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5. Dr. Richard Taylor (Wyre Forest) (Ind): What assessment she has made of the effects of the operation of the internal market in the national health service on staff morale and job numbers in trusts which lose service provision. 
The Secretary of State for Health (Ms Patricia Hewitt): We had ample opportunity to assess the disastrous effects of the NHS internal market that the Conservative Government introduced in the 1990s, which is why we scrapped it. By contrast, this Governments approach has seen record investment in the NHS with about 300,000 more staff compared with 1997, better pay and longer holidays for our NHS staff, more choice for patients and waiting lists at their lowest level since records began.
Dr. Taylor: I thank the Secretary of State for that reply. I was not allowed to use the word marketisation when I tabled the question, but marketisation certainly still exists. That was brought home to me by letters from constituentshighly skilled cytologists in the county of Worcestershire. That county has just lost the contract for its own cytology services to Gloucester, which is 40 to 50 miles away from where my constituents live. With the increasing impact of marketisation on health care, this problem will
Ms Hewitt: Thank you, Mr. Speaker. As it happens, I have had the opportunity to see the hon. Gentlemans column in his local newspaper, Kidderminsters The Shuttle, in which he objected to the fact that his local NHS was getting its cervical smear service in the most efficient way possible. I draw his attention to what Dr. Abudu, the cervical screening co-ordinator for the local primary care trust, saidthat the new cervical cancer screening service will give women faster and better results and that they will go on having their samples taken locally. Although I have great respect for the hon. Gentlemans clinical expertise, I would expect him to support his local NHS in getting the best value and the best services for his local constituents, which is
Paddy Tipping (Sherwood) (Lab): Is it not the case that the various royal colleges speak out strongly in favour of an internal market and service reconfiguration? What more can the Secretary of State do to ensure that senior consultants argue strongly for service reconfiguration when it is in the best interests of good clinical practice.
Ms Hewitt: My hon. Friend is absolutely right that clinicians need to be in the lead in deciding how best to organise local services and then in arguing the caseif the decisions are difficult, as they sometimes arewith the local public. I am glad to say that this morning we published two excellent clinical reports from the national clinical director for maternity and childrens services making the case for change and yesterday we published a report from the national clinical director for primary care services. That is exactly the kind of approach that the royal colleges are, I am glad to say, supporting.
Norman Lamb (North Norfolk) (LD): May I ask the Secretary of State about the impact that the private clinical assessment, treatment and support centresto which patients will be referred by their GPs, first in Cumbria and Lancashirewill have on what seems to me to be the internal market? Is not there a risk that these centres, with their guaranteed income, will distort the internal market, and directly undermine patient choice and staff morale? Might not they create the possibility of a conflict of interest in which the same group runs the treatment centre to which patients will be referred? Will they not also undermine the viability of local hospitals?
Clinical assessment and treatment services are an essential part of continuing to give patients better and faster care and, in particular, of ensuring that we achieve our goal of reducing waiting times to an absolute maximum of 18 weeks for most hospital operations by 2008. For most patients, of course, the waiting time will be far less. Whether those services are run by NHS organisations or by the independent sector will depend on decisions being
made in each region on how to get the best services and the best value for money. I hope that the hon. Gentleman will support that, because it is in the interest of patients.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): In recent years, there has been a steady increase in the number of GPs working in the Calderdale primary care trust area, and major improvements to primary care facilities.
Mrs. Riordan: I thank my hon. Friend for that reply. Hundreds of residents in the Mixenden area of my constituency have recently signed a petition calling for their local GP surgery, which is very popular and vocal in the community, to be included in the redevelopment plans for the area. Will the Minister outline what support his Department will give to the project to improve GP services in that part of Halifax?
Mr. Lewis: My hon. Friends constituents will welcome the announcement today of an additional £202,000 for capital investment in her primary care area. The local primary care trust is seeking additional GP hours at Horne street, in the centre of Halifax, for which I know my hon. Friend has been campaigning. Also, between 2001 and 2005, four new purpose-built practices have been built in the area, including the Horne street health centre, and there have been major extensions and refurbishments at a further eight practices. My hon. Friends local community has already seen massive investment in primary care as a consequence of this Governments policies, and I expect that to continue. I hope that she will continue to work in partnership with her primary care trust to continue the investment in primary care services.
Miss Anne McIntosh (Vale of York) (Con): I am sure that GPs and patients will benefit from GP services being opened up to enable them to do more clinical work, with less being done in hospitals. Does the Minister agree, however, that there should be no role for bureaucrats in the PCTs blocking referrals from Calderdale or other PCTs for any other reason than clinical need? On what grounds have 100,000 more managers and bureaucrats, who are blocking treatment on grounds other than clinical need, been appointed to the health service since 1997?
Mr. Lewis: That is a disgraceful attack on the integrity of the people who do their best to manage the health service in our local communities. What we really need is a proper partnership between the managers and the clinicianssupported, I hope, by responsible politiciansmaking the right decisions locally to meet the needs and expectations of patients. If the formula advocated by the hon. Ladys party were applied to her constituents, there would be a reduction in health expenditure in her constituency.
7. Dr. Evan Harris (Oxford, West and Abingdon) (LD): What assessment she has made of the number and nature of reductions in clinical and care services that may be required to achieve financial balance in the NHS in Oxfordshire. 
Dr. Harris: I am surprised that the Minister is unable to make an assessment about the service cuts, because Oxfordshire primary care trust has been forced to create restrictions, including those on consultant-to-consultant referrals, and on so-called low-priority treatments for hernias. It is now looking at placing restrictions on hysterectomy, tonsillectomy and D and C procedures. As someone who voted for the increased resources that the Government put in, and for the tax rises involved, will the Minister now explain what elective stretch is? Will he confirm that it involves forcing people to wait up to the maximum waiting time, as is now being proposed in Oxfordshire? That is not what we envisaged when the Government were talking about reducing waiting times.
Mr. Lewis: Does the hon. Gentleman welcomeI should like him to nod if he does, if that is allowedthe 17 per cent. increase in allocation for revenue over two years in his PCT area? Does he welcome todays announcement of an additional £1.4 million capital in his local PCT infrastructure, which is an increase from £1.1 million last year? It is not Liberal Democratic policy to spend one additional penny on the national health service
Mr. Andrew Smith (Oxford, East) (Lab): Will my hon. Friend join me in praising the accomplishment of staff at all levels in the NHS in Oxfordshire, not only in reducing the deficit, but in starting up the wonderful new childrens hospital that we have alongside £100 million of new investment to extend services relocated from the Radcliffe infirmary? Are not those achievements of which the NHS and the local community can truly be proud?
Mr. Lewis: At last, a right hon. Member who is talking up the national health service and paying tribute to the everyday heroesthe professionals on the front linewho are making a difference to the quality of patients lives. The reality is that much of the redirection of resources in local health economies is leading to enhanced services, resulting in services that patients need and want. I am proud of the fact that we treat children in our national health service no longer as little adults but as children, and ensure that they have access to the specialist services that they need and deserve.
Tony Baldry (Banbury) (Con):
Many of the changes in Oxfordshire that are causing concern are not cost driven; they are seemingly driven by a desire to centralise. Labours manifesto at the last general election promised
that mothers would have greater choice. If the recommendations of the Shribman report, published today, are followed through, that will reduce choice for mothers and threaten many valued maternity units, such as that at the Horton general hospital in Banbury. Why are this Government so hellbent on centralising NHS services?
Mr. Lewis: What women and fathers tell us they want from the whole experience of antenatal care, post-natal care and the actual birth is choice. That choice is home birth, or the opportunity to have the birth at a maternity-led unit or a consultant-led unit. What is important in every community is that we make a reality of that choice for home-based birth, midwife-led birth and consultant-led birth. When we produce our plan to deliver our commitment that by 2009 every parent in every community will have access to that choice, the hon. Gentleman will finally understand that we are responding to what parents tell us they want.
Mr. Boris Johnson (Henley) (Con): Some of my constituents have written to me to say that they cannot get vital cancer treatments on the NHS in Oxfordshire, but now have the opportunity to travel and make use of addresses in Scotland, where such treatments are free. What advice, encouragement or support can the Minister offer such patients?
Mr. Lewis: Does the hon. Gentleman support the role of the National Institute for Health and Clinical Excellence, because the Conservative party needs to make that clear? How dare he talk about cancer care when waiting lists and waiting times are at record low levels? The scandal was that too many people died unnecessarily because of the disinvestment in the health service under the Conservatives.
The Minister of State, Department of Health (Andy Burnham): The NHS LIFT scheme is delivering modern surgery facilities that co-locate a range of services offered in the heart of deprived communities. To date, 107 super-surgeries have opened under the LIFT scheme and a further 80 are under construction. Throughout 2006, on average one facility opened every weeka rate of progress we expect to continue throughout 2007.
Dr. Palmer: I thank the Minister for that reply. In my constituency, the LIFT centre in Stapleford serves 18,500 of my constituentsnearly a quarter of the whole constituencywith a range of services from health to dentistry to social services and many others that were not available locally before. In my last question at Health questions, I asked Ministers about the difficult reorganisation of secondary services in Nottingham. In this question, I ask the Minister to reinforce success. As my hon. Friend the Member for Bolton, South-East (Dr. Iddon) says, prevention is better than cure; let us reinforce the primary health sector.
Andy Burnham: I could not agree more with my hon. Friend. The Stapleford care centre scheme is an excellent example of the success story that is LIFT. It has quietly got on with investing £1.2 billion in some of the most deprived communities in the country, which often have the poorest primary care services, and is delivering for constituents such as those of my hon. Friend. The extra time that we have allowed Nottingham University Hospitals NHS Trust may provide breathing space which will allow staff to work in the new community facilities that have been created in my hon. Friends constituency and others nearby.
Mr. Owen Paterson (North Shropshire) (Con): The maternity unit in Oswestry closed last Wednesday, and there is huge public pressure for it to be reopened as a demountable unit. Would LIFT funds be relevant to such an operation? I shall be visiting the strategic health authority tomorrow; would the Minister like to ring the chairman and chief executive before my meeting?
Andy Burnham: I commend the hon. Gentleman on his opportunism, but LIFT relates to primary care facilities throughout the country. We have heard him make his point about his constituency, but I think he should be focusing his attention on what his party will do to improve primary care in the same way as the Government.
Charlotte Atkins (Staffordshire, Moorlands) (Lab): How does the 30 per cent. increase in capital funding for PCTs fit in with the LIFT scheme? Should the Government not be focusing investment much more on dental practices, so that areas such as Biddulph in my constituency can have new NHS dental surgeries?
Andy Burnham: My hon. Friend is absolutely right. Only today we announced £60 million of capital for primary care trusts across the country to invest in improving dental facilities for communities like my hon. Friends, and her PCT will benefit from the extra cash.
The truth is that more dentists and more GPs are working in our communities. There is more to be done to ensure that people everywhere have access to the highest-quality primary care services, but we have a strategy to provide new buildings through the LIFT scheme and recruit extra staff to work in some of the most deprived communities in this country.
Mr. Stephen O'Brien (Eddisbury) (Con): What is the Minister doing to ensure that the exclusivity given to LIFT companies is not deterring or deferring other interested investors from building new GP surgeries, community hospitals and other core services in LIFTCo areas?
Andy Burnham: The hon. Gentleman makes the point very well. A mixture of investment is being made in primary care: LIFT is one example, but other forms of finance are also improving primary care facilities. What is important is not the means by which funds are delivered, but ensuring that facilities are built quickly so that we can rapidly improve primary care in communitiesparticularly those that need enhanced primary care servicesand prevent the ill health to which Labour Members have referred.
The Minister of State, Department of Health (Caroline Flint): Improving public health relies on the engagement of many partners in the private, public and voluntary sectors, as well as individuals and their families. There are many examples of private sector employers making a positive contribution, and of key agents contributing to improving public health.
Andrew George: Contrary to what the Secretary of State told my hon. Friend the Member for North Norfolk (Norman Lamb) a few moments ago, the Government gave PCTs no choice but to enter into private contracts with providers of non-complex, non-urgent procedures. Those private treatment centres are still being paid regardless of whether they complete the work. Have the Minister and the Government made any assessment of how much taxpayers money has been wasted on those contracts, and on contracts like them?
Caroline Flint: What is clear is that 480,000 people have already benefited from access to independent treatment centres. The way in which the NHS used to buy from the independent sectorthe old-style ad hoc spot-purchase procedureled to the paying out of more than 40 per cent. of the cost of the same sort of service. Bulk procurement has cut the cost of doing business with the independent sector.
I am pleased to say that the Plymouth and Bodmin treatment centres are on target for up to 100 per cent. capacity. I am sure the hon. Gentleman would not want to suggest that his constituents should not benefit from quicker and good access to health care.
Kitty Ussher (Burnley) (Lab): I was very taken when I visited a pharmacist in my constituency recentlyCoopers chemist on Abel street in Burnleyby quite how much work it does in the field of public health, such as in methadone administration and smoking cessation. Is that a model that my hon. Friend the Minister hopes to build on?
Caroline Flint: I thank my hon. Friend for that contribution. Our partnership with pharmacists has grown and grown. Chlamydia testing is happening throughout London through Boots, many pharmacists provide blood pressure testing, and I am pleased to say that next week the Co-op is promoting condom use as part of our safe sex strategy. I will be down at the Co-op in Rossington to support that, and I hope that every Member will take the opportunity to support their local Co-op in promoting good sexual health. However, we have not begun to realise the contribution that pharmacists can make in providing the best quality services at the most local level for the people whom we all represent.
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