travelled to the Isle of Man for their holidays. The numbers travelling now are around half what they were in the '40s, '50s and '60s of the last century, so there is no longer any basis for the agreement as it stood. I am sure that he would agree that, right now, I have to look at securing the maximum value for money from every piece of Government expenditure. However, I hear the concern that has been expressed by those in all parts of the House, so I will keep the matter under close review, as I said to the Chief Minister of the Isle of Man when I met him on 19 January.
Jane Kennedy (Liverpool, Wavertree) (Lab): Does my right hon. Friend agree that the success or otherwise of the reciprocal health care agreement with the Isle of Man has depended on the excellence of the hospital care available, particularly in Liverpool? Will he undertake to do everything in his power to advance the building projects at the Royal Liverpool University hospital and Alder Hey in particular, as there is some anxiety about whether we will see decisions on either in the near future?
Andy Burnham: I am certainly aware of the long historical ties between the Isle of Man and Merseyside, given my roots. I also congratulate my right hon. Friend on the ingenuity of her question, in mentioning the Royal Liverpool. There is a flow of patients from the Isle of Man to this country and vice versa, and we hope that that will continue. The Royal Liverpool is a crucial project of great significance for health care and the economy in Merseyside and the north-west. I would like to make progress on it shortly, but I am not in a position to make an announcement today.
3. James Duddridge (Rochford and Southend, East) (Con): What discussions he has had with the Minister for the Olympics on the preparedness of NHS London for the London 2012 Olympics; and if he will make a statement. 
The Minister of State, Department of Health (Mr. Mike O'Brien): The Department of Health has been working jointly with NHS London, the London Organising Committee of the Olympic Games and Paralympic Games-LOCOG, as I understand it is known-and the Government Olympic Executive to ensure that the NHS will be fully prepared for the 2012 games.
"additional funding was not going to be forthcoming to support the commitment to offer free healthcare for those participating in the 2012 Olympics,"
"concerns about how to resolve the cost and resource implications without diverting funding from services for Londoners"?
Mr. O'Brien: Fairly easily. The Department of Health has provided NHS London with an extra £1.5 million for this financial year, which it has confirmed meets its current requirements. The Department is also in discussions with NHS London authorities on the provision of further funding, and we are going through some figures that they have provided us with. At the moment they look to be figures for a worst-case scenario, but we want to go through the detail and examine what is needed. However, we are certainly clear that the health needs of Londoners will not be compromised and that the health needs of visitors will be met.
Mike Penning (Hemel Hempstead) (Con): But the figure of £1.5 million that the Minister just cited is well short of the £30 million that is the estimated cost to London of putting on the games. Will the Minister publish the information that NHS London has given him, as well as the understanding reached when the games were bid for, about how much they would cost Londoners through the NHS?
Mr. O'Brien: First, the figure that the hon. Gentleman gave is contrary to some of the figures that have been circulated recently, which have actually been larger. NHS London has put forward a figure of £41 million, as a cost spread over four years. That is based on planning assumptions that appear to be based on a worst-case scenario, and were made last summer. We know that there is a good deal more planning work to do, to ensure that we estimate the cost much more carefully and get the figures right, and that we must work with NHS London so that our health care needs are delivered.
4. Mr. Oliver Heald (North-East Hertfordshire) (Con): What his most recent assessment is of the adequacy of provision of intermediate care in (a) north-east Hertfordshire and (b) England; and if he will make a statement. 
The Minister of State, Department of Health (Phil Hope): In 2009, as part of the prevention package for older people, the Department issued revised intermediate care guidance, entitled "Halfway Home", which strengthens the original 2001 guidance. It is for local NHS and social care commissioners to determine the range of services needed to avoid unnecessary hospital admission, help with timely discharge and prevent premature admission to long-term residential care.
I thank the Minister for his reply, but can it be right for the PCT review in north-east Hertfordshire, where we have relatively few intermediate care beds and where home services are relatively undeveloped, to be looking at possibly removing places from Royston
hospital-that is, care bed places that are used currently-and if so, what is the future for all the people using those facilities?
Phil Hope: I understand that a review of intermediate care is being carried out by the hon. Gentleman's primary care trust and the county council. The Friends of Royston hospital and local councillors have been invited to a workshop in March, and the PCT will, subject to various approvals, begin formal engagement with stakeholders about the future of intermediate care in May or June this year. I hope that the hon. Gentleman will take every opportunity, as one of the local Members of Parliament, to make a contribution and give his support to the development of more intermediate care. He might be interested to know that the number of beds has doubled over the past 10 years, and that three times as many people are now benefiting from intermediate care. I hope that that is also true of his own area.
Mr. Parmjit Dhanda (Gloucester) (Lab): It sounds as though some of the changes to the hospital trust in north-east Hertfordshire are similar to those taking place at the Gloucester Royal hospital in my constituency, where four hospital wards are to be closed by 1 April, according to the chief executive of the hospital trust. This significant change is happening without any prior consultation with MPs or those in the local health community agencies. Will my hon. Friend urge the local hospital trust and its chief executive to consult before making such major changes?
Phil Hope: Of course it is very important that local people-not least my hon. Friend, as the local Member of Parliament-have a chance to make their voices heard in regard to such changes. I urge all primary care trusts and local authorities to look at the guidance that we have issued on intermediate care. It talks about more flexibility in relation to the length of time people can get such care, as well as the need to ensure that people with dementia can have access to it, and the need to include reablement services, which are a critical part of the success of intermediate care. I hope that those messages will go out not only to my hon. Friend's hospital but to every hospital across the country.
The Minister of State, Department of Health (Gillian Merron): We received more than 6,000 responses to the consultation on the regulation of acupuncture, herbal medicine and traditional Chinese medicine. Ministers will receive a report on the analysis next month.
David Tredinnick: I am grateful to the hon. Lady; I understand that she has put in quite a lot of work on this. Given the rejection of the Booth case, which related to mis-prescribing, at the Old Bailey last week, is it not important to bring in this time frame? Secondly, is it not a fact that, in this time of economic difficulty, many Chinese practitioners are desperately seeking statutory regulation to give them a stamp of authority?
Gillian Merron: I understand very well the points that the hon. Gentleman makes. Indeed, the case to which he referred is deeply tragic. I accept that products can be damaging, which is why we are keen to take action. The importance of the consultation is obvious to me. It asks whether we should regulate and, if so, how. I am sure that he will join me in paying tribute to Professor Mike Pitillo-who, sadly, died recently-for the major contribution that he has made to this important area of work.
Alan Simpson (Nottingham, South) (Lab): I congratulate the officials in the Department on their work on this matter, but does not the Susan Wu case add a sense of urgency to the need for us to grasp the nettle in regard to regulation in a sector in which the practitioners themselves are pushing for a regulatory framework to set standards within which they can operate securely?
Gillian Merron: I understand the sense of urgency that my hon. Friend conveys, but regulation needs to be balanced and proportionate, which is why the consultation is so important. We have to look at public safety, choice and access, but we also need to consider whether regulation is justified, and, if so, what type. We will make a decision as quickly as possible, as soon as the analysis has been received.
The Minister of State, Department of Health (Phil Hope): We have held a wide-ranging consultation to develop the national strategy for adults with autism, which has included contributions from an external reference group, adults with autism, service users, family members, staff and many third sector organisations. We have received more than 1,000 responses, and the work is progressing well. I am pleased to say that the strategy will be published in the first week of March 2010-that is, in just a few weeks' time.
Meg Munn: I welcome my hon. Friend's answer, and the fact that the strategy will be published shortly. Will it specifically encourage the development of local specialist teams such as the Sheffield Asperger's syndrome service, which is doing excellent work in diagnosis and the provision of support? He will be aware that the National Audit Office has identified such local specialist teams as providing particular value for money.
Phil Hope: My hon. Friend is right to emphasise the value of specialist teams such as the one that she described. The strategy for adults with autism will include services for those with Asperger's. It will cover adults across the complete spectrum, as we discussed at the reception that you hosted recently, Mr. Speaker, at which many Members were present. I cannot pre-empt what the strategy will say when we publish it, but we have heard many strong arguments for specialist teams, particularly in relation to diagnosis. There is not just one model-my hon. Friend the Member for Sheffield, Heeley (Meg Munn) cited one in Sheffield, but there are others around the country. I would certainly like to encourage those developments, while also enabling local flexibility so that variations can suit local circumstances.
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