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Ms Dari Taylor (Stockton, South) (Lab):
My right hon. Friend will know that the science and practice of IVF treatment has moved on. More and more, there is a desire for single embryo transfer, which would reduce health hazards and be beneficial for both mothers and babies. The point has been made around the Chamber
today that until we have a clear statement from the Minister about what one full cycle iswhether that is three single embryo transfers and whether that would be universally acceptablesingle embryo transfer will not happen.
Dawn Primarolo: I congratulate my hon. Friend and the hon. Member for South Cambridgeshire (Mr. Lansley), who are members of the all-party group on infertility, which today published an excellent report covering many of those areas and which I have had a chance to consider. With regard to her specific point, the Human Fertilisation and Embryology Authority is considering the matter and is to advise me of the precise points that are raised in the report. I will certainly make that information available to Parliament when I have it.
8. Roger Berry (Kingswood) (Lab): What action has been taken to ensure that people with a learning disability are safeguarded in the NHS since the publication of the National Patient Safety Agencys 2004 report, Understanding the patient safety issues for people with learning disabilities. 
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): We have taken a number of steps, including the NPSA published guidance on supporting adults who have learning disabilities and swallowing difficulties; the Healthcare Commission audit of learning disability services; our work on developing a response to the report from the Disability Rights Commission; the establishment of an independent inquiry following Mencaps report, Death by Indifference; and our commitment to refresh the White Paper, Valuing People.
Roger Berry: I am grateful for my hon. Friends reply. The health inequalities of people with a learning disability have been well known for many years, thanks to the work of the Government, Mencap, the DRC and many others. What plans do the Government have to introduce annual health checks for people with a learning disability, and how is the treatment of those people to be monitored and evaluated?
Mr. Lewis: I agree entirely with my hon. Friendthat has been a source of concern for some considerable time. We have evidence that the system is nowhere near good enough in terms of access to primary and acute NHS care. There is a commitment on the table to regular screening of people with learning disabilities, particularly where they are at high risk of particular health conditions. For example, we have had discussions with GPs as part of contractual negotiations on the question of a guaranteed commitment to screening. Unfortunately, thus far we have not been able to reach agreement on that issue, but it remains Government policy. Ensuring that the NHS, at every level, takes its responsibilities to treat people with learning disabilities as it would treat any other patient is a top prioritythat is non-negotiable. We need to look at all the levers that are available to us to ensure that primary care and acute services treat people with learning disabilities as equal citizens as regards accessing the health service.
Dr. Brian Iddon (Bolton, South-East) (Lab): It is common for people with Downs syndrome to have heart defectsthey are born that way. In 1997, it was very difficult to get those conditions treated in the NHS. Will my hon. Friend join me in congratulating the Downs Syndrome Association on carrying out its vigorous campaign in the early days of this Government, which has helped to change the culture of the NHS and introduce training for medical students about people with all learning difficulties?
Mr. Lewis: I agree entirely with my hon. Friend. The access of people with Downs syndrome to specialist heart care is absolutely crucial to their longevity and quality of life. A constituent of mine, Mr. Alan Quinn, has a daughter with a learning disability and Downs syndrome who recently went into Alder Hey hospital for such heart surgery and had excellent NHS care. He is regularly keeping me updated with her progress. There have been tremendous advances in that specialist support, particularly for people with Downs syndrome, but we need to do a lot better.
The Parliamentary Under-Secretary of State for Health (Ann Keen): I thank my hon. Friend for her question, which gives me the opportunity to say that oral health in England is the best since records began. The proportion of 12-year-old children with decayed teeth fell from 93 per cent. in 1973 to 38 per cent. in 2003. Over a similar period the number, of adults with no natural teeth fell from 38 per cent. to 11 per cent. of the adult population.
Charlotte Atkins: I warmly welcome my hon. Friend to her new role, which is richly deserved. Does she recognise the beneficial effects of fluoridated water to dental health, given the stark contrast between the good dental health of children in the fluoridated Birmingham area and that of those in the Manchester area, which is not fluoridated? What will she do to encourage strategic health authorities to promote fluoridation in areas where tooth decay among children is unacceptably high? After 2008, for the very first time, the British Fluoridation Society will no longer benefit from central funding. I am concerned that strategic health authorities are falling behind
I thank my hon. Friend for her comments. I agree that fluoridation of water offers the best prospect of reducing inequalities in oral health. That is why we have amended relevant legislation to give local communities a real choice on whether to have fluoridated water. I congratulate her on becoming known as a champion by the British Fluoridation Society, and for the work that it has done. Strategic health authorities will have guidance from our Department, but the consultation will remain local. I am pleased to say that funding has been acquired until the point at which we look at the issue again, but I assure her that we shall monitor the situation carefully.
Mr. James Gray (North Wiltshire) (Con): Oral hygiene in England is of the highest standard, partly because of the advances of medical science. However, does the Minister agree that unless we can find a way of reviving the provision of dental hygiene on the national health servicein a county such as Wiltshire, it is virtually non-existentthose high standards of oral health will inevitably decline?
Ann Keen: I congratulate the hon. Gentleman on the work he has done in the area of dental care. Oral hygiene is paramount to the prevention of decay, and we have continued to train and re-train technologists and dental hygienists, and to encourage local PCTs to get involved in the commissioning of such work.
Mr. Ian Cawsey (Brigg and Goole) (Lab): I welcome my hon. Friend to her new role. I am sure that she agrees that better dental health would be helped by better NHS provision, particularly in our poorer communities. I recently met a constituent who is training to be a dentist, and wishes to be an NHS dentist, but the practice she is placed with, which does NHS work, will take her on only if she solely does private work. That is because the NHS now pays for procedure, and newly qualified dentists take too long to do them. Is it not time that the Department considered requiring newly trained dentists to spend part of their career in the NHS? Otherwise, what is the point of the taxpayer paying to increase the number of training places?
Ann Keen: My hon. Friend raises a good point. The contract that has been put in place recently is working well, but there is always room to consider everything and make progress, so I am very interested in his remarks.
Richard Younger-Ross (Teignbridge) (LD): The Ministers predecessor, along with Teignbridge district council, the Teignbridge primary care trust, myself and a local dentist, helped to provide good quality dental care for anyone in Teignbridge who wanted it. I congratulate her predecessors work for the Department on that. The new Devon primary care trust, however, is telling dentists in Teignbridge that they have to take new patients from anywhere in the county, which will undo all the good work of her predecessor. Will she consider that issue and find a way to protect the services provided by the dentists of Teignbridge to local residents?
Ann Keen: I suggest that as the local Member of Parliament, the hon. Gentleman engage in a serious conversation with the PCT and that a consultation is carried out with the local community. I am sure that that would help them to decide their future.
The Parliamentary Under-Secretary of State for Health (Ann Keen):
Primary care trusts salaried dentists already provide services for patients in some health
centres and I agree that including a wider range of NHS primary care dental services would definitely benefit patients. The dental reforms launched last year give primary care trusts greater flexibility to locate NHS dental practices in health centresa practice with which I firmly agree.
Dr. Nick Palmer (Broxtowe) (Lab): I congratulate my hon. Friend on her new position. Does she agree that one of the traditional problems with retaining dentists in the national health service is that some choose to build up a practice using the NHS, only to turn around and tell their patients that they are going private, and that if they want to keep their dentists they must go private, too. The Stapleford care centre in my constituency has retained the surgery and has dentists working there on condition that, if they leave the NHS, they must also leave the surgery. I commend that as a model of retaining dentists in the NHS.
Ann Keen: I thank my hon. Friend for that information. Stapleford health centre should be congratulated. It is good policy and practice, and the way in which health care could and should be delivered in future, when health centres share not only dentists, but pharmacists and all the aspects of health care that the community requires. That forms part of some reconfigurations, and is certainly part of Lord Ara Darzis review.
In order to receive funding, Dentists are required to meet Government targets that leave them without the time they would like to spend on patients to provide appropriate preventative care.
Mr. Paul Truswell (Pudsey) (Lab): In autumn this year, a new local improvement finance trustLIFThealth centre opens in Yeadon in my constituency. Will my hon. Friend ensure that Leeds PCT takes all the appropriate steps to provide the two dental chairs that have long been promised to tackle the shortage of NHS treatment in the area?
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): The Department has received 22 representations on the funding of childrens palliative care and childrens hospices in the past six months.
Bob Spink: I know that the Under-Secretary will join me in paying the warmest possible tribute to those who work in and volunteer for childrens palliative care. I am grateful to the former Prime Minister for his personal help in getting the £27 million stop-gap funding and the review of funding for childrens hospices.
The Association for Childrens Palliative Care and the Association of Childrens Hospices want childrens palliative care services to be included in the national indicator for disabled children that is currently being developed as part of the public service agreements for the next comprehensive spending review. Will the Under-Secretary delight the House by saying today that he will consider that suggestion favourably? [Interruption.]
Mr. Lewis: As my right hon. Friend the Secretary of State says, I always delight the House. It is a good sign when the Secretary of State says that, but I am not sure whether any other hon. Members would agree. Although I might delight the House with such a commitment, it could be a seriously career-limiting announcement. Of course, decisions about PSAs will be made in the context of our comprehensive spending review settlement. However, the £27 million that we have made available, the independent review that we have commissioned and our commitment to publish a national strategy on palliative care for children, alongside the significant investment in supporting disabled children and their families, mean that the specific needs of palliative care for children will have a high priority in the period ahead.
Mr. Stephen O'Brien (Eddisbury) (Con): To be realistic, given that the Government have broken their promise and failed to fulfil their manifesto commitment to double investment for palliative care, broken the former Chancellors compact with the voluntary sector by using charitable gifts to subsidise NHS care, broken their promise to implement payment by results for palliative care and continue to insult childrens hospices by funding them at 4.5 per cent. compared with 32 per cent. for adult hospices, will the Under-Secretary now steal and implement our policies of equal funding for childrens hospices and a national tariff for palliative care?
Mr. Lewis: The problem with the hon. Gentlemans point is that the Conservative party makes all sorts of uncosted spending commitments while simultaneously suggesting that it will cut taxes if it ever returns to power. That is an entirely disingenuous position. When the Conservative party was in power, hospices were expected to depend far more heavily on charitable donations. The Government have started to make significant state investment available for hospices for the first time, including a recent major capital investment. There is much more to do, but we will take no lessons from the Conservative party on hospice funding.
The Parliamentary Under-Secretary of State for Health (Ann Keen):
We already have the hygiene code
and an action programme to tackle health care-associated infections, including MRSA. However, the issue remains a priority, and we recently announced an extra £50 million to support local initiatives for front-line staff.
I thank the Minister for her answer and I am pleased to hear that the issue is a priority. May I draw her and the Houses attention to the situation in our care homes, where cases of MRSA and clostridium difficile have doubled in recent years? Does the Department have any plans to tackle that
growing problem or is it another case where, as with the report on nutritional standards in care homes, the needs of our elderly people in care homes are not being met?
Ann Keen: The needs of elderly people in our care homes are a high priority, and they always will be to me. We have doubled our teams to help in acute trusts. We need to look at the same co-operation with social services for care homes because the incidence of MRSA in them is far too high. We have a lot to do on training and skills to see how we can correct that.
The Secretary of State for Transport (Ruth Kelly): With permission, I would like to make a statement about how the Government intend to strengthen the countrys railways over the next seven years and beyond. Our proposal is the most ambitious strategy for growth on the railways in more than 50 years. This statement is being made against a background not of decline or crisis, as in the past, but of remarkable success for our railway network.
Of course, anyone who travels regularly by rail, as many of us in the House do, will know that big challenges remain before our country has the rail system that it needs. There is no room for complacency, but the measures put in place since the Hatfield tragedy mean that our railways are safer than ever before. Reliability, which declined sharply after Hatfield, is improving strongly on most lines and passenger satisfaction has improved. There has been sustained investment in the network, such as in the modernisation of the west coast main line and in new rolling stock. The result is that more freight and more people are travelling by rail than at any time for 50 years.
Our challenge today is not about managing decline. Instead, it is about how we can build on that solid progress to provide a railway that carries more passengers on more and better trains, and on more frequent, reliable, safe and affordable services. That needs the Government, working with the industry, the regulator and passenger groups, to take action in three main areas: first, to secure continued improvements in safety and reliability; secondly, to achieve a major increase in capacity to meet rising demand; and, thirdly, to deliver sustained investment through a fair deal for passengers and the taxpayer. Let me take each in turn.
Safety has improved and reliability is back to the levels seen before Hatfield, even though we are running many more trains. Those who work on our railways deserve credit for their focus. The White Paper sets out how we intend to continue reducing the risks to passengers and staff on our railways. We also intend to build on the improvements in reliability. Currently, 88 per cent. of services arrive on time. By 2014, I want that figure to reach 92.6 per cent., through investment in new rolling stock, maintenance and equipment, which would make our railway one of the most reliable in Europe. For the first time, we will require the industry to concentrate on cutting by one quarter delays of more than 30 minutes, which cause the most inconvenience to passengers.
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