1. Lilian Greenwood (Nottingham South) (Lab): What steps he is taking to improve rates of early detection of cancer. 
The Secretary of State for Health (Mr Andrew Lansley): Late detection of cancer is one of several reasons why our cancer survival rates are below the European average. That is why we will focus on improving those outcomes and achieving better awareness of the signs and symptoms of cancer. These aims will be part of our future cancer strategy.
Lilian Greenwood: Over half the men who receive a testing kit under the national bowel cancer screening programme throw it away. What action is the Secretary of State taking to improve the take-up of screening, particularly by men, and what provision has he made within the NHS budget for the extra costs of increased take-up?
Mr Lansley: I am grateful to the hon. Lady for that question, and I have had the privilege of twice visiting the national bowel cancer screening programme at St Cross hospital in Rugby-it looks after people in parts of the midlands and the north-west-and indeed, I have visited the Preston royal infirmary, which deals with bowel cancer screening follow-up. As I said in my first reply, one of the things we aim to do is to increase awareness of the signs and symptoms of cancer. It is unfortunate that, as a recent study established, only 30% of the public had real awareness of what the symptoms of cancer would be, beyond a lump or a swelling. We have very high rates of bowel cancer, so it will be part of our future cancer strategy to increase awareness of those symptoms and to encourage men in particular to follow up on them.
Mr John Baron (Basildon and Billericay) (Con):
The recent inquiry of the all-party parliamentary cancer group into cancer and equalities heard expert evidence to suggest that if people can survive the first year of cancer, their chances of surviving for five years are
almost identical to the chances in the rest of Europe. Does the Secretary of State therefore believe that a one-year survival indicator is a good idea both for encouraging early diagnosis and for matching the survival rates of the best in Europe?
Mr Lansley: My hon. Friend makes an extremely good point. When we set out proposals for an outcomes framework, I hope that he and others will respond, because that is one of the ways in which we can best identify how late detection of cancer is leading to very poor levels of survival to one year. I hope that we can think about that as one of the quality indicators that we shall establish.
Diana R. Johnson (Kingston upon Hull North) (Lab): I welcome the Secretary of State to his new position and wish him well in his role. I understand that he is keeping the two-week target for seeing a cancer specialist, but abandoning the work that the Labour Government did on the one-week target for access to diagnostic testing. Professor Mike Richards stated in the annual cancer reform strategy that improving GP access to diagnostic tests is essential to the drive for early diagnosis of cancer. Can the Secretary of State spell out some of his current thinking on what the alternative would be if we no longer have the one-week target?
Mr Lansley: Let me make it clear to the hon. Lady and the House that only 40% of those diagnosed with cancer had actually gone through the two-week wait. Establishing a better awareness of symptoms and earlier presentation across the board is, as we have been discussing, important to achieve. I am afraid that the hon. Lady is wrong: I have not said that we are abandoning any of the cancer waiting-time targets at the moment, but that we have to be clear about what generally constitutes quality. For example, seeing a cancer specialist without having had prior diagnosis is often pointless, whereas getting early diagnosis is often a serious indicator of quality.
2. Derek Twigg (Halton) (Lab): What assessment he has made of the effects on NHS waiting times of NHS targets in the last 10 years. 
The Minister of State, Department of Health (Mr Simon Burns): Targets focused the NHS on bringing down waiting times, but also put process above clinical judgment and patient choice. Changing the way in which we manage waiting times will empower both patients and clinicians. NHS targets have dictated clinical priorities and harmed patient care. Focusing on long waits has meant less progress on reducing average waits than could otherwise have been achieved.
Derek Twigg: I noticed that in his answer the Minister did not say that any assessments had taken place. How many representations has he received from clinicians, people working in the NHS and the public demanding the removal of the 18-week target, for instance? Targeting is about making people better and getting them seen more quickly, so is not the real reason for dropping targets the fact that the Minister wants to undermine the NHS again?
Mr Burns: I am sorry, but the hon. Gentleman, for whom I have considerable respect, is just plain wrong. There have been a number of representations over the last seven weeks or so. In addition, as my right hon. Friend the Secretary of State and his shadow team went round the country over the past five years, they were constantly told by GPs and clinicians from hospital to hospital that politically motivated targets were distorting clinical decisions and patient care.
Mr Stephen Dorrell (Charnwood) (Con): Does my hon. Friend agree that by far the most important way of improving the service delivered by the NHS is to focus on the three key indicators of clinical outcomes, patient experience and value for money? Can he assure the House that the Government will pursue those, particularly against the background of increasingly scarce resources, in order to deliver the objective we all have: a better-quality NHS?
Mr Burns: I am extremely grateful to my right hon. Friend, who is absolutely right, and I can give him the categorical assurances he is seeking, but I would also like to add one more: we need information to empower patients, because if patients are going to be at the heart of the NHS they must have the information to take the decisions that are important to their health care.
Mr Speaker: Order. May I gently ask the Minister to face the House? I am sure that Opposition Members will want to see his face.
Andy Burnham (Leigh) (Lab): We do, Mr Speaker, very much; we want to see him squirm.
First, let me say that we welcome the Minister back to the Department of Health; he was a Minister in the Department 13 years ago. As I have said before, we trust that he finds the NHS in much better condition than when he left office. Last week we had an independent verdict on those 13 years. The independent and respected Commonwealth Fund said that the NHS was one of the best health care systems in the world, and, indeed, that it was top on efficiency: a ringing endorsement of Labour's stewardship of the national health service. That verdict reflects the huge progress on waiting times that has been made over those 13 years. So does not the abolition of the 18-week target, which the Minister announced last week, put all that progress at risk? Will he today give us a straight answer to this question: can he guarantee that waiting times will not rise, and that patients will still be treated within 18 weeks?
Mr Burns: I thank the right hon. Gentleman for the kind comments at the beginning of his remarks; things went downhill thereafter, but that is politics.
The right hon. Gentleman needs to understand that patients have to come first in a national health service, and the trouble with the approach he took was that he wanted politicians and bureaucrats to micro-manage it from the top down, rather than having a bottom-up system that listened to local people. One of the key aims is to ensure that people get the finest and best treatment possible, and I am afraid that his approach-a straitjacket of targets in certain areas-did not work then, and will not work now.
Andy Burnham: I shall take that as a no, because the Minister did not answer the question; he could not give that guarantee. He says that we must put people and patients first, yet at a stroke he has taken power away from patients and handed it back to the system, turning the clock back to the bad old days of the Tory NHS. Let me quote some comments by Jill Watts, chair of the NHS Partners Network, which represents private providers. In the Financial Times on 18 May, she is reported as saying the following about the loss of targets:
"Waiting times will go up and if people want a procedure they have a choice: they can wait or they can look to pay".
Is that not always the Tory choice on the NHS: wait or pay?
Mr Burns: The right hon. Gentleman is not right. We have not taken that attitude; we never have taken that attitude. We want to have a system whereby the health service is not in a straitjacket of targets that disrupt and distort clinical decisions. We want to empower clinicians and GPs to take decisions about who should be treated when according to their clinical judgment.
Mr Burns: It is not waffle. The right hon. Gentleman is clinging to an outdated philosophy, and he is in denial about the need to change it.
3. Toby Perkins (Chesterfield) (Lab): If he will take steps to increase the number of dentists providing NHS services in Chesterfield; and if he will make a statement. 
The Parliamentary Under-Secretary of State for Health (Anne Milton): I assure the hon. Gentleman that the Government have committed to improving access to NHS dentistry, and the introduction of the new dental contract, focusing on achieving good dental health and increasing access to NHS dentistry, will be vital.
Toby Perkins: I thank the hon. Lady for her response. The Stubbing Road medical centre is a brand-new building in Chesterfield providing doctor services to people who are among the most deprived in Derbyshire. One floor there was also meant to provide dental services, but in the last week we have been told that that might not-indeed, that it will not-go ahead, although the primary care trust is paying the rent on the building and its new suite. Can the hon. Lady assure the people in the Rother ward who have been waiting so long for those services that the guarantee that everyone in Chesterfield will have access to an NHS dentist by March 2011 will remain in place?
Anne Milton: I cannot comment on the specific circumstances, but I would be happy to meet the hon. Gentleman if he would like. I must point out to him, however, that the number of people now seeing an NHS dentist remains lower than when the previous Government introduced the new contract in 2006. He mentions children, but there is no doubt that the inequalities in the oral health of children are scandalous.
Sir Paul Beresford (Mole Valley) (Con) rose-
Mr Speaker: Order. I hope that the hon. Gentleman will apply the ingenuity required to stay within the terms of a question relating to Chesterfield.
Sir Paul Beresford: Thank you, Mr Speaker. Given my declared interest, it was too great a temptation not to contribute.
Does my hon. Friend not agree that for dentists, the biggest disincentive to providing an NHS service in Chesterfield-and, in fact, in the rest of England too-is the contract that she just mentioned, with its targets, its "units of dental activity", its clawbacks and so on? Will she ensure that any new system that she introduces enables and encourages dentists to offer a choice between national health and private dentistry, thus encouraging those who have opted out to opt back in again?
Anne Milton: I thank my hon. Friend for his question-he speaks eloquently and with much knowledge on this subject-and for highlighting the perverse incentives in the contract. It is absolutely critical that we take those out of any new contract.
4. Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con): What steps he plans to take to implement the Government's proposals to end the target culture in the NHS. 
The Secretary of State for Health (Mr Andrew Lansley): On Monday 21 June I published a revision to the NHS operating framework in which I removed the central management of three process targets that had no clinical justification. We will carry on focusing on quality and outcomes, getting rid of top-down process targets.
Dr Poulter: Does my right hon. Friend agree that meeting targets does not necessarily mean improving health care, and that the last Government were far too focused on the process of health care, rather than on improving the patient experience?
Mr Lansley: My hon. Friend is absolutely right. I was here just a few weeks ago, announcing a public inquiry into the events at Stafford general hospital. Of course, in that hospital the adherence to ticking the box on the four-hour target was one of the things that contributed to the most appalling care of patients. We have to focus on delivering proper care for patients-the right treatment at the right time in the right place-and delivering the best outcomes for them. We will focus on that-on quality-not on top-down process targets.
Chris Leslie (Nottingham East) (Lab/Co-op): Is it really true that the coalition Government are going to scrap the right for people to see their GP within 48 hours? If so, will the Secretary of State publicise that, so people know that the right has been reduced? If it is true, is he not just axing public service quality under the pretence of dealing with so-called bureaucracy?
It is astonishing-the Labour Government spent money trying to achieve the GP access target, and the hon. Gentleman might at least have recognised that the latest data, published two or three weeks ago, show that public satisfaction with access to their GPs, and the things that the Labour Government had been paying for, had actually gone down. A consequence of the
48-hour access target was that patients were unable to access their GPs more than 48 hours in advance. Is it not reasonable to expect GPs to be able to manage their own services in order to deliver better patient experience and outcomes across the board? I think we can reasonably expect that.
Nadine Dorries (Mid Bedfordshire) (Con): It has been reported today that historically speaking, as a result of targets, an obstetrician in a hospital could herself have a caesarean section but then have to refuse one to a patient, because of the pressures that targets put on the local NHS trust. Can the Secretary of State give us an assurance that any woman in the NHS who needs a caesarean section will have one, and that no targets will be imposed?
Mr Lansley: My hon. Friend is referring to World Health Organisation targets, which have not in themselves been applied within the NHS, and it certainly would not be my intention to impose such targets. I agree with the implication of her question, which is that a woman who needs a caesarean section should have access to one. I am also well aware that when a woman does not require a caesarean section we should seek, through a process of discussion and providing information, to avoid that wherever possible. Birth should be considered a normal event, rather than being subject to excessive medicalisation.
5. Mrs Madeleine Moon (Bridgend) (Lab): What his most recent assessment is of the adequacy of the level of support provided for people with low vision. 
The Minister of State, Department of Health (Mr Paul Burstow): It is for primary care trusts and local authority social services departments to make decisions on commissioning, having assessed the evidence and needs in their areas, and taking account of standards and best practice.
Mrs Moon: Is the Minister aware of the excellent scheme in Wales that allows people with low vision to refer themselves to a high street optician or consulting ophthalmologist, and thus to have almost immediate access to the aids and support that they need? More than 87% of people are seen within two weeks under that scheme, whereas some areas in England have an 18-month waiting list, so will he examine the scheme to see whether it can be introduced in England?
Mr Burstow: I am grateful for that question. Obviously, the devolved Administrations are responsible for health care in their own areas, so we have an opportunity to learn lessons from each other. This Government will examine the evaluation of the scheme that the Welsh Administration are undertaking to see whether it provides any lessons for our system.
Miss Anne McIntosh (Thirsk and Malton) (Con): Will the Minister say whether the money provided by the primary care trust is ring-fenced? Will he ensure that the time-sensitive nature of such conditions, especially wet and dry macular degeneration, will be taken into account across all the English PCTs?
Mr Burstow: We need to achieve that not by ring-fencing budgets but by making sure that clinicians can deliver clinically evidence-based practice so that those with age-related macular degeneration receive the treatments that they need. Ring-fencing is not the way to go; we need to ensure that local commissioners have access to the right evidence, are empowered by patients and listen to clinicians, in order to deliver the right services.
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