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9. Charlotte Atkins (Staffordshire, Moorlands): What factors underlay the response rate times achieved by Staffordshire ambulance service in the last three years. [50984]
The Parliamentary Under-Secretary of State for Health (Mr. Paul Boateng): My hon. Friend will be aware that Staffordshire ambulance service has achieved the best response times in England for the third year running. I commend this achievement, which is attributable in part to an innovative system of positioning ambulances on standby close to areas where emergencies are most likely to occur. We need to spread that good practice, which I know other ambulance services are looking at. I congratulate both staff and management of Staffordshire ambulance service on their enterprise.
Charlotte Atkins: What plans does my hon. Friend have to ensure that all ambulance services take advantage of Staffordshire's valuable experience? It appears that nothing has been done in the past three years to ensure that other ambulance services--such as Cornwall, which is at the bottom of the league table--benefit from the Staffordshire experience. The results have been startling and have produced huge dividends for patients, particularly those suffering cardiac arrest.
Mr. Boateng: The Staffordshire ambulance service has already led several seminars that we have organised in order to encourage the spread of good practice. We must make it absolutely clear that we expect all ambulance services to respond to 75 per cent. of life-threatening calls within eight minutes by 2000-01. Staffordshire is so far the only ambulance service to have met that target already, and it is showing the way for others. Clear, strategic business planning has managed to achieve improvements without additional costs. Ambulance services nationwide must learn that lesson, and we intend to ensure that they do.
10. Mr. Tim Loughton (East Worthing and Shoreham): What meetings his Department held with members or representatives of local authorities prior to the June 1997 trawl for nominations to NHS trust boards; and if he will make a statement. [50985]
The Secretary of State for Health (Mr. Frank Dobson): So far as I know, the only meeting with local authority representatives at which nominations to NHS boards was discussed was an official meeting on 12 May involving myself and other Ministers and official representatives of the Local Government Association.
Mr. Loughton: Will the Secretary of State take this opportunity to confirm that last year's scandal of Labour activists constituting 80 per cent. of board appointments to trusts--as confirmed by the Commissioner for Public Appointments--is a thing of the past? If political correctness is no longer an overriding concern when it comes to appointments in the national health service, can the Secretary of State explain how, although the chairman of the West Sussex health authority recently approved and
offered 14 names to fill a vacant board appointment on the West Sussex health authority--all of them male--the Secretary of State managed to appoint a woman?
Mr. Dobson: I will make a start. Following the precedent set by the House of Commons some five or six years ago when we appointed 100 per cent. of the Speaker as a woman, I tried my best to ensure that at least half the appointments to NHS trust boards and health authority boards were women. We have achieved that target and I am proud to have done so. If the chair of the health authority--I forget which one--to which the hon. Gentleman referred could not come up with one woman out of 14 names, he should have his head seen to.
Dr. Phyllis Starkey (Milton Keynes, South-West): Does my right hon. Friend agree that it is extremely important that local authorities and health authorities work closely together if we are to achieve a seamless system of health and community care? I particularly commend to him the experience in my constituency, where the unitary council worked closely with the health authority with regard to the winter crisis money and, between them, effectively reduced the problems in the area and helped a number of elderly people to obtain more appropriate treatment with support in the community. Is it not reasonable that such co-operation between local authorities and health authorities should be reflected in appointments to health authority boards?
Mr. Dobson: It is true that one reason for appointing at least a number of members of local authorities to health boards is to improve the liaison between the two, but elected members and appointed non-executives should not be the main channel for such liaison. Liaison at an official level must be improved, and that is one reason why we propose that, in future, the chief executive of a local authority should be expected to attend and participate in, but not vote at, the board meetings of the health authority. Such co-operation is necessary.
Mr. Christopher Gill (Ludlow): When the right hon. Gentleman addressed the annual meeting of the Association of Community Health Councils for England and Wales on 9 July last year he said:
Mr. Dobson: When I set about making the appointments about which the hon. Gentleman complains, I was addressing the problem of significantly unrepresentative boards appointed by our predecessors. In case anyone says that I am justifying myself, the Commissioner for Public Appointments, who was
appointed by the previous Government and served in a senior position in the NHS as an appointee of the previous Government, has endorsed, in his official report, all that we have been doing, and has recognised that we have carried out the obligation that we entered into at the general election to make the boards more representative of local people. That is what we said we would do and that is what we are doing.The hon. Gentleman raises one relevant point, which is that where health authorities cover a substantial area it is sometimes difficult to obtain representation which covers each part of the area, a matter which I am trying to deal with. It is interesting to note that I am the first Secretary of State to ask for a map of each area showing whence each representative comes. None of my predecessors bothered to look.
11. Mr. Paul Flynn (Newport, West): What proposals he has to reduce the incidence of over-medication of the elderly. [50986]
The Parliamentary Under-Secretary of State for Health (Mr. Paul Boateng): The Department and the national prescribing centre will publish a report on GP prescribing support in September. The document will give many examples of good practice where pharmacists have assessed prescribing for patients in a number of areas, including nursing home settings.
Mr. Flynn: Is the Minister in a position to respond to my letters and the reports that I have sent him from Gloucester, Glasgow and Manchester, which reveal that up to one in five hospital admissions for elderly people is the result of the misuse and overuse of medicinal drugs; and that, of those patients in care homes who show symptoms of dementia, more than half have drug-induced dementia? Will he replicate the splendid review carried out by the department of psychiatry at the university of Manchester, which shows that reducing drug intakes for elderly people makes them more alive, relieves them from the confusion and misery in which they live, saves the health service a small fortune and makes available extra money to spend on care?
Mr. Boateng: I will reply in detail shortly to the points that my hon. Friend raised in correspondence, but I was glad to have the opportunity, on 26 June this year, to give a prize to that self-same department--the department of old-age psychiatry at the university of Manchester--as part of the pharmaceutical care awards. We have learnt from the experience of that Manchester project that where pharmacists go out and about in the community, particularly where they are concentrated around nursing homes, the number of drugs prescribed per resident can be significantly reduced, stays in hospital can be reduced, and, significantly, the number of deaths is reduced. We want that good news and good practice replicated throughout the national health service.
Dr. Peter Brand (Isle of Wight): Does the Minister agree that one reason for over-medication, especially of mentally ill and frail elderly people, is the NHS's withdrawal from respite care, day care and long-term care for elderly people? Does he recognise that the only way
in which those people are being contained in the community is by doping them up? Does he agree that, to avoid that problem, we need more resources to support people in the community?
Mr. Boateng: We certainly need to ensure that resources, including any new resources, are applied in ways that complement health and social care being delivered together. By making a wider range of therapies and assistance available to old people we can reduce their dependence on drugs, particularly where we work in contact with the voluntary sector, which has introduced some important and innovative ways of proceeding. We are working on that now.
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