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Angela Browning (Tiverton and Honiton) (Con): Can the Minister confirm that the strategy will incorporate all the recommendations of the National Audit Office report on autism, as promised to the Public Accounts Committee by the Minister's Department and the Department for Work and Pensions?
Phil Hope: The hon. Lady, along with many other Members, played a crucial role in helping to develop the Autism Bill and the autism strategy, so I would like to place on record my thanks to her and other hon. Members. I know that the hon. Member for Chesham and Amersham (Mrs. Gillan) is not in her place, but she was also critical to that process.
We have had a number of discussions about the content of the strategy. The hon. Lady will have to wait until it comes out before I can say what it is, but we have certainly been mindful and supportive of many of the NAO recommendations. The NAO was helpful in highlighting areas to be included in the strategy. If the hon. Lady can wait just a few more days, she will see that we have developed a thoroughgoing response to its concerns.
Derek Twigg (Halton) (Lab): A number of representations have been made to me by the support group in Halton and by parents of autistic children about whether the tribunals that hear the appeals on special needs and the education provision for their children are knowledgeable enough about the needs of children with autism. Within the strategy, will it look to ensure that the people who sit on those tribunals have the knowledge and background to be able to take fair and equitable decisions?
Phil Hope: I just want to emphasise that the strategy is one for adults with autism, although I appreciate that my hon. Friend's question was about the needs of children, statements made to the tribunals and so forth. However, the strategy will address issues connected with transition, when young people move from childhood into adulthood. My hon. Friend raises a key general issue-the training and awareness of professionals whether it is those sitting on tribunals, GPs or others in the system. We are very aware of that, so a key part of the strategy for adults with autism will be to raise general awareness, so that their needs are not overlooked in the years to come.
Sandra Gidley (Romsey) (LD): The consultation document set out five main themes, but I understand that the draft strategy deals only with two of them and repeatedly refers to existing workstreams that could be broadened-an approach that has failed before. The external reference group, which was disbanded in January, responded collectively, raising concerns about that approach, so why did the Government refuse to engage with that important group of stakeholders at such a key stage in the process?
The autism strategy, Mr. Speaker, has been developed in what I see as a co-production; we have worked jointly with a range of organisations, including the external reference group. I recently met the chair of that group
to go through key features of the strategy. The external reference group saw the early draft of the strategy, but it has changed quite significantly since then, taking on board many of its concerns. Frustratingly, I repeat that I cannot say any more about it at this stage, as we will publish the strategy in a few days' time. I am absolutely convinced, however, that the external reference group and Members across the Chamber will be pleased at the progress we are making in what amounts to a landmark strategy for this country.
The Minister of State, Department of Health (Mr. Mike O'Brien): According to the East of England Strategic Health Authority, no NHS hospital trusts in the region are currently forecasting a year-end deficit for 2009-10. The overall forecast surplus for the East of England SHA remains at £167 million, but one primary care trust-the Peterborough PCT-is forecasting a year-end deficit.
Alistair Burt: It is about this time of year in previous years that PCTs in financial difficulties have tended to go to their local hospitals to say that they have been overpaid or that there has been over-performance; they demand money back, thus precipitating a sudden unexpected deficit or financial crisis. Can the Minister assure me that no PCT or hospital trust in the east of England is involved in that sort of negotiation and that by the end of the year there will be no such sudden unexpected financial problems?
Mr. O'Brien: I understand that East of England SHA supports Bedford Hospital NHS Trust and Bedfordshire PCT by providing mediation on a number of issues affecting the contract between the two parties. The most significant mediation in respect of payment for out-patient services concerned a payment of £2.5 million to the trust. Such issues do arise, but they are usually resolved by mediation.
Mr. Kevin Barron (Rother Valley) (Lab): That is a great improvement. When the Health Committee produced a report on NHS deficits in 2006, the east of England was one of the four areas in the greatest difficulty, but the money that the Government have put into the national health service has made it possible to smooth out the problems in the area.
Mr. O'Brien: As Chairman of the Select Committee on Health, my right hon. Friend knows a great deal about this subject. There has indeed been an impressive turnaround in financial performance in recent years, culminating in the achievement of a £40 million total surplus by acute NHS trusts in the east of England in 2008-09. The fact that the present Government have invested extra money, rather than cutting money like the last Conservative Government, shows that we are delivering where they failed to deliver.
Norman Lamb (North Norfolk) (LD): Given increasing concern about the potential for deficits in hospital trusts and PCTs in the east of England and elsewhere, what reassurance can the Minister give about the Government's commitment to implementation of the national programme of screening for abdominal aortic aneurysms, which have killed 30,000 men since 2002? I have been told by a vascular surgeon that the financial situation in Norfolk has effectively blocked the introduction of a screening programme there, and that similar circumstances exist elsewhere. Delay will kill more men. What commitment will the Government give to ensuring that screening takes place for men over the age of 65?
Mr. O'Brien: That is a good question. We want to ensure that we deal with screening issues as effectively as possible. The chief medical officer has been considering some of the issues, and I shall have a word with him and report to the hon. Gentleman on his conclusions.
The Minister of State, Department of Health (Mr. Mike O'Brien): In line with the national improving outcomes guidance, upper gastro-intestinal cancer surgery was moved from Royal Devon and Exeter and Royal Cornwall hospitals and centralised at Plymouth's Derriford hospital on 1 January 2010. All pre and post-operative care for patients will continue to be provided locally.
Mr. Swire: That is as may be, but a constituent of mine says that having volunteered for a trial of a procedure intended to prevent post-operative complications when he was at Royal Devon and Exeter hospital in October 2009, before the move, he has been told that as a result of the move the trial has been cancelled. Can the Minister clarify the position in regard to research and trials in upper gastro-intestinal surgery since the move?
Mr. O'Brien: Some consultants who are carrying out trials involving particular kinds of surgery are reviewing the procedures that they use, and are currently discussing with colleagues how the operations can best be carried out in future. The issues are being examined by the clinicians involved.
The Secretary of State for Health (Andy Burnham): As of Friday, the total amount of swine flu vaccine delivered to the UK from Baxter and GSK is approximately 38 million doses. Because contractual negotiations with GlaxoSmithKline are in progress and because of commercial confidentiality clauses in the contract, it is not possible to give a final figure on spend at this stage, but I will update the House in due course.
John Hemming: There were a number of odd developments during the swine flu pandemic-not least the fact that very little effort was put into stopping people coming into the country with swine flu, and the fact that people who had it were prevented from leaving. Is the Secretary of State willing to place in the Library the advice received by the Department that justified their decisions on swine flu, in connection with the vaccine in particular but in connection with other issues as well?
Andy Burnham: I will publish all the advice in due course so that the hon. Gentleman can see why those decisions were made. However, I ask him to cast his mind back to last summer in Birmingham, when there was a considerable increase in the number of cases over a very short period. That was a difficult situation. He must also not forget that there have been 309 deaths from swine flu in England, and that there are still people suffering from it in hospital today.
I believe that we took the right action. We made preparations, and we got the country through safely. We minimised the amount of disease and suffering as best we could. We will now learn the lessons of the decisions that were made, but I believe that we made the right decisions at the right time.
Mr. Brian Jenkins (Tamworth) (Lab): Does my right hon. Friend agree with many in this House that "You're damned if you do, and you're damned if you don't," and that we must always err on the side of the safety-first approach of making sure we have sufficient vaccine, if we can possibly procure it, for our citizens to keep them safe?
Andy Burnham: I am grateful to my hon. Friend for his question. Many people are being very wise after the event, but last April the situation appeared to everybody to be very different; we had a new virus spreading on a worldwide basis, and we had little information about it-about how quickly it would spread and its severity. In such circumstances, the only prudent course of action is to plan with safety first in mind, of course, but I am sure that when we reflect on these events, we will realise that there are things we might look at again, and ways we might further improve our pandemic planning in advance of any possible future pandemic. However, I think that, overall, the right decisions were taken, and that the NHS coped very well with a difficult situation.
Mr. Andrew Lansley (South Cambridgeshire) (Con): Can the Secretary of State explain why there was a break clause in the contract with Baxter Healthcare, but there was no equivalent break clause in the contract with GlaxoSmithKline?
As the hon. Gentleman knows, as part of our planning we had entered into advance purchase agreements so that the UK was able to get swift access to the vaccine in the event of a pandemic. This was a good part of our preparations, and it put us at the very front of the queue internationally for swine flu vaccine. At the time, I do not remember anybody saying that that was the wrong thing to do. There were different arrangements with Baxter and GSK, which then led to different contracts. I am sure the hon. Gentleman would not expect me to go into all the
details of those contracts on the Floor of the House, but I can assure him that at all times we have sought to get maximum value for money for the public while also protecting the public. We are still in negotiations with GSK, and once they are concluded we will be able to come back to the hon. Gentleman and give him a full report.
Mr. Lansley: I am grateful to the Secretary of State, and, indeed, he knows that we called in this House for the establishment of advance purchase contracts for the vaccine and supported the action in implementing that, but we did so on the basis that break clauses would be included in the contracts. The Secretary of State also knows that last summer the question whether there would be a population-wide vaccination programme should have determined whether we were going to procure all the 90 million doses or a smaller amount. With Baxter, we could put in a break clause; with GSK, we could not. That is a fundamental difference between those contracts. Can the Secretary of State explain why there was no such provision in the contract with GSK?
Andy Burnham: The hon. Gentleman is right to say there was a difference between the two contracts. However, the overriding objective that my predecessor had to achieve was to secure enough vaccines to cover the whole population, and that meant having two doses for the population because that was the advice at the time. The hon. Gentleman must now accept that securing that vaccine was the overriding priority and that a contract had to be put in place to secure vaccines on that scale. Of course there are further discussions to be had with GSK to ensure maximum value for the taxpayer, and the hon. Gentleman would expect me to be pursuing those discussions, and we are. However, the first priority was to get enough vaccine to cover the whole population, and, of course, any commercial company needs sufficient security if they are to sign a contract of that kind.
Mr. Lansley: The Secretary of State has still not explained why what was okay with Baxter Healthcare for 30 million doses was not okay with GSK for 60 million doses. Ministers have today announced in a written ministerial statement that they are transferring £200 million from the Department of Health's capital budget to its revenue budget to meet the costs of the commitment on pandemic flu, of which the procurement of this vaccine will be a major part. The Secretary of State says he has 38 million doses; we have used 5 million. What will be the total cost of the procurement of these vaccines, and what capital projects will be cut back now in the NHS to pay for that?
Andy Burnham: May I gently caution the hon. Gentleman about being wise after the event? In proceeding on this, we communicated with him at all times. We explained the actions we were taking, and we took those actions in good faith at all times. May I also remind him that although we have secured a surplus, the H1N1 strain is likely to replace seasonal flu as the main strain this year?
We will continue to have a need for this vaccine, so we will announce in due course the arrangements that we are putting in place to ensure that we have sufficient stock. He will know that the chief medical officer's advice to the at-risk groups is that they continue to
accept vaccination because, although the second wave has ended, there could be a third wave later in the year. For all those reasons, we will proceed with caution. However, when we have concluded the negotiations with GSK we will set out exactly what we have done, so that the House can see the decisions we took and why we took them.
10. Mr. Peter Bone (Wellingborough) (Con): How much money his Department recovered from other EU member states for treatment of their citizens in the UK in the latest period for which figures are available. 
The Minister of State, Department of Health (Gillian Merron): In 2008-09, the UK received slightly more than £33 million from other member states. Given the nature of the process, payments are frequently made several years in arrears, so that figure does not represent the cost of health care, nor claims made in any one year.
Mr. Bone: I thank the Minister for that answer, but it is extraordinary: we pay our European Union colleagues more than £630 million each year for treatment provided to British citizens abroad, yet-I think she said this-we claim back only about £30 million for treatment provided to EU citizens in this country. Why?
Gillian Merron: The question I answered did not relate to moneys claimed, and perhaps it would be helpful if I were to explain further. The figures are not directly comparable because, for example, about 171,000 pensioners who are UK citizens live in Spain, France and Ireland-it is right that we are responsible for their health care-whereas only 5,000 registered pensioners from member countries live in the UK. I can assure the hon. Gentleman that the average payment per UK citizen who lives abroad is about £3,225 whereas the amount we claim per citizen from other member states is about £3,369.
Mr. Denis MacShane (Rotherham) (Lab): Is it not a fact that many more British citizens live in EU member states than Europeans live here, and that they tend to be older and not at work, whereas the younger European citizens are working here? Thus, it ill behoves the Conservative party, despite its loathing for Europe, to bring this up with a xenophobic tone such as we have heard from those on the Conservative Benches.
Gillian Merron: It is true that we have responsibility for about 220,000 UK citizens who choose to live in other EU member states. The House might be interested to learn that from May new EU regulations will come into force that will speed up the reimbursement and claims process. That will be of benefit to all member states.
Mark Simmonds (Boston and Skegness) (Con):
I must press the Minister further on her response to my hon. Friend the Member for Wellingborough (Mr. Bone). Despite considerable immigration into the UK in the past decade or so and according to Government figures, the amount that the UK is claiming against EU member states is less than 10 per cent. of the net UK payment to
member states. Is she confident that these figures are comprehensive and complete? Could she explain why the Government are failing to reclaim 20 per cent. of the taxpayer's money owed by these countries?
Accounts are resource based, and if we look at those accounts-they are being referred to-we find that they do include money or claims yet to be received. I hope that the House will also be interested to learn that we have recently negotiated a deal with the Irish Government to reduce the UK liability by some €87 million over three years, and we will be reviewing our agreement in order to provide further savings. I hope that the House will welcome that progress.
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