Health and Social Care Bill (Programme) (No. 2)

Jim Shannon Excerpts

Tuesday 21st June 2011 Commons Chamber

[John Healey]

I give way for the last time to the hon. Member for Strangford (Jim Shannon).

[Jim Shannon (Strangford) (DUP)]

The Committee had 28 meetings, 100 Divisions and hour upon hour of debate. That has been reflected in public opinion. The electorate who put us all in the House to represent their views are clear about what they want: a full debate in Committee, not a short-term Committee. They want it to sit until 18 October, not until 14 July.

[John Healey]

The hon. Gentleman served on the Public Bill Committee. I hope he will continue to serve when the Bill is recommitted. He is right. The public and NHS patients expect us to do our best to get the legislation right. To do that, we require the detail, we require the time, and we require the whole Bill to be recommitted.

The House cannot do its proper job without an impact assessment. The current assessment says that

“the full benefits of these changes will not be realised unless there is a change to regulation to promote competition”.

The Government now say that this policy will be altered. There will also be greater bureaucracy, longer time scales and more bodies with more complex accountabilities. Both the supposed benefits and the stated costs have changed, yet the Government tell us that the new impact assessment will not be published until the Bill reaches the Lords.

How much will this reorganisation now cost? How much can the Government now claim this will save? What are the risks? Why has the Health Secretary being blocking my freedom of information requests to release the official risk register since November? Why will the Government not welcome and allow full scrutiny of the Bill in view of the significant policy changes they say they are making? Why are they preventing this elected House from doing its proper job of fully scrutinising the legislation?

If the programme motion is passed, more will need to be done on Report in this House and during the Bill’s passage through the other place. We will continue to oppose this reckless and needless NHS reorganisation, lead the detailed scrutiny this legislation requires and speak up as patients start to see their NHS services suffer again under the Tories. We will oppose the motion.

Caring Responsibilities

Jim Shannon Excerpts

Wednesday 15th June 2011 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I do not think of my constituency as different from anyone else’s, so I am sure that the hon. Lady will agree that young carers clearly play an important role. Those who are 16 years old and under do not qualify for any financial assistance, but their role is critical for the family, parents and those they look after. Does she feel that the coalition Government should address the importance of young carers?

[Barbara Keeley]

I very much agree. I have a point to make later about that topic, because the staff who work on the young carers project in my constituency have said that they are very concerned about carers losing their education maintenance allowance. That is the one support that the state gave young carers and it is going, which is a worry.

To return to the testimony from Parkinson’s UK, the final points were about more carers contacting the staff member to ask for help finding respite because they are struggling to cope; financially, they cannot now afford a break, a treat or a holiday. I am glad that the hon. Member for Banbury raised that point. The staff member said:

“I know of one carer who has had to take on a part time cleaning job in the early evening because money is so tight. She puts her husband to bed before she leaves”—

for work—

“at 4pm so that he is safer and so she won’t worry that he will fall while she is out.”

I think that we would agree that we would rail at care agencies that put a person to bed at 6 or 8 o’clock, yet this carer has to put her husband to bed at 4 o’clock because that is the only way that she can do the cleaning job that she has to do.

I also had some input from a branch of Age Concern in Greater Manchester about how cuts to grants are affecting its dementia support service, which is important because it is another line of support. Cuts to grants of 40% over the next three years are affecting its capacity to deliver individual and group support. That goes against objectives 5 and 7 of the national dementia strategy. The staff member told me:

“Carer support groups have had to close. These are groups where carers can get a break, have a chat to other carers and get advice and information from staff. These groups help to maintain morale and prevent carers from becoming socially isolated.”

Even though there are personal budgets, which will come in in Greater Manchester, carers of people with dementia often find it hard to mix in other social groups because of the “different” behaviour of the person with dementia. Carers have described the groups as a “lifeline” and something “to look forward to”. The fact that they are being cut back is important.

The proactive support to carers of phoning them every few weeks is another aspect of Age Concern’s work that is being cut. The staff member said:

“We now have to wait for them to contact us for time-limited intervention. We know that many older people are proud and longsuffering and will often suffer in silence rather than ask for help.”

Before the cuts, branches of Age Concern in Greater Manchester ran special events for carers such as a carers day each year, parties and trips. The reduction in funding means that it can no longer offer the extras that it knows give people a better quality of life. I am very concerned to hear that carers in my area in Greater Manchester are starting to suffer.

I want to return to the two sides to the debate—values and choices. We are fortunate in Salford because, due to the way in which the cuts and the organisational turmoil in the NHS are being managed, we are not suffering as much as other areas. There are choices. Labour-run Salford city council is now one of only 15% of local councils still providing support to people with moderate care needs, as well as to those with substantial or critical needs. We are fortunate to have an excellent carers’ centre run by the Princess Royal Trust for Carers. Salford has tried to ensure that carers continue to be supported through these difficult times. As I mentioned earlier, however much the council and our local NHS bodies support carers and try to maintain what they are providing, the national changes and cuts affect our carers.

The young carers project will be affected when the young carers lose their education maintenance allowance. The centre manager told me of two other concerns: the changes to benefits and disabled people being called in to take work capability assessments. The extra worry of having to take them and of having benefits curtailed are starting to affect carers.

The centre manager also said that a major concern for her organisation was that although the carers’ centre was very well established, the service has to go out to tender through the joint commissioning process next year. She said:

“We are aware of a number of carers’ services which have gone out to tender in other areas, and bids have come in from organizations and agencies which have no experience, knowledge or expertise in carers and carer issues, including organizations from abroad.”

What reassurance can the Minister give to staff of the carers’ centre that an established, trusted and effective organisation such as theirs will not be undercut in the tendering process by organisations with no local knowledge and no experience or expertise with carers or in carers’ issues? Our carers in Salford would lose out if they lost the valuable support that they get from their carers’ centre.

The Government’s economic policies are damaging support to carers. Government cuts to local council budgets have gone too far, too fast. Councils pleaded not to have their budget cuts front-loaded. We have lost £1 billion from adult care services at a time of rising need, and we have lost billions in grants to the voluntary sector, but the worst thing is that we are only a few months into the first year of cuts, and we can already see the impact on carers. Carers are fearful about the cuts and distressed that they cannot manage financially. People with serious conditions such as Parkinson’s are being turned down for attendance allowance and made to feel like beggars if they appeal. Young carers are losing their education maintenance allowance. Carers are now unable to afford a break or holiday. It is shameful that a carer should have to take a part-time cleaning job and put her husband to bed at 4 pm.

That is not a record of which the coalition Government can be proud, and it is so early in this Parliament. I hope that carers week gives Ministers time to rethink the impact of the cuts that they are making.

Cannabis and Psychosis (Young People)

Jim Shannon Excerpts

Thursday 9th June 2011 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for raising a matter that could well justify a full debate here or in Westminster Hall. In Northern Ireland, we have seen a rash of suicides as a result of this very drug. Does the hon. Gentleman believe that the laws on drugs should be tightened? I ask because what is happening in his constituency is happening in mine, and throughout the United Kingdom.

[Mr Walker]

I am very interested by what the hon. Gentleman says, but this evening’s debate is not about classification. A Health Minister will respond to it. However, classification might be a subject for another debate here, and if the hon. Gentleman tables a motion for such a debate I shall certainly support him.

For many young people, smoking skunk cannabis is like holding a loaded gun to their heads. It might not kill them—they may continue to have a life—but if they suffer from severe psychosis or schizophrenia, it will not be much of a life. It might be just an existence.

The Government need to get to grips with this, but the problem is that law makers and the clinicians who advise them view cannabis through the prism of their own experiences in the 1970s and 1980s, and, as I said earlier, things have moved on since then. The drug with which we are dealing now is highly toxic and highly dangerous. We must talk not about harm reduction, but about harm prevention.

We are responsible adults. I have had enough of the current trend of everyone trying to make adults children’s best friends. I am not my children’s best friend; I am their parent—I am their father and I must guide them and have their interests at heart. That is the duty of adults. We must not abrogate responsibility. We have to make young people aware of the risks they run if they smoke skunk cannabis.

I have an admission to make here tonight. I was the beneficiary of very good drugs education at the age of 14 and 15. I was educated in the mid-’80s. I have not lived a blameless life. There are things I have done in my past that I am ashamed of and I wish I had not done, but, as the Prime Minister said, everyone is entitled to a past. There were many drugs, but the one drug I really did not touch was LSD, because I was told that if we take LSD just once, we can have a bad trip and that can be the end; we may never return from that experience—the gate in our brain that opens up may never close. If we are lucky enough in our youth to survive using it intact as a whole person, we might in our mid-40s—as I am now—be driving our children back from football practice and suddenly start hallucinating again. That terrified me. The idea that I could lose my brain and my future terrified me, and ensured that at a time when LSD was rife in London I never—ever—touched it.

Drug education works, but we need to educate the educators. They need to be aware of the research that shows a strong causal link between skunk cannabis, psychosis and schizophrenia. As I have said, our health trusts are full of young people suffering the consequences. Families are being destroyed.

I will conclude by saying just a few more words. In an ideal world—let us have lofty ambition and strive for an ideal world—I do not want any youngster to take drugs. It is not a good thing to do; it is not good for their health, their future or their prospects. I will just say this, however: it is a lot easier to repair a septum in one’s nose than to repair a brain. Once our brain is gone, often the best pharmaceutical drugs in the world will not bring it back again—that is it. I have talked to dozens of parents across the country who are facing up to the fact that their children—the children they love, and brought into the world and nurtured—now have no future but simply an existence to look forward to. I do not think that is good enough, and I do not want to settle for it.

So here is my call to action for the Government: please take this matter seriously. Skunk cannabis has changed over the past 30 years. It is a major public health risk. It is robbing thousands of people of an opportunity to live fulfilled lives. I have worked with the Minister, and she has been fabulous up to this point, and I am sure she will continue her efforts to get this topic higher up the Department’s agenda.

Finally, I want to pay tribute to my enormously good friend Mary Brett, a former teacher who has worked for decades in the interests of young people and their welfare.

Public Health Observatories

Jim Shannon Excerpts

Tuesday 17th May 2011 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

I am grateful to have this opportunity to raise the very important subject of the future of our public health observatories, which are an integral part of the national health service. They are responsible for public health intelligence work—collecting the evidence base and directing how different agencies work to improve public health. It might be useful if I give a definition of public health. The best definition I have been able to find is one from the World Health Organisation’s expert committee on public health administration that was published as long ago as 1952. It defined public health as

“the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts for the sanitation of the environment, the control of communicable infections, the education of the individual in personal hygiene, the organization of medical and nursing services for early diagnosis and preventive treatment of disease, and the development of the social machinery to ensure for every individual a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity.”

The Association of Public Health Observatories represents and co-ordinates a network of 12 public health observatories in Scotland, Wales, England, Northern Ireland and the Republic of Ireland. That body brings together joint public health intelligence work from all its organisations across the United Kingdom and Ireland and also works in collaboration with its counterparts across Europe. Without that range of high-quality and trustworthy knowledge, expertise and support from public health observatories, much of the work carried out by practitioners and, indeed, local authorities, policy makers and the wider community, would be carried out in the dark. That would, without doubt, result in a less focused and less effective service delivery. All that makes public health observatories central to both local and central Government health policy and decision making.

Public health observatories were set up to monitor the state of the public’s health and the causes of poor health and health inequalities, with the information being used by a range of organisations involved in providing health care, including the NHS. The White Paper, “Saving Lives: Our Healthier Nation”, which was published by the Department of Health in 1999, proposed the establishment of the public health observatories that were then set up in 2000 by the Labour Government. The Association of Public Health Observatories was also established in 2000. That umbrella group provides a link between regional public health observatories and national arrangements. It comprises representatives from all the regional public health observatories, the Department of Health and other partners, and one concern that I wish to raise is the fact that its funding has been removed this year.

I hope that the Minister will accept that improving the knowledge and evidence base behind health care was a key element of the previous Government’s policy and was instrumental in making progress in tackling health inequalities. The changes outlined by the Health Secretary in the Health and Social Care Bill move us away from a co-ordinated health service towards a competition-based health service. The public health White Paper, “Healthy Lives, Healthy People”, published on 30 November 2010, set out a new structure for public health in England. Its aim was to shift the balance of responsibility away from central Government to local authorities. There has also been much greater emphasis on the need for people to be supported in taking more responsibility for their own health—the so-called nudge philosophy.

There are many public health issues that I would like to discuss but unfortunately do not have time to develop tonight because of the shortage of time. I want to press on and put some points to the Minister, particularly about public health observatories, and I hope she will have the opportunity to respond to them.

[Jim Shannon (Strangford) (DUP)]

Prevention is key to having a healthier nation and perhaps this issue should be reconsidered in the NHS review, as it might help to improve the nation’s health.

[Grahame M. Morris]

I am grateful for that and I agree. It is fundamental to have a solid evidence base on which to plan health interventions.

As I mentioned, the Government propose in the Health and Social Care Bill to transfer health improvement functions from PCTs to local authorities, and to create a new body, Public Health England, to be rooted in the Department of Health. Public Health England is expected to take on full responsibility for overseeing the local delivery of public health services, as well as dealing with national issues such as flu pandemics and other population-wide health threats from next year. The majority of public health services will be commissioned by local authorities. However, the revolution under way in the NHS is just as important to the future of public health in England.

The Bill, which proposes the abolition of strategic health authorities and primary care trusts, raises more questions than it answers. The responsibilities currently held by PCTs could be moved to local authorities, to the Department of Health, to commissioning consortia or to the NHS commissioning board. How the important work of public health observatories will be safeguarded for the future is still unknown. The decision to divide public health responsibilities between the Department of Health and local authorities will fragment any cohesive approach to tackling health inequalities. Whether new commissioning consortia will carry out some functions is at this stage unknown.

There are further concerns about whether Public Health England should be outside the Department of Health to protect its independence. If it was placed within the NHS, perhaps as a special health authority, surely that would better meet the Government’s own aim, often stated, of liberating the NHS from political control.

The Minister will be aware of the response to the White Paper by the public health observatories in March 2011. That response calls for a sub-national level of organisation of Public Health England to be created, with sufficient critical mass to ensure that the outputs of Public Health England continue to be valuable locally as well as nationally. There are many examples where that is the case, not least in my own region, the north-east, where the public health observatory has done excellent work on addressing inequalities that affect people with mental health issues and inhibit their ability to access services. The lessons of that can be rolled out across the country.

The important work of the observatories over the past decade has been self-evident. On 24 June 2008 the health profiles for every local authority and region across England were published jointly by the Department of Health and the Association of Public Health Observatories, an organisation which, as I mentioned earlier, has lost all its funding. Using key health indicators, public health observatories were able to pinpoint national health statistics at a local level, providing valuable information to address health inequalities and improve health outcomes.

As the Minister at the time, my right hon. Friend the Member for Bristol South (Dawn Primarolo), now the Deputy Speaker, noted, the importance of those statistics was

“to target local health hotspots with effective measures to make a real difference.”

In my constituency, Healthworks, an excellent clinic established in Paradise lane in Easington and opened by Sir Derek Wanless, is a prime example of how that information collected by the observatories was used to great effect to target the areas in greatest need.

The Association of Public Health Observatories, with the Department of Health, also published a health inequalities intervention toolkit to enable every English local authority to model the effect of high-impact interventions on the life expectancy gap. As far back as 1977, the Department of Health’s chief scientific adviser, Sir Douglas Black, was asked to produce a report on the extent of health inequalities in the UK and how best to address them. The report proved conclusively that death rates for many diseases were higher among those in the lower social classes. It acknowledged that the NHS could do much more to address the situation. It called for increases in child benefit, improvements in maternity allowances, more pre-school education, an expansion of child care and better housing. A further report was subsequently produced by Professor Peter Townsend. Indeed, only last week I attended a seminar, in which the principal speaker was Sir Michael Marmot, on the impact of cold homes on health outcomes. The report indicated that the cost to the NHS of illness resulting from poorly insulated houses and cold homes is £2 million a year.

Medical Students

Jim Shannon Excerpts

Tuesday 3rd May 2011 Westminster Hall

[Mr Smith]

The hon. Lady will know all about the matter. That was a very well made point. I will come to the subject of commercial loans later.

I also want to press the Minister on the position of graduate-entry medical students. That is an even more important route of entry than the 10% of total numbers that they represent suggests. The BMA has pointed out to me that its 2009-10 medical student finance survey shows that a higher proportion of students from poorer socio-economic groups enter medicine through graduate-entry courses than do so through undergraduate courses. Oxford university medical sciences division has pointed out to me that the best graduate-entry students are extremely strong and do exceptionally well. That route into medicine is important both for excellence and widening access.

[Jim Shannon (Strangford) (DUP)]

The pharmaceutical and medical sectors of industry have clearly made many financial commitments to a number of universities across the whole of the United Kingdom, including at Queen’s university, Belfast. Does the right hon. Gentleman think that the pharmaceutical and medical industry could do more to help poorer students with tuition fees?

[Mr Smith]

A number already do, and of course we are grateful to those who give support directly, or through foundations and trusts. If more could be given, that would be very welcome. As the hon. Gentleman says, whether in Northern Ireland or elsewhere in the UK, the contribution that spin-offs make to our economy, as well as the direct benefits of investment in medicine, is enormous. Those who benefit from that in profit should put extra back.

The point that I was making about graduate-entry medical students is that they are not eligible for loans to cover tuition fees and have to find first year fee costs out of their own pocket or from other sources of help, some from specific university bursaries. If graduate-entry students had to raise £9,000 for their first, and maybe subsequent, year fees, on top of the debts that they would have already accumulated as undergraduate students, that might be prohibitively expensive and inflict real damage on the quality and social range of graduate-entry medical students. What assurances can the Minister give on graduate-entry student funding? Will there be additional help for first year fees in light of the increase? Will tuition fees for subsequent years be supported by the Department of Health at the new, higher rate?

Another concern, which relates to the point made by the hon. Member for Oxford West and Abingdon, regards graduate-entry students who may no longer have access to some of the loans for professional development that have been made available by commercial lenders. The BMA has cited the recent decision by banks such as NatWest to withdraw those loans, which were obviously hugely important for graduate students who were ineligible for tuition fee support. Will the Minister make representations directly to the banks and to the Chancellor of the Exchequer, who might usefully underline that this is an especially important area for us all to be in it together in doing what we can for graduate medical entry?

All in all, there are big challenges facing prospective medical students. Yes, demand for the courses is high, and it is good for patients, science and the economy that so many of the brightest want to study medicine, but we cannot be complacent. It is vital that people from all backgrounds are encouraged and helped to fulfil their potential in medicine when they have something good to offer.

I would like to thank and praise the work of access officers, at Oxford university and elsewhere, who are working hard to reach out to schools and students who have not in the past thought of Oxford, and to raise aspirations and challenge prejudice. A very good example is the university of Oxford’s UNIQ summer school—it is unique, I think, but it is called UNIQ too—which is a programme of free residential courses in July and August for year 12 students from UK state schools and colleges.

The summer schools are targeted at academically talented students whose school or college has little or no history of making successful applications to Oxford. Participants follow a week-long academic course designed and taught by Oxford lecturers and tutors, as well as taking part in social activities and meeting up with alumni of the university and current students.

In its first year, 69% of UNIQ summer school students went on to apply to Oxford and 27% were given conditional offers by the university. I understand that the medical strand of that initiative has attracted a lot of state school applicants, and that the conversion rate to application and the offer of an undergraduate place in medicine is very good. That shows what can be done. Let us, through the funding arrangements for medical students, make the job of those promoting access arrangements easier, not harder.

This country can be very proud of the quality of education, training and research in medicine, and the scale of achievement in my constituency is awesome. We all want to see the most able people, regardless of background, working in the profession. Criteria for admission and the judgment of would-be students’ potential must, as with the assessment of their progress and qualifications, be matters for the medical schools and universities, not the Government. The Government have a clear responsibility to act and open up opportunities to ensure that there is the right advice and support, to raise school standards and aspirations, to remove barriers and to fund medical students fairly. I look forward to hearing from the Minister on whether and how the Government intend to set about that.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 26th April 2011 Commons Chamber

[Mr Lansley]

I understand my hon. Friend’s concern and that of colleagues in other locations across the country. If—I repeat the “if”—the consultation were not to arrive at what he or others in any specific location regarded as justified conclusions, it would be open to them, as this is a service reconfiguration of the NHS, to seek a referral of the proposal to me as Secretary of State.

[Jim Shannon (Strangford) (DUP)]

Diabetes UK has a strategy to reduce the number of people with diabetes across the whole UK. Will the Minister tell the House what discussions he has had with the Northern Ireland Assembly—the matter is devolved in Northern Ireland—to ensure that the strategy of prevention, awareness and education is followed across the whole of the UK?

[Paul Burstow]

The hon. Gentleman is absolutely right, because this strategy must contain four elements; it must be about prevention, earlier diagnosis and appropriate self care, and we also have to have world-class research. Discussions with the Northern Ireland Assembly are ongoing.

NHS Reform

Jim Shannon Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

I know that the whole Committee will have been grateful to my hon. Friend for his chairmanship, because what was achieved in Committee, as was acknowledged by the hon. Member for Halton (Derek Twigg), was that every inch of the Bill was scrutinised. It is our intention to secure proper scrutiny for any changes that result from our engagement.

[Jim Shannon (Strangford) (DUP)]

The Public Bill Committee was one of the busiest since 2002, according to the Clerk, with 26 sittings and more than 100 Divisions. Does the Secretary of State not agree that that reflects the level of concern that the general public have, but that they will exercise theirs at the next general election?

[Mr Lansley]

No, I am afraid I do not accept that. All that 100 Divisions demonstrate is that time and again the Labour party was simply trying to divide the Committee in order to delay or, indeed, to wreck the Bill.

HIV

Jim Shannon Excerpts

Wednesday 1st December 2010 Westminster Hall

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I am pleased to have the opportunity to speak in this important debate on world AIDS day, and I congratulate my hon. Friend the Member for Inverclyde (David Cairns) on securing the debate.

Let us remember that some people who are suffering from HIV/AIDS, or suspect that they are, will have supportive partners, be in supportive communities and face the future with some positivity. Many, however, will be very frightened and very alone. It is a good thing that we in this Chamber can openly debate this issue and its ramifications, because it will reassure not just communities, activists and lobbyists but individuals who may read and see the debate this afternoon.

We must remember that we have moved some way since the early frightening adverts in the 1980s. No one who saw those adverts, with the tombstones collapsing and the voice of doom, has ever forgotten them. We should congratulate Norman Fowler on taking up the cause and using the power of his Department to put it in front of the public.

When we look at some of the indices around HIV/AIDS, we see that there has been an increase in HIV testing among gay men. Testing rose from 58% in 1997 to 72% in 2008. We have seen a plateau in new diagnoses among gay men, and we now see a consistently high rate of condom use among them—at least nine out of 10 now use condoms. The fact that we have seen such progress is partly a tribute to the people who took up the issue all those years ago. It is also a continuing tribute to the communities, activists and health providers who provide both care and commitment, and we need to acknowledge that today in this debate.

However, there is still some way to go. How we go forward on HIV/AIDS will be a test of the reorganisation of both the NHS and public health that has been announced in recent months. In principle, I do not think that anyone in this Chamber is opposed to the reorganisation, but it is just this sort of issue, which is not consistent across the country, that is not necessarily well represented in GPs’ lists and has different levels of information across the country; there may not be as much information in rural areas as there is in Brighton and London. That will be a test of the reorganisation’s effectiveness.

We know that AIDS can affect anyone, and that apart from the gay community the largest community affected by HIV/AIDS is that made up of black African men and women; currently, 38% of new HIV diagnosis is among that group. The stigma attached to HIV in that community cannot be overstated, and it very much hampers efforts to reach out to people and achieve early diagnosis.

The problem among black African men and women—and among other groups, as well—is that they present late and are therefore diagnosed late. That not only gives them a poor prognosis; it means that the cost of treatment is much more expensive than it need be. That is true of any individual or any group that presents late.

Another issue with black African men is that, even though they may be having sex with men, they refuse to consider themselves as gay. They think that HIV is something for the gay community and not for them, so they end up presenting very late indeed. They are more likely to be undiagnosed and to live in areas in which a relatively high proportion of the population are not on their GP’s list, so they are not really interacting with the authorities.

I should like to use this debate to stress the importance of educational and informative work generally and with the black and African community in particular. We must do more with the Churches, because that is probably the most effective way to reach those groups. Any Sunday morning, there will more people in African-led churches in Hackney than at any political party meetings for 12 months of the year.

We need to normalise testing and offer it in a much wider range of settings—not just for black and African men and women, but for the population as a whole. I was routinely tested when I had my son 19 years ago and thought nothing of it. We need to make testing more routine so that people do not think, “If I go for this test, it will badge me as someone at risk.” Universal testing may well be a step too far, but we need to make testing available in a wider range of contexts.

My hon. Friend the Member for Inverclyde said that he did not want to talk about international issues, but given that 38% of new HIV diagnosis is among black African men and women, I do not apologise for raising the issue of funds for the Global Fund to fight AIDS, Tuberculosis and Malaria. I know that that is not a matter for the Minister and I do not expect her to respond on the specific point. None the less, will she pass on to her colleagues the very concerning fact that the global fund is £13 billion short of what it needs? If the UK was to raise its pledged amount in line with France and other western European countries, the fund would be able to go to private sector donors such as the Gates Foundation and reach the amount of money it needs.

In that context, I should like to mention—again, I do not expect the Minister to respond on this point—that in the next few weeks we will have EU trade talks with India in Brussels. There is a great concern that as a consequence of the trade talks, India might not be able to produce the cheap generic drugs that have played such a huge role in the fight against AIDS in Africa. That would be a blow not so much for Indian industry, but for the millions of people in Africa who have benefited from access to cheap generic drugs.

HIV/AIDS is no longer a death sentence, which is good news. Thanks to new drugs, research and greater understanding, people are now living with HIV. As one of my hon. Friends said earlier, we have 65,390 people in the community living with HIV. In fact, it is increasing faster among the over-50s than among any other group, which raises new issues that were not considered in the era of the adverts with the crashing tombstones and the voice from above.

My hon. Friend the Member for Ealing, Southall (Mr Sharma) mentioned the issue of depression and how that interconnects with sufferers of HIV/AIDS and the support that they need in relation to that. There are ongoing concerns about care and support that were not an issue 20 years ago. If we are to offer sufferers from HIV/AIDS equity of health care and, as far as possible, a good quality of life, we must consider care and support, within the new health service and local authority structures, as we have not in the past.

As I said at the start of my remarks, the reorganisation of the commissioning of health care and of the public health service will be tested by this issue. Many ordinary people on the ground will judge the reorganisation by how issues such as this are dealt with. I stress, as my hon. Friends have stressed, the importance of a national strategy. We need to consider how it can go forward under the new arrangements. Will the Minister tell us who will be responsible for commissioning and funding the information work that is needed now more than ever—in particular, the specific education work that goes into the communities that I have mentioned? Who will be responsible for commissioning preventive work, care, treatment and support? I will listen with interest to the Minister’s responses to those questions.

I welcome the new public health arrangements in principle. Public health has been a core activity of local government since the 19th century and so, as a former local councillor, I am glad that public health has “come home” to local authorities. However, because I know local authorities and how they work, I want to be convinced that it is possible effectively to ring-fence the public health funds that they will receive.

I imagine that what some local authorities will do—or will be tempted to do, conceiving themselves to be under financial pressure—is to rebadge existing work in the areas of social care and environmental health as public health expenditure, and the new funds that all of us in Westminster Hall imagine are there for public health will melt away in the current climate. So this will be a test, as much as anything else, of how far it is possible effectively to ring-fence public health funds once they fall to local authorities.

Then there is GP commissioning, and the issue of HIV/AIDS will be a test of that system. The important thing with GP commissioning is that GPs should commission for their community and not for their list. As an east end Member of Parliament, I know that there are many public health issues that manifest themselves more extensively among people who are not actually on GPs’ lists, for a whole number of reasons. Tuberculosis is a case in point. A disproportionately high number of people who suffer from TB are not on a GP’s list, for a number of reasons. HIV will be a test of the extent to which GP commissioning consortiums will commission for the community as a whole and not just for the people who are on GPs’ lists and present themselves for treatment.

It will be important to know what will happen to some of the survey work that is carried out by organisations such as the London Health Observatory; I had a meeting with representatives of that organisation this morning. That survey work is the only way of seeing what the trends are in issues such as HIV. It is easy for us to say this afternoon that 43% of HIV/AIDS sufferers are in London, many more are in Brighton and so on. However, we live in a globalised environment and there are trends and changes. Only survey work—not only national survey work, but sometimes precise survey work—can track what is really happening with HIV/AIDS.

[Jim Shannon (Strangford) (DUP)]

I understand that some of the figures that have been released in the past year for those who have just been diagnosed with HIV show that it is not just a young person’s disease any more; it also affects those who are 50-plus or 55-plus. I wonder whether the hon. Lady is aware of that. If she is, what does she feel should be done to address that issue of those in an older age bracket who are now succumbing to the disease?

[Ms Abbott]

That is an important point, and it is one that I touched on earlier. It shows that anyone can find themselves—

NHS Reorganisation

Jim Shannon Excerpts

Wednesday 17th November 2010 Commons Chamber

[Rosie Cooper]

Yes, glib. Where is the substance? Will it make any difference if the GP consortiums do not agree with the Secretary of State? Will those consortiums meet in private or in public? Will he listen to those patient voices? Will he be able to hear them?

[Jim Shannon (Strangford) (DUP)]

Does the hon. Lady agree that when it comes to prevention and early diagnosis of diseases, the GP and what happens at the clinic and the surgery is critical? Money can be saved in the long term. Perhaps that is what the Government should be doing—making sure that money is there on the front line, in the GP surgeries and in the clinics.

[Rosie Cooper]

Nobody could disagree with that.

The NHS will be one where the area and street where people live will determine whether they have access to certain drug treatment, because of the weakening of NICE and a shift back to value-based pricing, placing drug companies back in control, and a return to postcode prescribing—an NHS where people may or may not get certain operations. Already in my area, across Lancashire, primary care trusts are reviewing funding for 70 procedures, so if patients require an endoscopic procedure for their knee or back, or a hysterectomy, those may no longer be available.

How far people travel to their hospital depends on whether they have a hospital close by that offers the treatment that they need. On 26 October at the Select Committee, various witnesses gave evidence that hospital closures will be necessary to release moneys back into the wider health service. How many patients would agree that such a state of affairs is part of a patient-led NHS? Not many, I bet.

Improving health care outcomes was the Secretary of State’s second aim. It seems highly unlikely, given that the ability to deliver improved outcomes is reliant on front-line services and the availability of the staff to deliver them. The Royal College of Nursing expects to lose 27,000 front-line jobs. That is the equivalent of losing nine Alder Hey children’s hospitals. The work of the RCN suggests that under the guise of 45% management cuts, the NHS will lose health care assistants, nurses and medical staff—front-line cuts by stealth.

All this must be set in the context of what was said to be the lowest financial settlement since the 1950s, reputed to be 0.1%—as we heard today, that is already disputed—together with massive pressure on NHS budgets from increased VAT costs—[Interruption.]—redundancy payments, budget short-falls and hospitals having tariffs frozen—[Interruption.]

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 7th September 2010 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his response to the question. I also wish to declare an interest as a type 2 diabetic. The junk food culture of the moment is a serious problem, so what steps is the Minister taking to address that in his effort to reduce the number of people being diagnosed as diabetic over the next year?

[Mr Burstow]

The best way of responding to the hon. Gentleman’s very appropriate question is to say that we are taking a four-pronged approach to diabetes. First, we need to tackle the causes of the condition through a renewed impetus on public health. We shall announce more of our plans in our White Paper later this autumn. Secondly, we need earlier identification and diagnosis so that we can help people to manage their condition at an earlier stage so that it does not progress. Thirdly, we need effective management and self-directed care. Finally, we need world-class research so that we can better understand the condition and deliver better treatments.