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Health Care (Ageism)
6. Dr. Vincent Cable (Twickenham): What steps he is taking to ensure that age is not used as a criterion for allocating health care. [72380]
The Parliamentary Under-Secretary of State for Health (Mr. John Hutton): The fundamental principle of the national health service is to provide services for everybody on the basis of clinical need. We are putting in place a number of measures that should improve fair access to services, including national service frameworks, the National Institute for Clinical Excellence, local clinical governance and a new performance assessment framework. We have made it clear that access to NHS services should be based on clinical need alone.
We are taking a number of steps specifically to improve the health of older people. For example, this year for the first time all people over 75 years old have been targeted for influenza vaccination.
Dr. Cable:
I thank the Minister for his positive reply. Is he aware that, from the serious research that has been undertaken in the NHS on specialisms such as cardiac rehabilitation and kidney dialysis, there is hard evidence that many NHS trusts are discriminating on the basis of age? They are, in effect, rationing health care on the basis of age. Does the Minister agree, confirming his previous reply, that that is fundamentally wrong? Will he undertake to carry out a more far-reaching review of specialisms in the NHS to ensure that age discrimination does not occur?
Mr. Hutton:
I repeat what I said in my previous answer about the emphasis we place on clinical need: that is the determinant and should govern what treatment a person receives. I hope that the hon. Gentleman welcomes the initiatives that we are taking. I draw his attention in particular to the proposed new national service framework for older people, which we hope will help to drive up quality and standards of care for older people.
Mr. Michael Fabricant (Lichfield):
Although I welcome the Minister's comments, does he realise that
Mr. Hutton:
I am afraid that that was one of those questions that started with a point, but I am not sure where it ended up. I do not think that the beginning and the end were connected. The hon. Gentleman may not be aware that waiting lists have come down by a further 14,000 in January. I hope that he welcomes that excellent news. I remind him that we are taking initiatives--I should be grateful to know whether he supports them--to try to ensure that we improve the range and quality of health services for older people. They make up a significant group of people who use the NHS, and we want to make sure for them, and for others, that the NHS is a first-class service.
8. Dr. Phyllis Starkey (Milton Keynes, South-West):
What action he is taking to promote the spread of nicotine replacement therapy in health action zones. [72382]
The Minister for Public Health (Ms Tessa Jowell):
Up to £60 million will be available over the next three years, initially in health action zones, to develop smoking cessation services. Part of those funds will provide for the distribution of one week's nicotine replacement therapy free of charge to those smokers least able to afford it.
Dr. Starkey:
I welcome the Minister's response in relation to health action zones. May I remind her that the south-east has not a single health action zone, because the region is relatively affluent? However, there are pockets of deprivation, some of which are in my constituency--one of them has a smoking cessation programme. Will she consider extending the week's free nicotine replacement therapy to people on benefit in projects such as the one at Netherfield in my constituency?
Ms Jowell:
It is intended that, following assessment of the effectiveness of smoking cessation services in health action zones after the first year, there will be further cessation services and free nicotine replacement therapy in the subsequent two years. This is intended to be a national programme.
It is important to link the scheme with its original purpose. We as a Government have committed ourselves to improving the health of the worst-off at a faster rate than the rate of improvement in the health of the
population as a whole. More poor people than those who are better off die prematurely of cancer and heart disease, and many of those early deaths are due to smoking. That is why our providing free nicotine replacement and tackling the problem of smoking with smoking cessation services is so important to our broader aim of tackling health inequality.
Sir Peter Emery (East Devon):
May I declare a non-financial interest as chairman of the National Asthma Campaign?
Has the Minister seen reports of research done at Oxford, showing that heart and lung disease are now major killers, and that the biggest cause of such deaths is smoking? Will she ensure that the money spent on nicotine replacement therapy is not misused or used ineffectively, in view of a major campaign by the cigarette companies, which are trying to suggest that tax on cigarettes should not be increased in the Budget? It ought to be increased, and I hope that the Minister will ensure that comes about.
Ms Jowell:
As the right hon. Gentleman will recognise, tax on cigarettes is a matter for the Chancellor. We may well hear more about it next week.
As for the right hon. Gentleman's broader point, we are determined to ensure that each of the measures set out in "Smoking Kills", the tobacco White Paper, is implemented and assessed in relation to its effectiveness. We must also ensure that the money invested is invested in saving lives from smoking, and tackling the inequality in health that it causes.
9. Mr. Dennis Canavan (Falkirk, West):
How many PFI projects have been approved in the national health service. [72383]
The Minister of State, Department of Health (Mr. John Denham):
The private finance initiative plays an important role in modernising the national health service and contributing to the biggest new hospital building programme in the history of the service.
The final decision to proceed with a major capital development in the NHS is made on the basis of an approved full business case. To date, in the NHS in England, 10 major PFI hospital schemes have been given full business case approval, and construction work has now started. In addition, a further 15 major schemes are being developed, and could be given approval as PFI projects subject to satisfactory full business cases being produced and approved.
Mr. Canavan:
May we have an assurance that the national health service in England will not follow the bad example of the notorious PFI deal in Scotland, whereby three Edinburgh hospital buildings on associated land were handed over to a private consortium that stands to make up to £200 million profit by developing the land for housing, and will also receive £30 million a year of public money for 30 years to build a new hospital that will never become public property? The shady deal will be financed partly by cutting the number of beds, cutting the number
Mr. Denham:
No. My hon. Friend made a number of points; let me deal with the important ones.
The PFI does not lead to a reduction in the number of beds. The number of beds required in the local health service is identified at the outset, whether a hospital is to be built with public sector funds or through the private finance initiative. My right hon. Friend the Secretary of State has announced and put in hand a national beds inquiry to ensure that the number of beds that is provided reflects local and national priorities properly.
As for the financing of the deal, open market value is obtained for any surplus NHS land that is included in a PFI deal. A PFI deal will go ahead only if it is affordable for the NHS and represents value for money.
Mr. Stephen Dorrell (Charnwood):
Does the Minister agree that, ever since the foundation of the NHS, its effectiveness under Governments of both political parties, has been undermined by the fact that it has tried to deliver modern health care with inadequate capital investment? That is largely the result of the health service being trapped in a public sector capital model. Therefore, does he agree that the best option for the health service capital programme is a partnership between the public and private sectors to ensure that clinical staff who are employed by the NHS have the most up-to-date capital resources at their disposal?
Mr. Denham:
The capital programme that is being developed by the Government includes a mixture of PFI arrangements and traditional public sector capital investment. That is absolutely right. There is a big difference between the present Administration and the previous one. They made a complete mess of the private finance initiative--numerous schemes were developed, none of which has ever begun construction. It was the present Administration who sorted it out and got the priorities right. We will build on that in due course with clear guidance on contracts to be used and the approach to be taken. We are using PFI not as a bit of political rhetoric, but to deliver new hospitals and better conditions for NHS staff and patients.
Jane Griffiths (Reading, East):
Is my hon. Friend aware of the situation in my constituency, where Royal Berkshire hospital failed in its PFI initiative, but has now received Treasury funding to provide the new hospital consolidation that is greatly needed? Is he further aware of the scandalous situation with regard to Berkshire health authority? It threatened savage cuts to health services in my constituency, but they were found not to be necessary by a recent National Audit Office investigation and, following a campaign by my hon. Friends the Members for Reading, West (Mr. Salter) and for Slough (Fiona Mactaggart), have been halted.
Mr. Denham:
I congratulate my hon. Friend on the close interest that she and her colleagues took in the proposals in Berkshire. I understand that proposals that were initially made last autumn have been substantially varied. She has drawn the House's attention to the
Mr. Archie Norman (Tunbridge Wells):
When is the long-awaited announcement on the next round of hospital PFIs likely to be made?
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