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House of Commons

Tuesday 29 October 2002

The House met at half-past Two o'clock


[Mr. Speaker in the Chair]


Committee of Selection

Order read for resuming adjourned debate on Question [16 October],

Hon. Members: Object.

Debate to be resumed tomorrow.

Oral Answers to Questions


The Secretary of State was asked—


1. Mr. Adrian Sanders (Torbay): If he will make a statement on progress towards a national service framework for diabetes. [75349]

The Minister of State, Department of Health (Jacqui Smith): We recently published two important national targets for the NHS to improve diabetes care over the next three years. We are currently finalising the wider delivery strategy that will underpin those targets and the national service framework standards, published last December. We shall publish the delivery strategy shortly.

Mr. Sanders: Given the ever-increasing rise in the number of diabetics being diagnosed, are the Government satisfied that the sums of money being talked about will be sufficient? What mechanisms will be in place to ensure that the Government's targets are met?

Jacqui Smith: I know that the hon. Gentleman and the all-party group play an important part and have a close interest in this issue, and I welcome that. The two targets that I outlined, for improving the monitoring and treatment provided through primary care and for ensuring that diabetic retinopathy screening is more widely available, are in the planning and performance framework. That is the programme for the NHS for the next three years, and it will receive historic levels of

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funding—real-terms annual increases of 7.5 per cent. Compared with even the wilder dreams of the Liberal Democrats, that is a considerable investment.

As I made clear, both the standards produced last December, which set out the basis and the direction of travel for local health services, and the delivery strategy that we will publish shortly will put some flesh on the bones of that policy. The strategy will be delivered at local level because diabetologists, specialist nurses, GPs, dieticians, podiatrists, ophthalmologists and, increasingly, patients managing their own care need to be able, within those national standards, to make the important decisions. I can assure the hon. Gentleman that, thanks to this Government, there will be extra investment to help to support those decisions.

Mr. David Stewart (Inverness, East, Nairn and Lochaber): As secretary of the all-party diabetes group, may I ask the Minister when she expects to receive advice from the UK screening committee on the possibility of having a screening programme for type-2 diabetics?

Jacqui Smith: I recognise my hon. Friend's important contribution to the all-party group.

As we outlined in the standards, there is an important role for the national screening committee in spelling out the most effective way of developing a screening programme for type-2 diabetics. I am sure that my hon. Friend will agree that, given that diabetes disproportionately affects people in disadvantaged areas and people from black and minority ethnic communities, and given that it is often causally related to coronary heart disease, it is important that we find the most effective way of targeting that screening programme and of ensuring that we effectively develop the services for those affected. We look to the national screening committee to come forward with more advice, and we may then need to consider how to pilot the programme to ensure that we are targeting it in the right places.

Mr. Nicholas Soames (Mid-Sussex): Given the truly wicked and insidious nature of the disease, is the hon. Lady sure that the gross discorrelation between services throughout the country—there is little consistency or sameness of service—will be addressed quickly enough by the steps the Government have taken? I accept that the Government have a big investment programme, but is she sure that it will happen quickly enough? Will she discuss with officials what steps could be taken to bring about greater efficiency in the service, so that more people get the same high-quality service?

Jacqui Smith: The hon. Gentleman asks an important question: how can we ensure that the good practice found in some parts of the country is spread more uniformly? That is the reason for the development of the national service framework. The standards published in December were the first ever national standards for diabetes care. As we have developed the delivery strategy, we have been careful to do so in partnership with those who will have to make it work—people working in primary care, diabetes specialists and, importantly, patients themselves, because patients are increasingly able to manage their condition. I am

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confident that the national service framework and the process of developing it will make an important difference to people with diabetes, but so, too, will the investment—investment that has already been made, as well as future investment—

Mr. Speaker: Order. I do not like to interrupt the Minister, but I need briefer replies.

Poverty and Deprivation

2. Mr. Tony Lloyd (Manchester, Central): What plans he has to give greater emphasis in the allocation of funds to poverty and deprivation as causal factors of poor health. [75350]

11. Andy Burnham (Leigh): If he will make a statement on progress with the development of a new funding formula for primary care trusts, with special reference to social deprivation. [75360]

The Secretary of State for Health (Mr. Alan Milburn): The existing formula used to allocate national health service resources is under review. Later this year, when I announce resources for local health services, distribution will take place based on a new formula that takes better account of health needs, which I hope will contribute to reductions in health inequalities.

Mr. Lloyd : My right hon. Friend will be aware that the historic formula inherited from Conservative Governments was perverse, in that it rewarded areas politically, not on the basis of health needs. Given that almost the whole of the north suffers from poor health, and that northern cities such as Manchester, Liverpool and Newcastle come near the bottom of most health tables, will he guarantee that the review will be driven not by the needs of London and the south-east, as his Department told my office this morning, but by a recognition that health deprivation is a nationwide issue and that funding is needed in northern cities such as Manchester?

Mr. Milburn: You always learn something new at Health questions, Mr. Speaker. We have taken some steps to address this country's severe inequalities in health outcomes. It is worth reminding the House that, for 50 years or more, the gap between rich and poor in terms of health outcomes has been widening, not narrowing. One of the ways to tackle that is to get the resources in the right place, according to need. My hon. Friend is aware that in this financial year we have allocated an extra #148 million—including an extra #4 million for his part of the country and Manchester—specifically to deal with those issues, but there is no doubt that there is more to do.

In any review, whether of local government resources or NHS resources, we have to get the balance right between two competing pressures: different labour market pressures and different needs pressures in different parts of the country. Only if we get that right will we get resources in the right place.

Andy Burnham : The Secretary of State will know that people in Leigh and the communities represented by my hon. Friend the Member for Manchester, Central

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(Mr. Lloyd) are more likely to develop chronic illness than people elsewhere in the country, and on average they do so at a much younger age—in my area, at 53 as opposed to 60. That places great strain on the local NHS, but the extra costs of providing health care in former mining areas, where there is a high incidence of chronic illness, are simply not picked up by the current formula. May I urge him to use his welcome review of health funding to right that historical wrong and to introduce a new formula that, while recognising the other pressures he mentioned, gives full weight and priority to deprivation and chronic ill health?

Mr. Milburn: We will try to do precisely that. Both my hon. Friends are due to come and see me soon to discuss the needs of Manchester and the surrounding areas and to make their case face to face. Later this year, for the first time, we will allocate resources directly to primary care trusts for the next few years. I confirm that when we do so, that allocation will be based on a new formula that addresses the issues my hon. Friends have raised.

It is important that we do that. Our intention is to improve the health of the nation overall, but given that there is a such a health deficit in the poorest communities, it must also be right to aim to close this country's health gap, so that we improve the health of the poorest people fastest. I hope that that objective is shared on both sides of the House. We have begun to try to put that right: for example, we have targeted intervention and treatment rates for coronary heart disease in those parts of the country where its incidence is greatest—there has not always been a straightforward correlation between treatment rates and incidence rates. The problems will take some time to put right, but we have an opportunity to do that now because we have the resources to ensure a more equitable distribution.

Mr. David Cameron (Witney): As well as poverty and deprivation, will the Secretary of State consider scarcity and rurality in terms of funding, especially for social services? There are three excellent care homes in my constituency, all of whose future is in question. One of them, in Milton-under-Wychwood, meets all the Government's standards. Yet, because it is small, it is threatened with closure. I hope that the right hon. Gentleman understands that rural communities want small care homes close to where people live. The funding formula should reflect that.

Mr. Milburn: I very much agree with the hon. Gentleman. He will be interested to know that those who have been examining how we distribute resources have been considering sparsity and rurality, for example. These are issues that he and other right hon. and hon. Members on both sides of the House have been raising. Obviously, we must get the balance right between how we distribute resources to areas of great health need, to areas with a rurality problem and to other areas with a labour market problem.

I say in all candidness to the hon. Gentleman that we can redistribute resources only if we raise resources. The problem for the hon. Gentleman and for other Opposition Members is that they are now committed as a party to not matching the levels of resources that the Government are putting into the national health service.

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[Interruption.] Well, they shake their heads but that is what their document, XLeadership with a purpose", had to say, when it said that—

Mr. Speaker: Order. I call Mr. Hywel Williams.

Hywel Williams (Caernarfon): Perhaps the Secretary of State will be familiar with the document entitled XLles yng Nghymru" or XWell Being in Wales", which was launched by the Minister with responsibilities for health and social services. The report contains the statement that

Is that not an indictment of the Government's policy and the policy of previous Governments? Does the right hon. Gentleman not recognise that there is inequality of resource allocation not only within England, but between England and Wales and other countries?

Mr. Milburn: As the hon. Gentleman knows, that is a matter for the Welsh Assembly.

John Cryer (Hornchurch): In Rainham in the south of my constituency, which is a relatively deprived area, we recently had a successful campaign to save a GP surgery. Despite that, we still have a shortage of GPs. Frequently, GPs have a list of 3,000 to 3,500. My right hon. Friend will know that the current funding formula often militates against these areas because it makes it difficult to draw in resources to attract the additional GPs who are needed. Will the new funding formula recognise that, so that we can start to attract new GPs into the area?

Secondly, does my right hon. Friend not find it extraordinary that certain Members argued for extra resources for their own areas but voted against the general proposal in the Lobby?

Mr. Milburn: I do not know to whom my hon. Friend was alluding, but I can guess. He is absolutely right on two counts. First, all too often we have the poorest services serving the poorest communities. That must be put right.

As for primary care services, for example, we are making available extra payments to try to entice GPs into some of the poorest communities. That is the right thing to do. There is a long way to go, and I hope that in time the policy will produce results.

In my hon. Friend's constituency and parts of inner-city London, we are making available extra resources through the private finance initiative and through public-private partnerships to improve the primary care estate. We will not get GPs, district nurses and other primary care staff into these communities unless they are working in decent premises. The state of some of the premises that I have seen in the east end of London is pretty deplorable. That is not surprising because for decades—[Interruption.] The hon. Member for North-East Hertfordshire (Mr. Heald) is chuntering from the Opposition Front Bench. He might take responsibility for the lack of investment over many decades, precisely in communities where the health needs are greatest.

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Secondly, my hon. Friend is right to say that it is pointless for right hon. and hon. Members to argue in the Chamber, and even more so in their constituencies, for more money for their local health service when they voted against money for the national health service.

Mr. David Tredinnick (Bosworth): Does the Secretary of State accept that the deprived are often unable to access complementary medicine? The problem is a direct result of his policy of not requiring primary care trusts to look closely at buying in acupuncturists, homeopaths or herbal therapists. Is he aware that, until he does that, there will always be inequality throughout the nation? It is only those who can pay for the 60,000 complementary practitioners who can get their services.

Mr. Milburn: Question Time would not be Question Time without the hon. Gentleman. He is a ray of complementary therapy himself. As for primary care trusts and their freedom—[Interruption.] I know that he has some complementary medicine that he will pass to me later. That had better be a private transaction rather than a public one.

Primary care trusts are free to commission appropriate services and should do so. We are moving to a situation in which more such decisions should be taken locally rather than nationally. We will try to provide more information to patients and primary care trusts so that they can make the right commissioning decisions, but in the end, the decision must be a matter for them rather than me.

Mr. Dennis Turner (Wolverhampton, South-East): The Secretary of State will be aware that Wolverhampton and the black country, through poverty and deprivation, have the highest incidence of heart disease in the west midlands. He will also be aware that bricklayers, glaziers, roofers and carpenters are very soon to be on site giving their skills to building a state-of-the-art #60 million coronary care centre to which he has given his full support. What he is not aware of, however, is the wonderful black country welcome that he will receive when he comes to Wolverhampton in January. He will be as welcome as the flowers in May.

The Minister of State, Department of Health (Jacqui Smith): But not as pretty.

Mr. Milburn: It is as my hon. Friend says. One cannot have everything.

I am grateful to my hon. Friend the Member for Wolverhampton, South-East (Mr. Turner) for his support. There is absolutely no doubt that the cardiac centre is desperately needed in the part of the black country to which he refers. We have had to consider such issues not only in Wolverhampton, but in other areas such as Blackpool, where we recently met for the Labour party conference, and Teesside. My hon. Friend the Member for Stockton, South (Ms Taylor) has been advocating precisely such measures. When we considered the big diseases that were killing too many people in this country, we saw that there was a gap between where they occurred most and where treatment services were available. That gap had grown up over

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very many years. It is right to take corrective action so that we can locate services in the right places and save more lives.

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