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Mr. Amess: As the Minister may know, during this Parliament I was involved in a meeting on hospice funding with the Prime Minister, during which he praised the hospice movement. Everyone knows that hospices depend on charitable giving and volunteers. In light of that, have the Government made any assessment of the impact of the recession on the hospice network?

Phil Hope: As the hon. Gentleman rightly suggests, the hospice movement plays a vital role. Many Members have in our constituencies hospices that do an excellent job. That is why the £286 million of additional funding to which I have just referred includes £40 million that is being made available to hospices through a capital fund in 2010-11. I will be making announcements on that soon.

Mr. Mark Todd (South Derbyshire) (Lab): The all-party group on motor neurone disease conducted an inquiry into end-of-life care that revealed that many primary care trusts have either not been fully utilising the money set aside or have not used it at all for this purpose and have instead taken it entirely for other purposes. Is that also the early evidence from the Minister's inquiries?

Phil Hope: First, I congratulate my hon. Friend, who has been a long-standing champion in the House for people with motor neurone disease. We are monitoring primary care trusts' expenditure of the £286 million for the reason he suggested. The results of that analysis will be shared with the Public Accounts Committee, included in the end-of-life care strategy second annual report, and published on the Department's website. We are making good progress, but we need to make sure that work is happening on the ground.

Mr. Stephen O'Brien (Eddisbury) (Con): I rise to ask a question in light of the Government's admission in the past few weeks that, distressingly, only 30 per cent. of the money earmarked for end-of-life care users has reached patients under the Government's end-of-life care strategy, and that, similarly, dementia sufferers have received only a third of the funding pledged under the Government's dementia strategy-let alone the fact that only one quarter of funding under the carers strategy has been received by those for whom it was intended. On behalf of those who have not received their respite breaks, or, indeed, the dignity they deserve, I ask the Minister when he intends to honour his promise not just to have the money properly audited and reported on, but to make sure it is wrung out of the wasteful bureaucracy and put to front-line use, as promised.

Phil Hope: As the hon. Gentleman knows, we are looking carefully at how primary care trusts and strategic health authorities are spending money at the local level on a variety of important resources and support for patients and carers. I might add that we hope no one will have to monitor what impact the £6 billion a year of cuts the Conservative party announced yesterday would have on local care services throughout the country.

Rob Marris (Wolverhampton, South-West) (Lab): The excellent Compton hospice is headquartered in my constituency and does a fantastic job. One of the things it does is train workers in palliative care. Will my hon. Friend tell me what financial support is available from the Government-it certainly should be-to help with the training of workers who will be doing palliative care?

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Phil Hope: My hon. Friend puts his finger on an important part of how we raise the quality of end-of-life care for people right across the country. Training is one particular issue, but I should add that by working through the Dying Matters coalition, we want to raise public awareness of issues associated with death, dying and bereavement. We not only need the professional training to be right, but need to address the taboo that too often exists in this country about discussing these matters, so that people are encouraged to think about, and plan and prepare for, this period in their life or in the life of a loved one in their family.

Carers Strategy

7. Angela Watkinson (Upminster) (Con): What plans he has to audit spending on the carers strategy. [324911]

The Secretary of State for Health (Andy Burnham): Each Department that supports the cross-government carers strategy is responsible for auditing its contribution. My Department's programmes are subject to independent evaluation. We have asked strategic health authorities to identify where primary care trusts have agreed with their local authorities to prioritise support for carers.

Angela Watkinson: I thank the Secretary of State for his reply. He will know that some young carers fall behind in their studies because of a lack of awareness of their circumstances on the part of school staff. What guidance is given to schools to ensure that they are aware of what is happening and can help those young carers to balance their caring responsibilities with their personal development and education?

Andy Burnham: The hon. Lady raises an issue about which I care greatly. Some young people in our communities carry an incredible burden whereby they care for a family member and often sacrifice a great deal of their own life chances in doing so. Part of the problem is that the authorities often do not know that they are performing those caring responsibilities. We all have a duty to work harder to identify who those young people are and give them extra support, so that they do not miss out in later life as a result of performing a crucial function in caring for a loved one at a young age.

Dr. William McCrea (South Antrim) (DUP): Does the Secretary of State accept that many carers feel undervalued in the work that they do? How does he see that being radically changed? Will he assure us that family carers do not lose any benefits that they should normally receive?

Andy Burnham: I agree with the hon. Gentleman that people feel undervalued. It is right to say that carers often face a battle to get support and that that can be very wearying, particularly at a difficult emotional time for their family. That is why we have published today-he did call for radical change-a White Paper that proposes a fundamental reform of social care in England by establishing a national care service, which will be free at the point of use and operate according to need and on NHS principles. It will also give everybody the ability to get peace of mind in later life and to protect what they have worked for. We have also said that the essential characteristics of attendance allowance and disability living allowance will be preserved in any new system.

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Expenditure Changes

8. Paul Rowen (Rochdale) (LD): What mechanism he plans to use to determine changes to expenditure on health services in the next four years. [324913]

The Minister of State, Department of Health (Mr. Mike O'Brien): Overall primary care trust funding rose by 5.5 per cent. in this financial year and it will rise by 5.5 per cent. in the financial year 2010-11. Under Labour, these rises of 11.3 per cent. overall will be locked in for two further years up to 2013. In addition, the NHS is looking to make savings of £15 billion to £20 billion, which will be reinvested in NHS budgets.

Paul Rowen: I am sure that the Minister is aware of a leaked letter sent by the chief executive of the North West strategic health authority to PCTs calling on them to prepare cuts of 10 per cent. across the board and 15 per cent. in operational services. Such cuts include the shutting of Rochdale's accident and emergency department from 12 o'clock at night. Will the Minister admit, and stop trying to fool people about the fact, that the Government are planning real cuts after the election?

Mr. O'Brien: Heywood, Middleton and Rochdale PCT will receive £358 million and £378 million in this financial year and next, which is an increase over the two-year period of £38.4 million, or 11.3 per cent. That is what we are planning for the hon. Gentleman's area. I should tell him that, contrary to what his website says, there are no "secret plans" to close his accident and emergency department overnight. There are concerns about understaffing in A and E and the board will examine how to address that in due course, but no decision has been made about closing the A and E department overnight.

Mr. Ian Cawsey (Brigg and Goole) (Lab): I hope that my right hon. and learned Friend has not been looking at my website. When he reviews expenditure for the next two years, will he consider the impact on other departmental budgets? I have recently been dealing with a difficult and complex mental health case of a constituent. It involved a significant cost to the taxpayer, arising mainly through the police and the Prison Service, from which my constituent received no care or treatment to meet his needs. Can we ensure that as we examine our health service expenditure for the next four years, the mental health needs of our society are given a greater priority?

Mr. O'Brien: My hon. Friend is right that we need to ensure, in accordance with the Bradley report, that mental health issues are given a very high priority. We heard questions earlier about assaults on staff and relevant matters; mental health issues might be a factor in such cases. The NHS and other public services must, increasingly, address that area.

Mr. Andrew Lansley (South Cambridgeshire) (Con): The Conservatives are committed to a real-terms increase in the NHS budget each year in the next Parliament. Is that a commitment that the Minister can match?

Mr. O'Brien: As I have already indicated, as far as we are concerned there will be an 11.3 per cent. increase this year and next year, and we are locking that increase in for the NHS for a further two years. Overall, for the next three years, we are going to see an increase not only on current budgets, but again next year.

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Mr. Lansley: The House will note that the Minister has merely said what Ministers have said before-there will be flat, real-terms funding in 2011-12 and 2012-13-so he cannot match the commitment that I have made. How can he reconcile his answer with the plans of strategic health authorities across the country which include cuts of 10 per cent. or more in staffing in hospitals?

Mr. O'Brien: As far as we are concerned, we are guaranteeing primary care trust budgets-that is what we are talking about: front-line services-in real terms. We are going to see an increase in those budgets, and we have already seen substantial increases in staffing. Everyone out there who is watching these proceedings and considering how to vote at the next election will remember that the Conservatives left the NHS on its knees. After we came into office in 1997, we got it up off its knees. It is now good and we can make it great. The hon. Gentleman could never do that.

Mr. Lansley: For all that bluster, the right hon. and learned Gentleman still cannot match the commitment we have made to real-terms increases for each year of the next Parliament-and, indeed, for the whole NHS budget. What about capital budgets? In the operating framework that was sent out to the NHS, the Labour Government have told it to expect a 50 per cent. reduction in capital expenditure over the course of the next spending review. How can he and his Secretary of State go around making promises of capital expenditure, as he did at Liverpool's Broadgreen hospital yesterday, given that Labour is committed to halving the capital budget for the NHS, while we are not?

Mr. O'Brien: The hon. Gentleman voted against the Wanless report and did not want national insurance to be increased for the NHS, and the Conservatives did not provide any of the extra funding that we have put into the health service in the past decade. Does anyone seriously think that they can be trusted with the NHS? I suspect that most members of the public do not. We will be able to test that in due course at the election. If people are asked who they can trust with the NHS, they have only to look at the Conservative record and then at ours to know that only Labour can be trusted with it.

Paddy Tipping (Sherwood) (Lab): Despite record increases in funding, all nine PCTs operating in the east midlands do not reach the Government's own funding target. Does my right hon. and learned Friend accept that part of the issue is fast population growth in the east midlands? Is not the solution to ensure that new population figures are fed into the funding formula as quickly as possible?

Mr. O'Brien: My hon. Friend is quite right. We need to ensure that the funding formula properly and accurately reflects issues related to population change, which can be significant in particular areas. We need to work through some of those issues, taking a great deal of care, with the other Departments that are affected by this issue.

Mr. Barry Sheerman (Huddersfield) (Lab/Co-op): Will my right hon. and learned Friend look at the report of the Select Committee on Children, Schools and Families on children's centres, which was published yesterday,
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when he is thinking about expenditure over the next four years? Will he consider the criticism that the health sector is often the weaker partner with the Department for Children, Schools and Families? Can we see a greater commitment in both resources and commitment to the children's centres, which are doing a wonderful job of cutting down the silos that we see too often in health and education in the early years?

Mr. O'Brien: My hon. Friend is quite right. Children's centres are absolutely crucial in breaking down barriers and improving children's health and well-being. That is why the Government will ensure that funding for children's centres is given due priority-unlike the Opposition, who we know plan to cut funding for children's centres.

Administrative Tasks (Nurses)

9. Mr. Oliver Heald (North-East Hertfordshire) (Con): What estimate he has made of the proportion of their working hours NHS nurses are required to spend on administrative tasks. [324914]

The Parliamentary Under-Secretary of State for Health (Ann Keen): NHS trusts are responsible for planning the activities of their nursing work force to meet the needs of their patients. It is not possible to collect centrally information on the proportion of working hours that NHS nurses are required to spend on administrative tasks.

Mr. Heald: Two years ago, the Royal College of Nursing carried out research into this and found that front-line nurses were spending 1.6 million hours a week on non-necessary paperwork. We are two years on from that, so is the Minister able to give any information about whether any progress has been made? For nurses to spend a day a week on average on non-essential paperwork is clearly unsatisfactory. We do not want them pen pushing; we want them helping patients.

Ann Keen: I think that we would all agree, but keeping accurate records is a nurse's essential responsibility under the code of the Nursing and Midwifery Council, the body that regulates nurses. We acknowledge the RCN's report, and that is why more than £50 million has been put into the health service to support the "Releasing Time to Care" programme, in which more than 80 per cent. of primary care trusts are now involved. It is exceptionally important that accurate records and assessments are made of patients and that all communication is recorded but, in my opinion and that of many nurses, that has improved greatly.

Trained First-aiders

10. Bob Russell (Colchester) (LD): If he will undertake research into the proportion of people attending hospital accident and emergency departments whose treatment could be delivered effectively by a trained first-aider. [324915]

The Minister of State, Department of Health (Gillian Merron): The Department has no plans to do so. First aid is normally given to sustain a patient in an emergency. It is not, of course, a substitute for effective treatment by a health professional.

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Bob Russell: I had hoped for a better answer. May I suggest to the Minister that there is a general acceptance that many people go to accident and emergency departments who should not be there? If society had more trained first-aiders-as my superb ten-minute Bill of 19 November 2003 proposed-there would be less pressure on the NHS budget and on our A and E departments.

Gillian Merron: I am, of course, disappointed to disappoint the hon. Gentleman. I am sure that he, like me, would pay tribute to organisations such as the Red Cross and the St. Johns Ambulance service, of which I used to be a member, and to the many first-aiders up and down the country who give their time to provide on-the-spot initial care. However, first aid is not a treatment, as it can involve anything from putting a plaster on to keeping a patient alive until appropriate medical care is given. There is a range of possibilities for people who need treatment: as well as going to A and E, they can consult NHS Direct or visit the many new walk-in centres that the Government have set up. They can also use the extra services provided by pharmacies and out-of-hours doctors, and we are piloting a three-digit number for the future.

Linda Gilroy (Plymouth, Sutton) (Lab/Co-op): A and E services are often put under great pressure by peaks in drinking, particularly binge drinking at the weekend. Will my hon. Friend look at how the Plymouth PCT and Derriford hospital have brought a service into the city service to address that issue? The service uses paramedics and others to treat people in situ, thus relieving pressure at the main service point in Derriford hospital.

Gillian Merron: I would of course be very happy to look at that service, and I congratulate the local health care services in my hon. Friend's constituency on showing such initiative. What they are doing is exactly what the NHS is about-taking the right services to the right people at the right time.

Cancer Survival Statistics

11. Mr. John Baron (Billericay) (Con): What consideration he has given to extending the range of cancers for which his Department publishes one-year survival rates; and if he will make a statement. [324916]

The Secretary of State for Health (Andy Burnham): The second annual report on the cancer reform strategy sets out one-year survival information for breast, lung and bowel cancer by primary care trust. Where it is statistically reliable to do so, we will include additional cancers in the third annual report on the cancer reform strategy.

Mr. Baron: I thank the Secretary of State for that answer, but given that the all-party group report on cancer inequalities found a groundswell of support for the introduction of a one-year survival indicator for all cancer patients to ensure that we move away from input-based targets to measuring how effective the NHS is in treating cancer, will he give that consideration further review, and do it with renewed vigour? Many believe that that would help to improve early diagnosis.

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