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House of Commons

Tuesday 20 June 2006

The House met at half-past Two o’clock


[Mr. Speaker in the Chair]

message from the queen

double taxation relief

The vice-chamberlain of the household reported Her Majesty’s Answer to the Address, as follows:

I have received your Addresses praying that the Double Taxation Relief (Taxes on Income) (Botswana) Order 2006, and the Double Taxation Relief (Taxes on Income) (Japan) Order 2006, be made in the form of the drafts laid before your House on 20 April 2006.

I will comply with your request.

Oral Answers to Questions


The Secretary of State was asked—

National Performance Targets

1. Dr. Vincent Cable (Twickenham) (LD): How many whole-time equivalent NHS staff are employed in monitoring and reporting on national performance targets; and how many there were in 1996. [78460]

The Secretary of State for Health (Ms Patricia Hewitt): The data are not held centrally. However, we are committed to reducing the number of national targets. That number has reduced from 28 in 1996 to 20 for the current three-year planning round.

Dr. Cable: If the Secretary of State cannot answer the question directly, does she accept that the need for constantly collecting information and reporting on targets is a significant contribution to the doubling of management staff since she took office, as opposed to a 30 per cent. increase in medical staff? Is she aware that if management staff had increased at the same pace as medical staff, there would be 12,000 fewer and the NHS would have saved about £500 million a year—a large part of its deficit?

Ms Hewitt: No, I do not agree, and the hon. Gentleman is absolutely wrong. The proportion of the NHS budget that is spent on management and senior management has gone down. It was 5 per cent. and it has gone down to below 4 per cent. in the latest figures. There are 10 nurses now for every manager, as there
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should be. The hon. Gentleman’s implication that good health care does not require good management is nonsense. I have great respect for him and he ought to know better than to suggest that.

Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab): In respect of reducing national performance targets still further, will my right hon. Friend be cautious about reducing performance targets in relation to mental health, since there is evidence already that mental health is regarded as a rather low priority by many primary care trusts? For example, the Milton Keynes PCT is targeting mental health services in trying to get within budget.

Ms Hewitt: I understand my hon. Friend’s concern about the impact of the overspending in a minority of organisations on the rest of the service, including on mental health services. The Minister of State, my hon. Friend the Member for Doncaster, Central (Ms Winterton) this morning launched a further document on the improvements that we need to continue seeing in mental health services specifically. I think she would agree that simply adding constantly to the number of national targets is not always the best way to ensure that local staff and local hospitals can respond in the best way possible to the needs of their local community, and ensure that they are delivering the best health care within the substantially increased budgets that we have given them.

Tony Baldry (Banbury) (Con): How does the Secretary of State justify the Oxford Radcliffe Hospitals NHS Trust losing 600 NHS posts, including managers? She might like to reflect on the fact that on Sunday some 5,000 of my constituents, along with Labour councillors and representatives of Unison, the Transport and General Workers Union and the GMB, all gathered together to express concern about what is happening to the health service in Oxfordshire, and to the Oxford Radcliffe Hospitals NHS Trust in particular.

Ms Hewitt: Of course I understand the concerns that the hon. Gentleman raises, which are reflected among his constituents and among the staff and their unions. Let me reassure him, and particularly the staff, who face a very anxious time, that the Oxford Radcliffe and any other hospital in a similar situation will do everything it can to avoid compulsory redundancies and to support staff to be redeployed, where necessary, to new jobs. Does the hon. Gentleman accept, however, that with medical technology changing, and with huge and unacceptable variations in the quality of care and the value that is given to patients by different hospitals, it must be right to expect hospitals to use new medical technology and best practice to become as effective as possible in their use of resources? That means difficult decisions in some places, but we should have the courage to take them, and he should have the honesty to support them.

Mr. Lindsay Hoyle (Chorley) (Lab): At the previous Health questions, I raised a problem involving staff at NHS Direct. I was promised a meeting with a Minister, but it has not taken place and I cannot understand why. In addition, the chief executive of NHS Direct has still
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not responded to my correspondence. I wonder whether the Secretary of State will ensure that a meeting takes place quickly. Jobs are going down the road, which is not good enough, and it is time for the Department to be put into order.

Ms Hewitt: I am extremely sorry that my hon. Friend has received neither a reply nor a meeting, although I understand that my noble Friend Lord Warner, the Minister with responsibility for health service reform, had to attend a debate in the other place when that meeting should have taken place. Another date and time that suits my hon. Friend will be organised as quickly as possible, and I will ensure that that meeting happens and that he gets a reply to his letter.

Steve Webb (Northavon) (LD): The Secretary of State will be aware that the monitoring of performance targets is undertaken not only by NHS staff, but by patients’ groups. Will she therefore urgently investigate the case of Queen Mary’s hospital in Sidcup, which has had problems with hygiene in the past and which has reportedly cancelled two inspections by its own patients’ forum—it has told the patients’ forum that it cannot investigate hygiene by using torches to look under beds? Will she investigate that refusal to participate?

Ms Hewitt: Of course I will examine that specific case, of which I was not aware. The Healthcare Commission routinely inspects all health care providers to make sure that they are raising standards to the highest possible level. The hon. Gentleman has made the extremely important point that inspecting and reporting on the quality of care, which requires a certain amount of management time, is essential if we are to give patients the best possible care, which is what we all want.

Mr. Ken Purchase (Wolverhampton, North-East) (Lab/Co-op): I support good management in every establishment. Good management has contributed wonderfully to the stupendous improvements that we have enjoyed in our health service in recent years. [ Interruption.] I am pleased that those who have not enjoyed the great care that we get in our hospitals have avoided the experience, but if they had had the great misfortune to be ill, they would have been cared for magnificently in our NHS. My local hospital trust meets its performance targets, which still need to be refined. I say that where there is bad management, it should be cured hospital by hospital. The blanket approach has resulted in my local authority paying £500,000 for a benchmarking exercise, which cannot be explained simply by the current cuts.

Mr. Speaker: Perhaps on future occasions the hon. Gentleman will take half the time to ask his question.

Ms Hewitt: My hon. Friend rightly refers to the exceptional improvements in many aspects of NHS care. Indeed, he might have been thinking of the improvements in accident and emergency that have got rid of those appalling trolley waits, which was a direct result of our target. The benchmarking exercise to which my hon. Friend refers is one of many ways in
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which every hospital can examine its own performance to see where it can do even better and improve its care to patients. My hon. Friend supports such improvements, and we will ensure that they continue.

Anticholinesterase Drugs

2. Paddy Tipping (Sherwood) (Lab): What recent representations she has received on the prescribing of anticholinesterase drugs to people in the early stages of Alzheimer’s disease. [78461]

The Minister of State, Department of Health (Andy Burnham): Ministers have received a number of representations on the availability of those drugs in the context of the drugs’ ongoing appraisal by the National Institute for Health and Clinical Excellence. I have also recently met representatives of the Alzheimer’s Society, the Royal College of Psychiatrists and the Royal College of Nursing to hear their views.

Paddy Tipping: In those meetings, did the Minister note the strong feeling among patients, carers and clinicians that the early prescription of these drugs leads to a higher quality and longer life? All those people believe that early prescription slows long-term decline—what is the Minister’s view?

Andy Burnham: I am aware of those strong feelings. It is crucial that the appraisal process is carried out properly, and, as my hon. Friend knows, the process is still ongoing. Independent clinical experts should be the ultimate arbiters, but it is also right that the strength of feeling among patients throughout this country is voiced through their parliamentary representatives, which my hon. Friend has done today.

Ann Winterton (Congleton) (Con): Is it not morally wrong that people with dementia are prevented from having the relatively inexpensive drugs that will prevent their dementia from getting worse? Preventing people from having those drugs is a false economy, because when dementia deepens, the cost of looking after the patient is much greater.

Andy Burnham: The National Institute for Health and Clinical Excellence was set up to take on the difficult questions that we face in judging the clinical effectiveness of treatments against their cost-effectiveness. The hon. Lady would perhaps be the first to complain if that judgment was being made by Ministers. It is important to make it clear that existing patients will not be affected and will continue to receive these treatments. However, we all want the process to be conducted fairly and, ultimately, an independent judgment to be made on the evidence.

Joan Walley (Stoke-on-Trent, North) (Lab): Having been to local meetings of people concerned about the use of these drugs, I know that it is a huge benefit for people to able to have them in the early stages of Alzheimer’s disease. When my hon. Friend speaks to NICE, will he ask it to consider the contribution that the drugs make to a more independent, less stressed, and perhaps even happier life?

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Andy Burnham: The NICE process has been undertaken with unprecedented thoroughness. My hon. Friend refers to the early stages of the disease, and the use of drugs at that time is precisely the issue that is being examined in depth and will be considered during the appeals process. I am sure that the strength of feeling that she represents will be heard, but ultimately it is right that an independent judgment is made by experts in that illness.

Sir Nicholas Winterton (Macclesfield) (Con): May I declare an interest in that I am patron of the east Cheshire branch of the Alzheimer’s Society and therefore take a huge and close interest in this subject? Does the Minister accept that society has a duty to enable those who suffer from Alzheimer’s, even those in the early stages of the disease, to have the best quality of life that is available to them, and that that means the use of the most advanced drugs? Will he ensure that the best drugs are available to give those with Alzheimer’s the best quality of life that this House would wish them to have?

Andy Burnham: Of course, there will be no division between Members in wanting to ensure that people get the best quality of life that they can. That is precisely what NICE is considering in terms of the difficult judgment that must be made. As a former Chair of the Health Committee, the hon. Gentleman will know that a balance must be struck between the available resources and the benefits that this treatment can offer. We have collectively asked NICE to investigate these difficult questions for us, and we all have a duty to support it through this difficult process and ultimately to consider fairly its recommendations.

Mr. David Kidney (Stafford) (Lab): Does it worry my hon. Friend that if the NICE guidance is implemented there will be less support in future for patients in the early stages of Alzheimer’s? Can he at least give assurances about the things that matter to those patients and their carers: early identification of Alzheimer’s cases; more support for the patient, the family and the carer; and more research into finding treatments that will be effective in the early stages of the disease?

Andy Burnham: I can certainly assure my hon. Friend on his last point. Research into those matters is hugely important. Of course, I am not a clinician, which is why it is important that the NICE appraisal process carefully considers questions about the early stages of Alzheimer’s and makes its judgment on whether there is evidence to support the arguments that he and other hon. Members are making. It is right that that process should be allowed to run its course, and it would be wrong for me to prejudice it. I am pleased that my hon. Friend and other hon. Members have expressed their points of view, and I am sure that they will be heard beyond this House.

Mr. John Baron (Billericay) (Con): Despite what the Minister says, he will have to accept that NICE has confirmed that these drugs are clinically effective but that people will now have to wait longer before receiving them. That is not only harsh but contradicts
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the Government’s own policy of early diagnosis and intervention. Given that, last year, the Government asked NICE to re-examine whether its model of cost-effectiveness took full account of the complexities of this case, particularly the impact that withdrawing those drugs would have on carer time and quality of life, is he completely satisfied that NICE has addressed those specific concerns; and if not, what further action does he propose to take?

Andy Burnham: The hon. Gentleman must accept that the appraisal process that NICE has gone through is extremely detailed and that it has examined all the available evidence. Indeed, the appraisal process continues—it is right that it should do so and that the questions that he identifies are properly considered. However, is it right for us to second-guess the independent experts? Is it right that we should set up NICE only to undermine—

Mr. Speaker: Order. It is best to answer the question.

Obese Children

3. Chris Bryant (Rhondda) (Lab): How many children in England are estimated to be (a) obese and (b) morbidly obese. [78462]

The Minister of State, Department of Health (Caroline Flint): The main source of data on childhood obesity is the health survey for England. According to the latest survey, 19.2 per cent. of boys and 18.5 per cent. of girls aged two to 15 were classified as obese. We are unable to provide estimates for morbid obesity in children, as there is no specific definition above which a child can be considered morbidly obese.

Chris Bryant: Does not that show that we have a virtual epidemic of obesity that affects our young children? However many positive messages parents and schools try to convey about exercise and eating healthily, the real problem is that advertisers pump out negative messages day after day about eating junk food and having drinks that are not good for children. Will my hon. Friend make representations to Ofcom to ban advertising junk food to children, not only during the day but during the programmes that they watch, including “Coronation Street”?

Caroline Flint: My hon. Friend is right to highlight concerns about obesity in children. He is also right to make the point about parents making informed choices. That is why we have worked to encourage the industry to introduce front-of-pack labelling and asked for the consultation about the promotion of high fat, high salt and high sugar foods to children. The consultation ends on 30 June, so everyone has time to make their views known. The options include a 50 per cent. reduction in the number of advertisements that promote high fat, high salt and high sugar foods and drinks to children. There is a healthy debate on the issue and I urge everyone inside and outside the House to make their views known.

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Dr. Andrew Murrison (Westbury) (Con): Given that, over the past decade, childhood obesity in some groups has nearly doubled and that British children are getting fatter faster than children anywhere else in Europe, does the Minister share our alarm at February’s National Audit Office report, which suggests that poor co-ordination, inadequate leadership and a tendency to apply myriad initiatives that lack a credible evidence base can be blamed for the complete failure of that important aspect of Government public health policy?

Caroline Flint: Of course, the problem has been developing over the past 20 years. Children do less exercise, the Playstation is often more important than the bicycle and parents obviously have to make choices. The NAO report made some suggestions for improvement, and several matters have been improved since it carried out its first research. We now have clearer guidance to clinicians on outcomes at general practitioner surgeries, we have provided a weight loss guide and obesity care pathways to primary care clinicians and we are examining options for treatment programmes. That is happening as well as all our work with the food industry on labelling, reformulation and, of course, promotion. The hon. Gentleman would agree that the subject is complex. The Government, the health service and the food industry have a role to play but so have the public in making the right choices for children.

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