The Parliamentary Under-Secretary of State for Health (Ann Keen): Between 1 April 2008 and 31 March 2009, there were 54,758 reported physical assaults against NHS staff in England. That figure is for all reported assaults and includes any linked to NHS employment including those that occurred while staff were off duty.
Ann Keen: Any violence against NHS staff is totally unacceptable. The NHS constitution pledges a safe working environment, free from violence, for staff. Historically, we worked in a culture in which we were not encouraged to report violence. We are pleased that our culture is now much more open, and that staff are now encouraged to report such incidents. Training is a matter for individual trusts, and training is given. That is important, but we also need to send a clear message to anyone who tries to assault our staff that we will seek to prosecute them. From April, we shall record the figures in such a way as to give the trusts access to them more quickly and more easily, so that we can monitor the trusts and assist in any training that is required.
Mr. Lindsay Hoyle (Chorley) (Lab):
Of course, anything that can be done, and any way of improving the collecting of information, is important. The reality is, however, that it is totally unacceptable for the hard-working staff of the NHS to have to suffer attacks. What can we do to
protect them, and what more can we put in place in the form of people and security measures? We should not tolerate this situation; we should be doing more about it. I look forward to my hon. Friend's answer.
Ann Keen: Absolutely; I totally agree with my hon. Friend. Each trust and primary care trust has responsibility as an employer for its employees, and different areas of work will require different measures. Security guards are employed in some areas, and police officers have a function in hospitals. We have also introduced new powers to remove from hospital premises anyone-including those who have accompanied patients-who is causing a nuisance or disturbance and diverting staff from carrying out their duties. This new offence could lead to a fine of up to £1,000. We want to give the strongest message that our NHS staff must be protected at all times.
Mike Penning (Hemel Hempstead) (Con): The whole House will agree that any assault on NHS staff is abhorrent, and that the full force of the law should come down on the perpetrators. The fact that 54,000-plus assaults on staff took place in 2008-09 is fundamentally wrong. However, the Minister's warm words about prosecution fall flat when we consider that only 1.3 per cent. of assaults on NHS staff result in any form of criminal sanctions. Why are so many people getting away with assaulting our NHS staff? Why is the full force of the law not coming down on them?
Ann Keen: The hon. Gentleman is right to show his concern, but it is not for us to prosecute such cases; it is a matter for the Crown Prosecution Service. We do everything in our power to encourage such prosecutions to be brought, however-for example, we do everything we can to encourage evidence to be produced. We also want to prevent such assaults, and train people to prevent them.
The Minister of State, Department of Health (Mr. Mike O'Brien): In November, the Government and medicines supply chain stakeholders published joint guidance to manufacturers and wholesalers on their existing legal responsibilities. On 2 March, the Government hosted a summit at which we agreed a further package of actions to ensure that patients continue to get the medicines that they need.
Mr. O'Brien: Research and development money is only part of the issue. The key issue is that patients are sometimes not getting the medicines that they need. That is what parallel exporting is all about; it is not so much about the research and development that takes place in a number of centres. When patients go to the chemist, they want to know that the medicines they need will be there.
Mark Simmonds (Boston and Skegness) (Con): I acknowledge that this is a complex issue, and that it has been exacerbated by the weak pound and the Government's renegotiation of the prescription pricing regulation scheme. However, parallel exporting has resulted in a shortage of nearly 50 medicines in the UK, including those needed for the treatment of cancer and transplant patients. The issue first arose in 2008, and the number of export licences has grown exponentially since then. Why has it taken the Government so long to begin to address this serious issue, and why does the Minister not insist that patients must come first and introduce tighter controls on access to medicine export licences?
Mr. O'Brien: It is certainly the case that we dealt with this issue during the course of last year and we also published the guidance, to which I have referred, in the same period. Furthermore, at the summit we held with stakeholders at the start of this month, a package of proposals was agreed, including a more explicit duty on manufacturers and wholesalers to provide medicine to NHS patients, target inspections by the Medicines and Healthcare products Regulatory Authority, tougher standards for licensing medical wholesalers and best practice guidance on how to deal with supply difficulties. We need to consult on some of those issues. Those consultations are already taking place; indeed, there are meetings going on today.
The Secretary of State for Health (Andy Burnham): Almost all NHS trusts are delivering the national guarantee for women to have a choice about place of birth as set out in "Maternity Matters". This supports our aim to give all mothers easy access to supportive, high-quality maternity services, designed around their individual needs, their families and those of their baby.
Hazel Blears: I thank my right hon. Friend for that reply. He will know from his recent visit to Salford that mums such as Lisa Kean and fabulous midwives such as Heather Rawlinson and Sarah Davies have been campaigning with me to make sure that there is a midwife-led maternity unit in Salford, so that the next generation of Salfordians can continue to be born in the city. Will my right hon. Friend give this unit his full support so that we have a real facility rather than the smoke and mirrors of "maternity networks", whatever they might be, which are currently on offer from the Opposition?
Andy Burnham: I spent a very enjoyable and interesting afternoon with a group of Salford mums recently and I would recommend it to anyone, as I learned a great deal. I know that they are giving their support to the formidable campaign that my right hon. Friend has led to establish a midwife-led unit in Salford. I know that NHS Salford has recently given support in principle for that scheme, but it will consider the full business case later this year.
Does the Secretary of State accept that a safe, successful and enjoyable birth is what every woman craves? Does he further accept that midwives are absolutely critical to the care given to a pregnant woman, not just before pregnancy, but during delivery and post-natally? Will he ensure that there are sufficient midwives to provide that quality of service?
Andy Burnham: I thank the hon. Gentleman for his question and I pay tribute to him in his honorary role with the Royal College of Midwives. I agree wholeheartedly with the way in which he has presented his question. It is crucial to give mothers the best possible support during childbirth. Eighty-nine per cent. of women say that the care they receive during pregnancy and childbirth is good quality, but there is more to do to ensure that that 89 per cent. becomes higher. We are recruiting more midwives. We have had 4,000 more since 1997; we need to recruit more to ensure that this one-to-one support is there. I pay tribute to the hon. Gentleman for the work that he has done.
Mr. David Crausby (Bolton, North-East) (Lab): The £20 million investment available for the new super-maternity centre in the Royal Bolton hospital is very welcome indeed, but is it not threatened by those who support proposals to abandon the Making it Better scheme that covers Greater Manchester?
Andy Burnham: My constituents will also benefit from that investment to the Bolton Royal, which is much welcomed. I am disappointed that candidates are going around Greater Manchester undermining the clinically-led process that we went through with Making it Better. We took difficult decisions because we wanted to improve the safety of services for mothers and children. These candidates cannot have it both ways: they say that they will save maternity units elsewhere in Greater Manchester, yet by attacking the scheme, they undermine the investment going into my hon. Friend's constituency.
Norman Lamb (North Norfolk) (LD): The Government have made repeated commitments about choice for all women in childbirth. Jenny and Hadleigh Farrer of Norwich, however, who specifically wanted a home birth were told when Jenny went into labour that no midwives were available between 10 pm and 8 am the following morning. She gave birth at home without a midwife in attendance. Does not this case and many others expose the sad reality, confirmed by the Royal College of Midwives, that there are not enough midwives to deliver either a safe birth or choice for women in childbirth?
I am not aware of the precise details of the case raised by the hon. Gentleman, but if he will write to me I shall be happy to look into it. I can tell him that 99 per cent. of primary care trusts offer home birth as a core part of their offer to mothers-to-be, although
the arrangements may vary according to the circumstances obtaining on any particular day and the levels of clinical risk that may be involved in any pregnancy. I want to go even further and enshrine in the NHS constitution a guarantee that all mothers-to-be can give birth in a place of their choosing.
The Secretary of State for Health (Andy Burnham): I am grateful to my hon. Friend for the interest that he has taken in this important subject. I can tell him that I am minded to appoint a national clinical director, but I am seeking the advice of the National Quality Board, which is currently focusing on the subject of musculoskeletal diseases.
Graham Stringer: I am delighted by my right hon. Friend's positive response, but will he tell us how quickly he expects to receive that advice, and what the schedule will be for the appointment of a clinical director?
Andy Burnham: It may be difficult to do in a matter of days, but I wanted to give my hon. Friend a clear commitment. I pay tribute to the work that he has done in raising awareness of the cost to our economy of failure to provide early treatment and diagnosis of musculoskeletal problems, particularly rheumatoid arthritis. Those who suffer from that condition take an average of 40 days' sick leave a year.
I appreciate my hon. Friend's push to ensure that the NHS does a better job in focusing on such conditions. As I have said, I am minded to appoint a clinical director, and I am grateful to my hon. Friend for the campaign that he has led.
David Tredinnick (Bosworth) (Con): The Secretary of State will be aware that some musculoskeletal conditions can be relieved through the use of herbal medicine and acupuncture. Is he aware that Hydes herbal clinic in Leicester has written to me again, wondering why the Government have not responded to the consultation on the statutory regulation of herbal medicine? Will they do so next week, in the last gasp of their tenure?
Andy Burnham: It is fitting that the hon. Gentleman should make us think about complementary therapies during our last session of health questions. I believe that he was once described as the hon. Member for Holland and Barrett, but his interests are far broader than that: he really represents the whole field of complementary and alternative therapies. I should like to say more about the matter that he has raised before the end of the current Parliament.
Miss Anne Begg (Aberdeen, South) (Lab): I am particularly delighted to hear the news that there is to be a clinical director-does that mean that he will be a bones tsar?-because I am aware of the cost to the economy of people who are out of work because of musculoskeletal problems. The number of people receiving incapacity benefit and the new employment support allowance has proved resistant to reduction simply because there is not enough focus on returning people with such problems to work and getting them moving.
Andy Burnham: My hon. Friend is right. That is why we asked Dame Carol Black to conduct a review. She published "Working for a healthier tomorrow", which proposed initiatives such as the "fit note" to help us to encourage people to return to work as soon as possible. Dame Carol's work also led to our fit for work service pilots.
This is a crucial issue for the country. There are 26,000 new cases of rheumatoid arthritis every year, and 690,000 people in the United Kingdom are believed to be living with the condition. If it is not detected and treated early, the damage to the joints can lead to severe disability and restrict people's ability to work in the long term. My hon. Friend is right to say that we should focus on the issue, as is my hon. Friend the Member for Manchester, Blackley (Graham Stringer). That is why I am minded to appoint a national clinical director.
5. Mr. Simon Burns (West Chelmsford) (Con): How many times patients have waited longer than 18 weeks for the start of treatment in the Mid Essex Hospital Trust area in the last 18 months; and how many patients were so affected. 
The Minister of State, Department of Health (Mr. Mike O'Brien): Mid Essex Hospital Services NHS Trust has met the 18 weeks standard in every month since August 2008. The standard allows patients to choose to wait longer, or alternatively to wait longer when that is clinically appropriate. It is reported that 5,649 patients at the trust have waited more than 18 weeks.
Mr. Burns: I thank the Minister for that answer, but I would be grateful if he would check it with those who briefed him, because I think he will find that the situation is not 100 per cent. as he has just said; I have reason to believe there have been breaches of the 18-week waiting time for those who wanted to be treated within that period but could not be. Will the Minister look into that and write to me, making a correction if necessary?
Mr. O'Brien: I will certainly write to the hon. Gentleman, but may I just say to him that there are issues in relation to some orthopaedic patients and, I think, three patients in urology and one in neurosurgery, but they are quite complex issues involving staffing levels? Nothing I have said to him contradicts that, but if he wishes me to write to him, I will be very happy to do so.
The Minister of State, Department of Health (Phil Hope): We attach great importance to improving end-of-life care. We know that most people would prefer to be cared for in their own homes, which is why in the next Parliament we will bring forward proposals on a right for people to choose to die at home if they wish. In the end-of-life care strategy, we made a commitment to monitor the £286 million of new money we were making available for implementation over 2009-10 and 2010-11. We have asked strategic health authorities and primary care trusts to report by 21 May this year on how they have invested the new money for 2009-10.
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