The Minister of State, Department of Health (Mr Paul Burstow): I thank the hon. Lady for her question-to which the answer is that we recognise the crucial importance of high-quality surgery in improving outcomes for cancer patients. Since 2003, cancer-related surgical training programmes have been developed when new technologies and procedures have proved that patients would benefit from their introduction. Through the national cancer action team we are supporting training in laparoscopic surgical procedures for colorectal cancer, and we will be introducing surgical training for lower rectal cancer.
Mary Macleod: As procedures for cancer surgery, including robotic surgery, are getting more and more complex, does my hon. Friend feel that there is a case for an earlier selection of specialism for surgeons, to ensure that the NHS maintains its reputation for clinical expertise and to influence positively cancer survival rates in the United Kingdom?
Mr Burstow: As I said in my original answer, we recognise the crucial importance of high-quality surgery. The hon. Lady has made the important point that we must equip our surgeons with the right skills to carry out highly complex and specialist procedures. That means that we must deliver specialised training for that purpose to our existing work force.
Mr David Hanson (Delyn) (Lab): Does the hon. Gentleman recognise that the 18% fall in the breast cancer rate between 1998 and 2008 was due not only to the expertise of cancer surgeons but to the target culture to which he is so opposed? What would he say to the 3,500 women who, because of those targets, did not die in 2008?
Mr Burstow: I imagine that that would be an answer the previous Government should be giving, and they should be sorry. [Hon. Members: "What?"] The reality is that this Government are clear that we are sticking with the targets in relation to cancer, but we are also clear that we need to raise awareness of the signs and symptoms of cancer, and ensure that people present themselves at an earlier stage and get access to the appropriate diagnosis, so that they get the right treatment.
The Parliamentary Under-Secretary of State for Health (Anne Milton): I thank the hon. Lady for her question. May I correct the hon. Member for Bolsover (Mr Skinner), who suggested from a sedentary position that one of us might be getting the sack, by saying that I doubt it, because it is the previous Government who have just got the sack? In answer to the hon. Lady's question, I say that there is no doubt that anything that the Government do must have a strong evidence base. It is for individuals to take responsibility for their health, and that includes healthy eating. However, the Government can help people make better choices-for example, by providing information, advice and so on.
Kate Green: I am little disappointed in that answer. Maternal nutrition before and during pregnancy is essential to the birth of a healthy baby. The Joseph Rowntree Foundation has shown that a healthy diet costs a minimum of £43 a week. A young woman on jobseeker's allowance receives only £51.85 a week, so can the Minister explain what she will do to ensure that young women on such low incomes can choose a healthy diet?
Anne Milton: I am sorry that the hon. Lady was disappointed. Clearly, she does not feel that the Government should take a strong evidence-based approach to public health. I should point out to her that although life expectancy has increased, the gap between the rich and the poor has widened. If we look at the difference between spearhead areas and the country as a whole, we can see that the gap went up by 7% for men and 14% for women. We are determined to reverse that.
Greg Mulholland (Leeds North West) (LD): Will the Minister join me in condemning the vote in the European Parliament not to back the traffic light system of food labelling, which is the clearest way of communicating nutritional messages? That followed a lot of lobbying by companies such as PepsiCo, Tesco and Kellogg's. What will she do in terms of speaking to European colleagues to get that important scheme back on the agenda?
Anne Milton: Again, the hon. Gentleman raises the point that anything we do must have a strong evidence base. We are considering a number of schemes at the moment. What is important is that people have the information on the pack of food that they buy, so that they can make good choices about what they eat.
Mary Creagh (Wakefield) (Lab): Last week's Budget scrapped the health in pregnancy grant, which helps all pregnant women to eat healthily in the final 12 weeks of their pregnancy. The previous week, the Government scrapped the free school meals pilot for 500,000 children, thrusting 50,000 children back under the poverty line. They have also scrapped free swimming for under-16s and pensioners just as the long summer holidays begin. Is that not the most extraordinary start for a Government who promised to rename the Department of Health the "Department of Public Health"? With so many broken promises in their first seven weeks, how can we trust a word that they say about public health?
The hon. Lady and I have exchanged niceties in a slightly calmer atmosphere in another setting. I find it staggering that Opposition Members
cannot understand that what matters is not what we spend but how effective that spending is. They simply cannot understand it. In fact, Labour has said that it would cut the NHS, whereas we have said that we will not. The sick must not pay for Labour's debt crisis. We did not get us into this mess, but I would point out to the hon. Lady that everything that we do must be based on evidence. It is not what you spend, but what you spend it on, that matters.
The Minister of State, Department of Health (Mr Simon Burns): The Department of Health is in contact with strategic health authorities regarding ongoing community hospital programme funding. This includes contact with the London SHA for Eltham and Mottingham community hospital and other schemes in the region.
Clive Efford: I am grateful for that answer, as far as it went-but there is a great deal of expectation in the community in Eltham that that project will be delivered. It has been in the pipeline for quite some time and will provide 40 respite beds, diagnostics such as blood tests and X-rays and, I hope, dialysis at a local level, as well as a GP-led walk-in urgent care centre. May I urge the Minister to revisit the project, and when I ask a future question, to come back with a better answer?
Mr Burns: I am a bit perplexed by the hon. Gentleman's comments, because I have answered the specific narrow question that he asked-but let me try to cheer him up, if I can. We understand that he has been a redoubtable campaigner for the hospital, and we support the principle of community hospitals. The Department, as the hon. Gentleman knows, allocated £4.58 million to help the community hospital in Eltham and has already given about £1.9 million to NHS Greenwich, the primary care trust, for it. I hope that the hon. Gentleman will not have to come back to me with another question, because I trust that I am now going to cheer him up: I can announce today that the balance of the money will be paid and made available during the current financial year.
Mr David Evennett (Bexleyheath and Crayford) (Con): I congratulate my hon. Friend on that announcement, which will bring considerable pleasure to people in south-east London. He is well aware that proposals are being made within our area of south-east London to reorganise health provision, which are causing considerable concern. Will he ensure that vital services are maintained in our area for patients?
I am grateful to my hon. Friend. As he rightly says, I am aware of the situation. As he will be aware, we believe that local people, local clinicians and local GPs should have an input into any reconfiguration of health care provision. As my right hon. Friend the Secretary of State said when he announced the changes to the criteria, there will be an assessment of whether they apply to the reconfiguration to which my hon.
Friend refers. Once that has been done and decisions have been reached, we will be able to move forward in the proper way.
The Parliamentary Under-Secretary of State for Health (Anne Milton): A public consultation on options for improving health information on the labels of alcoholic drinks closed on 31 May. The responses to that exercise are now being analysed, and we will set out our plans for next steps through announcements in the coming months.
Jim McGovern: I welcome all those on the Government Front Bench to their new posts. The tobacco health warning regime introduced by the previous Government has produced excellent results in improving the health of our citizens. Does the Minister believe that a parallel scheme for alcohol would achieve similar progress and benefits?
Anne Milton: I thank the hon. Gentleman for his warm words of welcome. It is important to note that sometimes such warnings are not transferrable between products. As he rightly says, there have been a number of initiatives on smoking that have, without doubt, had an impact on the number of people who smoke and the number who have given up. Whether those are transferrable to alcohol we do not yet know, but we will be looking at all the evidence available.
Nia Griffith: The Minister will be aware of a recent Alcohol Concern report that points out that a minimum alcohol price of 50p a unit would cost a moderate drinker only about 23p a week, but would reduce alcohol-related illness significantly, and would save the NHS millions. What discussions has she had with colleagues in other Departments about such a minimum price?
Anne Milton: We have had a number of conversations about all aspects of alcohol policy, and what to do about the 7% of hospital admissions that are due to alcohol and the £2.7 billion cost-some estimates put it much higher, at about £5 billion-to the NHS. Without doubt, we have to change the public's relationship with alcohol. We are committed to a ban on selling below-cost alcohol, which is important-but it is also important not to disfranchise responsible drinkers, as plenty of people enjoy alcohol responsibly. What we have to do is stop irresponsible drinking and protect people's health.
Mr Don Foster (Bath) (LD): I thank the Minister for that answer. She will recognise the problems that binge drinking causes our health service, our police and our local communities. I am delighted that she has recognised that there has been an agreement to ban the sale of alcohol at below cost price, but will she assure us that the Government are taking this issue seriously, and that we will hear an early announcement?
Anne Milton: The hon. Gentleman is right; this is a cross-departmental issue. This is not just about health; it is important for local government as well. We need a multi-faceted approach. As I have said, we will look at all the evidence to see what works, and to make those changes not only in law and order, as he pointed out, but in people's health.
Caroline Flint (Don Valley) (Lab): There are cross-references between the labelling on alcohol and on other products, and the evidence clearly shows that with food labelling, the public find colour-coded, front-of-pack labelling far easier to understand. What has the Minister learned from that, and will her Department, with other Departments, seek an opt-out for retailers that want to continue, voluntarily, with front-of-pack colour-coding on their products?
Anne Milton: It is important not to pre-empt the consultation that has already gone on, and to collect all the evidence together. To find out the best method for getting that information to the public in a way that they find accessible, we have to look at what works.
The Secretary of State for Health (Mr Andrew Lansley): I have stopped top-down reconfigurations where the NHS has not listened to local people. Our coalition agreement is clear that we will give patients more control over their own health care, and give patients and the public a stronger voice in the design of local health and care services.
Mr Raab: NHS managers have justified cuts in community hospitals in Walton, Cobham, Molesey and other parts of the country on efficiency grounds, but in 2009, because of targets, almost 1 million patients were discharged and then readmitted within 30 days, at a cost of £1.6 billion. What plans has the Secretary of State to strengthen local democratic control over community hospitals and the vital services that they provide?
Mr Lansley: My hon. Friend has raised an important issue. Let me make two points. First, we need to strengthen not only the local public and patient voice but the voices of GPs who are involved in commissioning, so that they can act on behalf of their patient population in commissioning the services, and design of services, that they need. Secondly, as I have made clear in the revision of the operating framework, we must look at results. When someone goes into hospital for treatment, we must consider not just their treatment in the hospital, but their subsequent rehabilitation and re-ablement. I believe that that will allow greater use of intermediate care beds in the way that my hon. Friend has described.
Hazel Blears (Salford and Eccles) (Lab):
I thank the Secretary of State for agreeing to meet me-together with representatives of my local primary care trusts, local mums and midwives-to discuss maternity services in Salford. In the light of his new criteria for
reconfigurations, will he confirm that he is prepared to reconsider the decision to close Salford's maternity services, and to recognise the views of thousands of people throughout Salford and Eccles, including me, who opposed it at the time?
Mr Lansley: The right hon. Lady knows that we will meet to discuss the issue. However, as I said when I was in Greater Manchester, it is not for me to reconsider the application of the new criteria from 21 May. That is for local people to reconsider. It is for GPs, the public, local authorities and, indeed, PCTs in Salford and district to start thinking about what they consider to be viable and successful future services for mothers-to-be.
Mr Edward Timpson (Crewe and Nantwich) (Con): In helping local people to become more involved in NHS decision making, will my right hon. Friend agree to consider my Ambulance Response Times (Local Reporting) Bill, which received its Second Reading during the last Parliament? The Bill requires all ambulance trusts to publish local as well as regional response times and patient outcomes so that-as is already the case in Crewe and Nantwich-they have access to those details and can deliver better response times, with the help of local initiatives such as Community First Responders.
The Secretary of State for Health (Mr Andrew Lansley): From April 2011, the accident and emergency four-hour waiting time standard will be replaced by a set of clinical quality standards, developed with clinicians, which will support quality care without the damaging distortion of the four-hour tick-box target. On the basis of clinical advice, I have immediately reduced the threshold for meeting the four-hour standard from 98% to 95%.
Paul Goggins: I am sure that the Secretary of State will want to join me in congratulating the staff at Wythenshawe hospital in my constituency. Last year 85,000 patients were seen in the accident and emergency department, 98% of them within four hours. Can the Secretary of State explain to my constituents why he has decided that this year 4,500 of those patients will not need to be seen within that time?
Mr Lansley: As I told the right hon. Gentleman, I made that decision on the basis of clinical advice. It was clear that the 98% standard was distorting clinical care for patients. There is no benefit for patients if, for the purpose of meeting a four-hour target, they are discharged inappropriately, transferred to wards when they have not been thoroughly looked after in the accident and emergency department, or indeed put in an observation ward for 48 hours, which is under the scrutiny of the accident and emergency department but ticks the box. None of that helps patients. I will focus on what is actually in the best interests of patients, and delivers the right outcomes for them.
The Parliamentary Under-Secretary of State for Health (Anne Milton): Evidence of the impact on public health of plain packaging of tobacco needs to be developed further, because no jurisdiction globally has yet introduced it. However, Australia will do so from 2012. We will monitor developments there with considerable interest.
Phil Wilson: Smoking costs the NHS £2.7 billion a year, six times the cost of a new hospital for north Tees and Hartlepool. In the north-east, approximately 10,000 children between the ages of 11 and 15 are smoking. We want all of them, not just half of them, to lead a fulfilled life. Will the Minister ensure that the assessment of plain packaging is expedited, so that we can be given an answer as soon as possible?
Anne Milton: The hon. Gentleman is right to raise the impact that smoking still has on the health of children in particular-I believe that 200,000 take up smoking each year. We still have 80,000 smoking-related deaths in this country. It is important to watch what happens in Australia and see where the evidence points for the future.