Order for Third Reading read.
Queen's Consent, on behalf of the Crown, signified.
Read the Third time and passed.
Read the Third time and passed
Alistair Burt: Why does the Minister think that the Health Service Journal reported in the past two weeks that trusts were being offered money to massage the figures on the number of consultants still in place at the end of March 2004? Does he think that it was connected with an internal policy document from the Department of Health, that warned of the short-term nature of some measures designed to maximise the consultant count in March, such as delayed retirement? Does he appreciate the damage done to the health service through the constant manipulation of all sorts of figures, which means that no one can trust anything that the Government say any more on the health service?
No, I do not accept any of the hon. Gentleman's points. It is a good thing, not a bad thing, to bring forward consultant appointments. It is a good thing, not a bad thing, to delay consultant retirements from the NHS, for one simple reason: it allows more
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patients to be treated more quickly in his constituency and in the constituencies of all his right hon. and hon. Friends.
Dr. Richard Taylor (Wyre Forest) (Ind): Difficulties with continuity of care appear to me to be one of the most difficult factors with which consultants must cope. What plans has the Minister to address those concerns?
Mr. Hutton: I agree with the hon. Gentleman, who speaks with some experience on these matters, that continuity of care for patients is an important issue. Equally, it is an important issue for NHS consultants and doctors. The best way to tackle those problems and others is to continue to expand the number of consultants and doctors working in the NHS, and that is precisely what we will do.
2. Norman Lamb (North Norfolk) (LD): If he will make a statement on the impact of the cost of the private finance initiative contract for the Norfolk and Norwich hospital on the health service in Norfolk. 
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): The Norfolk and Norwich university hospital private finance initiative scheme was the fourth major PFI scheme to reach financial close and sign contracts. The Norfolk and Norwich university hospital is a high-quality hospital and was recently named among the top 40 hospitals in the United Kingdom by an international company involved in measuring health care performance.
Norman Lamb: May I draw the Minister's attention to the fact that there appears to be a black hole of well over £20 million in the Norfolk health economy and that many people in the health service in Norfolk blame the extra cost of the PFI contract, compared with traditional means of financing public sector projects? Is not he concerned that Norfolk is paying the price for being a pioneer of this form of financing and that other services, such as cancer and learning disability services, are being put at risk? Will he do anything to help Norfolk, given that it was a pioneer of this PFI form of financing?
Dr. Ladyman: I am surprised that the hon. Gentleman is not celebrating the fact that he now has one of the best hospitals in Europe serving his constituency. When a new hospital is built, that is bound to put pressure on the local health economy. That pressure does not come about as a result of it being a PFI scheme; in fact, the PFI scheme is cheaper, if we also take into account the cost of risk, than a traditional building scheme would be.
Mr. Henry Bellingham (North-West Norfolk)
(Con): Certainly, people in Norfolk do not begrudge this excellent hospital, but is the Minister aware that one of the big disappointments in relation to the project has
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been the lack of public transport access from the A47? Has he been briefed on that point, and will he do anything about it?
Dr. Ladyman: The hon. Gentleman knows perfectly well that those issues must be addressed by the local health economy. This is a 1,000-bed hospital that has been built as a result of this Government's PFI initiative, and it provides services for the whole Norfolk health economy. I would have thought that he would have joined in the celebrations of that and made sure that people were addressing those issues, which are best addressed locally.
Mr. Paul Burstow (Sutton and Cheam) (LD): Given that PFI projects such as those in Norfolk and elsewhere often result in fewer beds in the new hospitals, and given the Government's commitment to introducing payments by resultswhich is about rewarding increased activityhow will the recommendation of the Health Protection Agency that bed occupancy rates should be reduced in order to reduce infection rates be implemented? Surely the two are incompatible. There is potential for more infections in our hospitals as a consequence of the Government's policies.
Dr. Ladyman: The hon. Gentleman should recognise that 45 hospitals have been completed and are being occupied as a result of the PFI. This is a major hospital rebuilding programme. Each hospital has been rebuilt following a thorough review of local health needs by local people to ensure that the right number of beds is there for those people. I should have thought that the hon. Gentleman would join in the celebrations of a magnificent hospital delivering magnificent services to the people of Norfolk.
The Minister of State, Department of Health (Ms Rosie Winterton): A £60 million capital investment programme to expand renal services began four years ago. There are now at least 700 extra dialysis stations and 28 more dialysis units, which will make it easier for renal patients to take holidays and travel on business.
Mr. Pike : I know that tremendous advances have been made in Preston and Burnley in the north-west, but does my hon. Friend accept that the scheme needs to be improved so that people can arrange to go away in the knowledge that they can get a dialysis slot wherever they go? They should not have to be confined to taking holidays in this country. In this day and age, should we not be doing something to enable people to have dialysis abroad?
There are a number of arrangements that enable people to travel abroadmainly within the European Union, but we have reciprocal arrangements with other countries such as Australia. We made it clear in the national service framework for renal services,
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published in January, that it is important for patients to be able to dialyse away from home, whether they are on holiday or on business. A group of renal commissioners, chaired by Robert Dunn of the National Kidney Federation, is considering how we can support the implementation of the framework and guidance.
The Secretary of State for Health (Dr. John Reid): The NHS improvement plan sets out the Government's plans for providing personalised support for the millions of people with long-term or chronic conditions. All that will of course be free: there will be no charges for anyone.
Dr. Starkey : I welcome the increased emphasis on managing patients with chronic diseases, but a significant number suffer from more than one chronic disease. One of my constituents who has Crohn's disease was recently in hospital for an unrelated operation and there was clearly a lack of communication between the different specialties involved in her care. What is being done to encourage clinicians to co-operate more across clinical specialties in the management of patients with chronic diseases?
Dr. Reid: That is an important and pertinent question. The plans that we outlined last week will ensure that, over the next four years, we provide more support for patients, especially those who suffer from a number of conditions and therefore have the most complex health and social care needs.
The focus will be on improving care in three main ways: by supporting all patients so that they can care for themselves and manage their conditions better whenever possible, by ensuring that all patients have access to the care that they need, andthis is particularly relevant to my hon. Friend's questionby providing personalised, co-ordinated care for the most vulnerable patients with the most complex conditions.
Angela Watkinson (Upminster) (Con): The Secretary of State will be aware of the importance of respite care for those who care for family members with long-term conditions, but is he aware that no such care is available to many parents of children on the autistic spectrum because of the very specific needs of those children? What plans has he made to ensure that it becomes available?
The hon. Lady makes yet another important point. It is true that, in addition to the extra resources that we are putting in and the extra people to provide chronic care in the localities, I announced that an additional 3,000 community matronsspecialised nurseswould be provided to help out. We try wherever possible to provide for respite care. She has drawn attention to a particular illness with particular problems in respect of respite care for the carers. I promise to look at that and perhaps to write to her on it.
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Mr. Andrew Lansley (South Cambridgeshire) (Con): The Secretary of State just said that he is planning to provide additional community matrons. He might like to explain why, after seven years of a Government who have failed to deliver community nursing care, there are 800 fewer district nurses than there were seven years ago; why there are 15 per cent. fewer episodes of care from district nurses than there were seven years ago; and why there are 20 per cent. fewer episodes of care from health visitors than there were seven years ago.
The Government have only just discovered the needs of those with long-term diseases. Even now, the Government's approach is not to design services around the needs and choices of patients but to put in place some community nursing without necessarily understanding how that meshes together with the role of general practitioners. Perhaps the Secretary of State would like to explain where community nursing has gone over the past seven years.
Dr. Reid: I confess that I would like to have turned to this as a first priority seven years ago. Had we inherited something other than an impoverished and undernourished NHS in which there had been under-investment[Hon. Members: "Oh!"] The hon. Gentleman asked me what we did for seven years before we got the 3,000 community matrons. It is a fair question.
Dr. Reid: I will answer it, if the hon. Gentleman will be courteous enough to contain his excitement. We have been providing 67,500 more nurses, 18,000 of them, incidentally, in primary care, exactly the sector to which the hon. Member for South Cambridgeshire (Mr. Lansley) referred. We have more than 19,400 new doctors. Sixty-eight major new hospitals have been built, are under way or have been improved, and 2,200 GP premises have been improved. In the past three years alone, we have provided 1,600 more general and acute beds than we inherited. We have 265 one-stop services. We have slashed the waiting lists and improved the health care of millions. On top of that, we are providing yet more facilities, including 3,000 community matrons. I wish that we could have done more but we followed a Government who could not have done less for the health service.
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