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House of Commons

Tuesday 4 November 2008

The House met at half-past Two o’clock


[Mr. Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—

Patient Administration Systems

1. Dr. John Pugh (Southport) (LD): What progress has been made on the deployment of patient administration systems in hospitals. [232530]

The Minister of State, Department of Health (Mr. Ben Bradshaw): There have been 141 patient administration systems deployments in total, including 43 in acute hospitals, 23 in mental health trusts and 75 in primary care trusts.

Dr. Pugh: I thank the Minister for that ingenious reply, but the Financial Times last week said of the new systems that in the north, planned implementation has not happened and in the south, the contractor has been fired, and that hospital bosses generally believe that the project is near to death. Which bit of “not working” does the Minister not understand? Is it not time for a review?

Mr. Bradshaw: No; the hon. Gentleman is getting confused between full implementation and connection with the national spine in acute trusts, and the implementation of patient administration systems in general, in many cases, which has been very successful. We acknowledge that there are problems; there are always problems with computer systems on such a massive scale—the biggest IT programme in the world. There have been problems with its introduction in acute trusts, which have between 40 and 60 systems of their own, but we are working very hard, including with his local acute trust, with the provider and with Connecting for Health, to try to resolve the problems as soon as possible.

Mr. Kevin Barron (Rother Valley) (Lab): How necessary does my hon. Friend believe it to be, particularly in acute trusts, for the patient administration systems to be capable of passing on electronically patient discharge notes, so that we do not wait days and days when patients are back in the community, but wait seconds?

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Mr. Bradshaw: My right hon. Friend makes a very important point in highlighting one of the real benefits of a computerised health care system, not only regarding discharge notes, but so that clinicians can exchange in real-time information about patients. Any hon. Member who has visited any systems that are already up and running successfully will have heard not just from patients but from doctors and other health professionals about the benefits that they bring to patient care.

Mr. Richard Bacon (South Norfolk) (Con): Can the Minister confirm that one of the risks that the Royal Free hospital has identified is that some of its patients may be exposed to a double dose in the radiology department because of flaws in the Cerner Millennium system?

Mr. Bradshaw: That is one of the reasons why the implementation at the Royal Free hospital has been stopped for the time being. Active discussions have been going on between the strategic health authority in London, Connecting for Health and the Royal Free to ensure that exactly what the hon. Gentleman fears could happen, could not do so. That is why the system has not been carried forward at this time.

Mark Hunter (Cheadle) (LD): The patient administration system is not the only one going wrong in the health service at the moment. Has the Minister had any opportunity to review the progress being made with choose and book? Does he understand the very significant difficulties that it causes for the very many people who do not find the system at all customer friendly?

Mr. Bradshaw: On the contrary, in many parts of the country, choose and book is operating extremely successfully. It is one of the great success stories of the national programme for IT. However, the hon. Gentleman is absolutely right that in some primary care trust areas, performance is quite unacceptable. We are working very closely with those primary care trust laggards who are not performing very well on choose and book to ensure that they come up to the performance standards of others.

Mr. Stephen O'Brien (Eddisbury) (Con): With £12 billion at risk, choose and book, and electronic prescriptions, still 50 per cent. and 75 per cent. behind the Government’s target for completion last year, and fewer than 0.5 per cent. of electronic records uploaded against their target of 100 per cent. by next month, will the Minister say how many lives have been lost, delays suffered and mistakes made—affecting patients and their loved ones—that would have been avoided but for his Government’s ongoing failure to design and implement a health care IT system on time and that works?

Mr. Bradshaw: The hon. Gentleman knows quite well that the £14 billion is not at risk, because he knows that one very important part of the contract—

Mr. O'Brien: It is £12 billion.

Mr. Bradshaw: Or the £12 billion. The hon. Gentleman knows that one very important part of the contract is that the costs of any delay are incurred by the supplier not by the taxpayer. That is a result of the excellent
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contract that the Government drew up. He knows also that the independent National Audit Office confirmed in its report earlier this year that progress was being made in all parts of the programme, and that that was bringing real benefits in terms of in-patient care, saving lives and saving taxpayers’ money.

Andrew Mackinlay (Thurrock) (Lab): Will the Minister investigate the London teaching hospitals, some of which are abusing choose and book, and even ignoring it in some cases? The Healthcare Commission is aware of the issue. It is a scandal; it is the fiddling of figures, and it is now time that the Minister, or the Secretary of State for Health himself, undertook a search and scratched the surface on the matter. London teaching hospitals are abusing the system.

Mr. Bradshaw: I shall certainly look into the points that my hon. Friend raises, but he is right to raise the concerns that were expressed on the publication a couple of weeks ago of the Healthcare Commission’s annual health check, which highlighted, as I said in response to a question from the Liberal Democrat Benches, the very big variability in the performance of PCTs and trusts on the use of choose and book. That is completely unacceptable, and I shall look into the matters that my hon. Friend raises.

Mental Health Act 1983 (Sectioning)

3. Tim Loughton (East Worthing and Shoreham) (Con): How many people have been sectioned under the Mental Health Act 1983 in the past 12 months. [232532]

The Minister of State, Department of Health (Phil Hope): In England in 2007-08, the most recent year for which information is available, there were 28,100 compulsory admissions to hospital under the 1983 Act and about a further 19,500 detentions subsequent to informal admission.

Tim Loughton: In November 2006, the Minister’s predecessor gave an undertaking that within two years no child under 16 would be detained in adult psychiatric wards, and undertakings to that effect were given during discussion of the Mental Health Bill last year. Will the Minister guarantee that that pledge has now been fulfilled, two years on, and that improvements have been made so that children in appropriate child psychiatric wards can access education so that they do not fall behind with their studies during their illness?

Phil Hope: In fact, two commitments were made at that time. The first was that within two years no one under 16 would be treated in an adult psychiatric ward and the second was that nobody under 18 would be in an age-inappropriate setting. The latest available figures, for April to June this year, show that there were only 16 bed days for under-16s on adult psychiatric wards—the lowest level since such data collection started in 2005. I shall certainly take away the hon. Gentleman’s comments about the education of young people in those settings.

Mr. Andrew Love (Edmonton) (Lab/Co-op): Under the Government’s 10-year plan, mental health is meant to be a priority, along with cancer services and heart services. However, there is still growing evidence locally
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that money is being channelled into hospitals to meet the requirements of their plans, rather than into mental health services. What reassurance can my hon. Friend give me that that is being taken into account and that priority is being given to mental health services, as was stated in the 10-year plan?

Phil Hope: I am pleased to be able to tell my hon. Friend that no less a body than the World Health Organisation praised the Government’s record on investing in mental health. We have one of the highest spends on mental health in Europe, and our spending on adult mental health services has increased by £1.7 billion in the past six years—a 44 per cent. real-terms increase for mental health services.

My hon. Friend is absolutely right. We are now looking to the future and talking to key stakeholders about our New Horizons project for mental health services. We expect to publish proposals for that future direction for mental health services next spring.

Mr. Graham Stuart (Beverley and Holderness) (Con): Less money is spent on the mental health needs of East Riding of Yorkshire residents than on those of the residents of any other area in the country. Their primary care trust receives hundreds of pounds less per head for general health needs than do the constituents of the Secretary of State for Health, who live not very far away. The primary care trust in East Riding directs just 7 per cent. of its expenditure to mental health. That is about half the national average, so there is a double whammy for my constituents. What message can the Minister send to the managers of the PCT to ensure that my constituents get a decent and proper mental health service?

Phil Hope: The obvious response is to advise the hon. Gentleman’s constituents to support Labour at a future general election. Since 1997, spending on the health service has increased up to £100 billion. We are very proud of that record, and I might say to him that it is a serious issue—

Mr. Stuart: You should be ashamed of yourself.

Phil Hope: The hon. Gentleman talks about being ashamed, but he should be ashamed of the fact that his party consistently voted in every Budget against our extra spending on the national health service.

Mr. David Drew (Stroud) (Lab/Co-op): My hon. Friend will be aware that people being sectioned are among the most vulnerable. I have always supported independent advocacy in such situations. I know that there has been an improvement, but I would like someone who is sectioned, as of right, to have access to an independent advocate. Does the Minister also aspire to that?

Phil Hope: I am grateful for that thoughtful question. As my hon. Friend may know, from April 2009 we will give such people for the first time a statutory right to an independent mental health advocate. That builds on the excellent practice in some parts of the country of engaging non-statutory mental health advocates. In a few months’ time, from 1 April, people who are sectioned will have a statutory right to such an advocate to help them through the system.

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Anne Milton (Guildford) (Con): I warmly welcome the Minister to his new position, although we have already met across the Floor in Committee.

Despite the drop in total psychiatric admissions, the number of involuntary admissions since 1996 has increased by 20 per cent.—it is up by a fifth. Does the Minister share my concern that with bed occupancy in psychiatric hospitals now at 86 per cent., and with a drop in bed numbers of 17 per cent. since 2001, decisions on treatment for people with psychiatric illness are being made not with the clinical needs of the patient in mind, but because of a lack of, and declining, in-patient facilities?

Phil Hope: I thank the hon. Lady for welcoming me to the Dispatch Box, but she is completely wrong: all decisions are made on the basis of clinical need. She is also wrong about the number of detentions, which has remained roughly stable since 1998, at some 47,900 in 1998-99 and some 47,600 in the last financial year. We now have 64 per cent. more consultant psychiatrists, 71 per cent. more clinical psychologists and 21 per cent. more mental health nurses than in 1997. That suggests that our investment in mental health is a record that we can be proud of. Nevertheless, we will take measures to publish a new strategy for mental health services next year.

Health Inequalities

4. John Robertson (Glasgow, North-West) (Lab): What research his Department has undertaken into the reasons for health inequalities; and if he will make a statement. [232533]

The Secretary of State for Health (Alan Johnson): The Government’s programme for addressing health inequalities is informed by a wide evidence base on the complex underlying factors, as highlighted in the Acheson Report and, more recently, the World Health Organisation report “Closing the Gap in a Generation”, which was published in August and which the Government welcome and support.

John Robertson: I thank my right hon. Friend for his answer. I know that he agrees that the postcode lottery in health has to be stopped and we have to move forward. For example, in Scotland we have twice the waiting lists that people have in England. Can he assure me that such inequalities, and the problems that we have in the regions in general, can be looked into to ensure that best practice is taken forward and that the money that is supplied will go to where the needs are greatest?

Alan Johnson: My hon. Friend is right to draw attention to this crucial issue, which we regard as a huge priority. The Department of Health alone cannot tackle these issues of health inequality: we need concerted action across government involving education, planning, local government and housing. We are therefore working with colleagues in government. I suggest that the introduction of 113 new GP practices in under-doctored areas—the 25 per cent. with the least provision of GP services—goes a huge way towards making our contribution to tackling this crucial problem.

Mr. John Redwood (Wokingham) (Con): What would be the impact on health inequalities of permitting people to buy their own medicines where they were not available while keeping their NHS treatment?

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Alan Johnson: I shall make a statement on precisely that point later on. The right hon. Gentleman reminds me—he is interested in health inequalities—that between the ’70s and the ’90s the situation on health inequalities got worse. For men of working age, comparison of the mortality rate of the unskilled with that of professionals shows that it was twice as high in the 1970s, and it ended up three times as high in the 1990s. Whatever we do, we will do much more to tackle health inequalities than the Government of whom he was a member.

Derek Twigg (Halton) (Lab): Halton has the worst rate of early deaths from cancer in England, and life expectancy is three years less than the national average. A lot of work is being done locally to improve things, but I am particularly concerned about teenage health. The chief medical officer has said that poor health in teenagers can last a lifetime. Can my right hon. Friend tell me what the Government are doing to address that concern, which relates to a group that is particularly difficult to reach?

Alan Johnson: My hon. Friend is right about the need to focus on people in this group, who sometimes miss out because we are focusing on children’s and adults’ services. That transition period is very important. The biggest contribution is made by public health. This is about smoking—there are still far too many youngsters starting to smoke at age 16 and even younger. The Minister of State, my right hon. Friend the Member for Bristol, South (Dawn Primarolo), proposes to tackle that through a number of measures, including not allowing cigarettes to be sold in packs of 10. That will make a big contribution. We must also do more to tackle the problems of excessive alcohol consumption among children in their teenage years. That will be the subject of a report in the near future.

Sir Patrick Cormack (South Staffordshire) (Con): What do I say to those of my constituents who truly believe in a national health service, but who have relations in Scotland who get treatments and drugs that they cannot get in England?

Alan Johnson: The hon. Gentleman should say that that is not true. There are no drugs available in Scotland that are not available in England. It is true that the Scottish system, via the Scottish Medicines Consortium, works more quickly than the one in England, but that is because it takes its lead from the National Institute for Health and Clinical Excellence, by and large, and it does not have a consultation process. It does not consult the public on its decisions. The hon. Gentleman, as a Member for an English constituency, can take heart from the fact that the accusations he hears in his local Dog and Duck are quite unfounded.

Charlotte Atkins (Staffordshire, Moorlands) (Lab): I am delighted that Fiona and Julian Keen in my constituency have opened a brand-new NHS dental surgery that is well supported by the local PCT, but does the Secretary of State recognise that two years on from the new dental contract, access to NHS dental services is still inadequate? What will he and the Government do to ensure that dental health inequalities are dealt with urgently?

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