There is increasing evidence that the number of people taking part in shisha smoking is on the rise. Hookah pipes have become a regular sight on university campuses, and shisha cafés or bars are springing up across the country. I have seen evidence of this in my own constituency of Preston, and it is particularly true of young people from ethnic minority Asian communities, as shisha smoking is seen as a legitimate social activity compared with drinking alcohol. This is creating a number of issues for both the Government and local authorities. Chief among them is how best to educate smokers about the health risks associated with shisha.
First, what is shisha? To avoid confusion, let us be clear that shisha is the process of smoking tobacco through an ornate water pipe. Tobacco is mixed with fruit or syrup and then wrapped in aluminium foil before being heated by charcoal. The smoker then uses a pipe to breathe in, forcing the smoke through the water, producing bubbles, before it is inhaled. Shisha is also referred to as hookah, hubble-bubble, goza and narghile and is a common pastime in parts of Asia and Africa, where it dates back around four centuries.
There are a number of myths surrounding shisha, the most prevalent of which is the belief that it is either not a danger to your health, or much less serious than smoking cigarettes. This is simply not the case. There is of course variety in what is smoked, but in the majority of cases it is tobacco. The fact that it is flavoured or described as herbal hides the impact it can have. I stress this because reports have suggested that some people do not realise that tobacco is involved and many do not regard the activity to be the same as smoking cigarettes.
In addition, there is a belief that the process of passing the smoke through water filters out many of the harmful chemicals that are released by burning tobacco, but it does not. Shisha smokers expose themselves to nicotine, carbon monoxide, heavy metals and other cancer-causing chemicals, and they do so in much greater quantities than those smoking a cigarette. Research carried out by the World Health Organisation found that the average cigarette involves eight to 12 intakes and produces a total of between 0.5 and 0.6 litres of smoke over a five to seven-minute period. When looking at shisha, it was found that the average smoking session involves between 50 and 200 intakes, producing between 0.15 and 1 litre of smoke per intake, over a 20 to 80-minute period.
The health dangers associated with smoking tobacco are now well established. Shisha smokers expose themselves to the same risks as those who smoke cigarettes. Increased risks of heart disease, cancer and gum disease are all direct consequences of smoking tobacco. As I mentioned at the start of my speech, the increasing popularity of shisha smoking as a social activity is resulting in a number of challenges. How can we effectively regulate shisha cafes and bars to ensure that they comply with the Health Act 2006? How can we ensure that safety is maintained and risks minimised?
In short, Britain is witnessing the emergence of a shisha culture. Young people from a range of backgrounds, but especially those from ethnic minority communities, are taking up shisha smoking. We need to do more to dispel the dangerous myths out their relating to shisha smoking. Today I call upon the Government to instigate a nation-wide campaign, similar to that instigated by the previous Labour Government, to talk about the dangers of this type of smoking.
Before the House rises for the summer recess, I would like to draw attention to the importance of speech therapy and communication aids for profoundly disabled young people, and to raise a query about care home costs.
I am privileged to have in my constituency, in Ivybridge, the Dame Hannah Rogers Trust, which for over 220 years has provided education, therapy, care and respite for children and young people with profound physical disabilities. It is a genuine centre of excellence and has been rated as outstanding by Ofsted since 2006. A few weeks ago, I attended one of its special assemblies, which was designed to promote a greater understanding of the importance of electronic communication aids for people who have no other way of communicating. A number of dignitaries and members of the press were invited, along with parents and friends of the students.
During the time together at the assembly, we were given a presentation by a young man called Ben, whose sole method of communicating is by pushing a yellow button with his cheek to select certain words and phrases from his computer. In a very powerful presentation lasting about 15 minutes, he sat in his wheelchair in front of the whole assembly and told us, with a large screen behind him to illustrate his computerised words, about his family, his likes and dislikes; about his life. He told us that when we spoke to him we should look at him and not at his carer, and that when we asked him a question we should be patient when waiting for his response. I will never forget those words of guidance.
Ben did something else: he told us a joke—in front of all those people, using just his cheek, his yellow button, and his computer. I was so impressed that I promised him that I would share it with the House of Commons, and here it is: “I say, I say, I say, why did the fish blush?” “I don’t know”, came the reply, “why did the fish blush?” “Because he saw the sea weed!” As you can imagine, the assembly dissolved into laughter. I am sure the House agrees that that would be a pretty good joke at any time, in any place, but for it to be delivered by a fine young man facing so many challenges, in a school assembly, with dignitaries and press present, was quite remarkable. I went up to him afterwards and told him that his presentation was awesome. I pay tribute to Ben, to his family and to his carers. I acknowledge the wonderful work done by Nicola Blundell, the speech therapist at the school, and her team, and of course to Dame Hannah Rogers Trust itself for so many years of astonishing service and dedication.
I intend to return to my second issue, which relates to the cost of residential and nursing care, in the autumn, but I wish to put down a marker at this early stage. It was recently drawn to my attention that local authorities are operating one set of charges for residential homes run by themselves and another, much lower, set for care homes run in the independent sector. I have taken these issues up with councils in my area and wish to share my findings with the House. In one local authority area, the going rate for a person entering one of its council-run care homes is £630 per week, while in independent homes in the same area the going rate is £429 per week—a differential of £200 per person per week. A similar disparity appears in neighbouring authorities.
My immediate reaction was to wonder why it is possible to have such a discrepancy. I have visited many care homes in the private sector and the public sector over the years, as we all have, and I would certainly not say that local authority care homes are necessarily superior. I took up the discrepancy with the council and received an interesting response:
“the £630 per week cost of in house services includes nationally agreed terms and conditions for local authority employees to include pensions, absenteeism, sickness and leave entitlements. This makes it difficult to compare rates with the independent sector.”
I do not agree with that. The Minister needs to look into this—no doubt he can do so in his thorough review following the Dilnot report on the costs of residential care—as it is something that possibly needs to be changed.
Mr Streeter makes the House a better place with his story about Ben. I am delighted to follow him on that basis.
I, too, want to talk about care homes, particularly in relation to Southern Cross. The House will know that not so long ago Southern Cross announced its intention to go into liquidation—to cease trading. That means that the 750 Southern Cross homes in this country now face a varied and uncertain future. Some 250 of those homes will pass automatically to landlords who intend to continue to offer care, but that means that the majority of homes, and therefore the majority of residents, are still in a kind of limbo as to what their future is. In my own city of Manchester, where the local authority has already made contact with one of the care home owners who intends to carry on the process of caring for the residents, things are proceeding in a sensible way. However, my local authority has found it difficult to have any dialogue with some of the offshore companies, which are merely rentiers, that own the property in the Southern Cross homes system but seemingly have no interest in pursuing the care packages involved.
Everyone on both sides of the House would agree that the care of the 31,000 elderly people affected should be the paramount consideration. It should not be a question of the profits of these companies. The care element must come first and foremost. A secondary issue, which was mentioned by the hon. Member for South West Devon, is the important employment base involved. These homes do not exist to create employment, but they do have employees who are entitled not only to reasonable working conditions but to some certainty about continuity of employment. However, the primary need must be to give reassurance to the 31,000 care home residents that their future is secure.
In previous exchanges in the House, the Minister has rightly said that the regime that allowed Southern Cross to operate as it did was not the right one, and that people need to look back and accept responsibility for that. I absolutely agree with him.
I would ask the Minister to do two things. First, up and down this land there are people who are genuinely concerned. They want to know that the offshore landlords will not simply take the roofs from over their heads, and that there will be continuity of care. We need an absolute statement that that will be the case. I know that things have progressed with NHP, one of the property owners, and that it made a statement yesterday. We need a much more positive approach that tells people home by home, or residence by residence, that their future is secure, who their landlord will be, and how their care will work.
Looking to the future—the Minister has hinted that he is sympathetic to this—we need a system that locks in a process whereby in all circumstances the needs of the residents, not the needs of the private operator, are the paramount driving force. We must not have the kind of unseemly operation that applied with Southern Cross, where profit was filtered from the homes and some people made an awful lot of money. Those people are long gone, and the people facing uncertainty are the elderly people and their carers. I hope that they are not facing too much uncertainty, and that the Minister can put the uncertainty to rest today. We have to move on, and I hope that the Minister will be able to give some clarification.
I am grateful for this opportunity to speak, and for your patience, Madam Deputy Speaker. I apologise if I am unable to be here for the winding-up speech, but I have to be in Westminster Hall at 4.30.
This is an important opportunity to raise issues that are close to our hearts. I want to talk about the potential contribution of the NHS to medical innovation in the life sciences sector and in this country, and to driving economic growth. Before coming to Parliament I had the privilege of working for 15 years in the biomedical industry. It is a subject close to my heart, and I am pleased to have this opportunity to raise it. I draw Members’ attention to my declaration in the Register of Members’ Financial Interests.
My key message is that because of major changes in biomedicine and the structure of the pharmaceutical industry, including in the disciplines of drug discovery and drug development, the NHS is now one of the most valuable assets in global biomedicine. It is vital that Parliament and the Government support the NHS in unlocking that opportunity, ensure that our NHS reforms recognise and support it, and recognise the global potential of our health care sector and our NHS to drive growth and revenues around the world, which can be reinvested back into our research base.
The life sciences are an important sector in the UK. Some 27,000 people are employed in UK pharmaceutical research and development, and there are 250,000 employees in life sciences-related industries. Employees working in the highest value sectors each generate more than £190,000 in gross value added. We are of course home to GlaxoSmithKline and AstraZeneca, but we also have a range of specialty pharma, biotech, device and diagnostics businesses.
However, there is a problem: the pharmaceutical sector has been a victim of its own success. While research and development spend has doubled in the past 15 years, the rate of success in new chemical entities discovered has fallen by about a third. That crisis is driving a wave of consolidations and restructurings in the industry, some of which we have seen recently, and the rapid closure of some of the older-style, Fordist discovery structures. The increasing trend in biomedical discovery is towards patients and getting back to the places where one can observe disease and watch it taking hold in tissues. The trend is to look at anonymised, consented mass patient data to understand how it is that different patients respond differently to diseases. That is undermining the global pharmaceutical business model. These days, a one-size drug does not fit all. The industry needs to understand why it is that people react in different ways.
As the industry looks around the world for places where it can access large repositories of anonymised, consented patient data that are in the hands of world-leading clinicians and scientists with an ethical regulatory framework, this country and the NHS stand out. This is a massive opportunity for our sector and the NHS to unlock new revenues around the world. The benefits for us are obvious. We can accelerate new medical discovery, cut costs, generate new funds for the NHS and give our sector a position of global leadership. The irony and the challenge is that the NHS itself is an obstacle to the rapid uptake and adoption of some technologies and innovations because of its centralised and bureaucratic budgeting, its lack of empowered and devolved responsibility, difficulties with its reimbursement and procurement structures, which are often dominated by the bigger companies rather than smaller more innovative companies, and problems with career structures for our most innovative scientists.
I know that Ministers and officials at both the Department of Health and the Department for Business, Innovation and Skills are considering this matter. I merely wanted to take this opportunity to highlight how important it is, not just for our medical innovation and health care but for our global growth imperative, for the UK to unlock that potential and ensure that the NHS reforms, far from undermining that important sector, support it.
NHS changes and the drive to achieve efficiency savings are causing a diminution in health services in my constituency. Salford has fewer GPs than the national average, and the Little Hulton ward is in the most deprived 3% of areas for health, yet the Little Hulton walk-in centre, which has served 2,000 people a month, is set to be closed by the primary care trust—a real blow to local people.
Salford PCT has also consulted on ending active case management for people with long-term conditions. Active case management is aimed at co-ordinating health and social care interventions to prevent deterioration, enable the patient to stay at home and avoid an emergency admission. It has had positive benefits for my constituents, and the loss of that support is another blow. Health Ministers say that they are protecting NHS budgets, so can the Minister tell me why my constituents in Salford are losing those vital health services?
GPs in Salford are also in the final year of moving on to practice-based commissioning budgets, which are based on the Department of Health’s fair shares toolkit. Two local GPs have alerted me to a problem with the way budgets are calculated. Their practice had 70% of its patients from the most deprived categories, whereas another practice had only 58%, yet the toolkit weighting applied to list size gave an uplift of 9% to the more deprived population’s practice but a 21% uplift to the less deprived. We could call that a lottery within a postcode. That calculation means that the practice in the more deprived area is faced with an apparent overspend of £200,000, and that GPs have to re-examine referrals and cancel activity for patients, giving them an increased work load and potentially having an impact on treatment for patients. Will the Minister find out why the toolkit gives a smaller uplift in weighting to a practice serving a more deprived area? As GP practices move on to real budgets, getting those calculations right is vital, as is dealing with the anomaly that I have outlined.
On social care, I welcome the report of the Dilnot commission and the opportunity to deliver a settlement on the funding of care and support. We need to work together across parties to agree a solution based on the report’s recommendations, and that work has already started in Parliament. I feel that it must include an acceptance of the report’s clear finding that additional public funding is required now for social care. As the Dilnot commission says,
“the impact of the wider local government settlement appears to have meant that additional resources have not found their way to social care budgets”,
“the current social care system is inadequately funded. People are not receiving the care and support they need and quality of services is likely to suffer”.
Social care provision is suffering as councils struggle with the Government’s front-loaded cuts of 27% over four years, and research by Age UK has highlighted cuts of 8.4% this year in council spending on older people’s social care. The social policy research unit has projected that spending cuts of 6% to 7% would mean that 250,000 older people would lose their services, so cuts greater than that would mean more than 250,000 losing services.
Back in 2005-06, half of all councils provided support to people with “moderate” care needs, but now only 22 councils provide that level of support. In its document “Care in Crisis”, Age UK states that there are
“huge discrepancies in the quantity and quality of support offered to older people by different local authorities”.
We have to deal with the current crisis as well as working to carry forward the reforms in the Dilnot report.
The principle that the national health service should be free at the point of delivery and based on clinical need, regardless of background or wealth, is one that few in the House would disagree with. It is a principle that we are all proud to defend, knowing that there is nothing as important as the health of the nation. We recognise that the NHS is paid for by taxpayers’ money and is the result of the hard-earned wages of citizens and taxpayers, and as citizens we are happy to provide for those in the greatest need—the vulnerable, the elderly, those who cannot care for themselves and those who are dying; we know that one day that fate will be ours, and we hope that the NHS will be there for each of us then.
We also recognise that the NHS must make record efficiency savings over the next four years, savings that will be reinvested in the service so that the NHS can meet another challenge—rising demand and an ageing population, which will put ever greater pressure on health care services. As a result, NHS spending is coming under greater scrutiny than ever before. But in recent years there has been a rise in the number of foreign nationals, ineligible for free care, who have been using NHS services. A recent parliamentary answer that I received on this issue revealed that since 2002-03 the Department has written off, and is no longer seeking to claim back unpaid bills, of nearly £35.4 million. The figures show that last year alone £6.9 million was written off, three times the £2.1 million lost in 2002-03.
It was made clear in the Minister’s reply to me that this figure does not include money yet to be collected, or money owed to foundation trusts for which the Department does not hold data. I have now begun to collect these data, which the Department does not keep, as a result of a freedom of information request to each trust. As a result of this, a picture is beginning to form that points to a far deeper problem than perhaps we recognise. So far 31 trusts have responded, stating that they have written off a total of £7.8million. This includes my own local trust, North Bristol NHS Trust, which has written off a total of £1,727,000 since 2003. That is as unacceptable as it is unsustainable.
The problem is not just one of cost. The variation and discrepancy in the collection of data is astounding. It seems that no criteria or framework exists under which one hospital or trust might charge another for its services. As soon as I have a more detailed and complete picture, I shall be happy to share these findings with the Minister.
I know that the Minister and the Department have been actively consulting on the problem of how to deal with the use of NHS services by foreign nationals, and I would welcome an update on the Department’s current thinking on how to tackle this issue for the future. We need to expose the reality of the problem, especially at times when the NHS seeks to make savings. We need a comprehensive plan to ensure that local services are not put under pressure by what many are now calling “health tourism”. The NHS may be free, but it is not a free-for-all. It is a national health service, not an international health service. Let us do all that we can to ensure that that remains the case.
I am pleased to have the opportunity to speak on the critical issue of public health. This time I want to look at the importance of exercise to promote health and well-being. Like many people, I have been alarmed at the rising levels of obesity in the UK and its associated diseases. Treatment of chronic conditions now takes two thirds of the health budget.
The problem is complex. The chair of Public Health Wales, Sir Mansel Aylward, believes people have lost their sense of belonging—once so evident in the south
Wales valleys when heavy industries, coal and steel thrived. So he has called for local communities to be made formidable again—a bold ambition.
The latest figures for Wales show that one in three children are overweight. The costs of obesity are huge. If you include the wider cost of days lost from work and out-of-work benefits, they nudge £8 billion. Given the complexity of the problem, we need a much stronger regulatory and policy toolbox. Only 25% of children are getting the recommended 60 to 90 minutes of daily exercise outside school. Nothing can be more fun, or better exercise, than taking a young child to the park. So it is important that we invest in play for young children, and veto charges for playground entry.
Encouraging youngsters to keep active can take patience, good humour and a tailored delivery. Teenage girls sometimes feel that sport at school is a “boy thing”, so I applaud the BBC for its recent coverage of the women’s football world cup. But if young women do prefer dance, martial arts or yoga, they should be timetabled and encouraged. Swimming is a great way to exercise for all ages, all sizes and both sexes. I therefore regret the coalition’s removal of free swimming for under-16s and over-60s—a Labour Olympic legacy initiative.
Buzz Bikes in Blaina, in my constituency, was founded by teenage boys hanging around on their bikes. They received money from the Prince’s Trust, which helped them to set up an outdoor cycling club, and now they run a small shop, and repair and hire out bikes too. Funding was not given to improve the boys’ health, but rather to keep them out of trouble, but it has been a great boost to their physical health and self-esteem.
Finally, I would like to comment on the need for the elderly to keep active. In my area up and down the country, bowling is a popular pastime enjoyed by all ages. It is a source of physical, social and mental activity. It makes for better neighbourhoods, and opportunities to play should be increased, not jeopardised. I understand that the Government’s new obesity strategy should be published soon, and I hope that it will be the subject of a full parliamentary debate. If people of all ages are to become and keep active it is critical that local infrastructure, and play and leisure facilities, be maintained, and that charges be kept low. Many people cannot afford a gym subscription to keep fit, and investing in projects with longer term dividends is always difficult. Nevertheless, if we do not do it the cost to the NHS could be overwhelming.
I wish to bring to the attention of the House and particularly the Minister the east midlands cancer drugs fund. The original concept of the fund was to help thousands of extra cancer patients receive treatment if their clinicians believed it would help them. The policy was warmly welcomed by cancer patients and their families. I have had two patients come to my surgeries on different occasions trying to access the life-prolonging drugs Avastin and Rituximab.
Since my election, I have discovered enormous anomalies between different parts of the cancer drugs fund. The East Midlands strategic health authority provides Avastin for the first-line treatment of both metastatic colorectal cancer and renal cell carcinoma, but it will not make provision for the use of Avastin as second-line treatment. In fact, it has been rather obstructive in giving us information about what it does. That has turned the life of one of my constituents, who is a cancer patient, into a living nightmare. In order to prolong her life, my constituent, who wishes to remain anonymous, has to date spent more than £50,000 of her own money on funding second-line treatment with Avastin. That included money that she got from taking early retirement. She has also sold many of her possessions, including her car and family heirlooms, to continue her treatment. But now she is running out of things to sell.
The drug costs my constituent £1,600 every three weeks—a sum that most people would find very hard to find—but she is still alive, which she would not be had she not funded it herself. She is living proof of the effectiveness of the drug in second-line treatment. However, if she resided just 12 miles away in Staffordshire, she would fall under the West Midlands SHA, which has confirmed that it provides Avastin—the drug that she so desperately needs to stay alive—for patients on both first and second-line treatments to treat the type of cancer that she is suffering from. However, the East Midlands SHA has not approved any applications for Avastin for second-line treatment of bowel cancer. This lack of consistency across the country is appalling. The Avastin that my constituent has funded herself, when used alongside chemotherapy, has seen her tumour levels drop from 41 to five—so clearly it is working very well. She is naturally infuriated that the east midlands cancer drugs fund is so resistant to funding Avastin for second-line treatment. I cannot understand why it is not looking at the clear medical evidence that she personally presents showing the effectiveness of the drug. She is living evidence that the medicine works, and she needs such help now.
I know of another patient with scleroderma who has been refused Rituximab. Hers is a terminal illness and she is being refused the drug. According to her doctors, she has three years left to live. She was told seven months after she applied that she could not have it, and it takes six months to take effect, so this lady is having enormous difficulty in understanding why she is not allowed it. She has been to London and been told that, yes, people get it there, but she cannot have it in the east midlands. I would therefore like to ask the Minister whether he will see how he can help those two brave individuals, because although I believe in local decision making, the current situation is just not fair, and they are not getting the treatment that they both deserve.
I rise to speak briefly in the time available to me about mental health services throughout the country. The Government are quite rightly focusing on mental health, as well as on provision in the acute sector. Their commitment to “No health without mental health” is absolutely right, and the £400 million being put into the early prevention of mental health conditions through talking therapies is an important commitment.
Before I go any further, however, it is worth highlighting how mental health services have historically been something of a Cinderella service in the context of the NHS budget. A good reason why we need reform to get rid of primary care trusts and put medical professionals in charge of service delivery is that mental health services have been particularly targeted for front-line cuts by PCTs over the past few months. For example, Leeds has seen £3.5 million cut from mental health budgets, with Oxford and Buckinghamshire withdrawing all police mental health liaison officers from their services. I am sure that the Minister would agree that mental health services are already under-invested locally throughout the country, and also that such cuts to front-line services are not desirable given the importance of early primary intervention in mental health. Indeed, that is exactly why we need reform to put professionals in charge of the NHS, so that they can deliver the community-focused services that we need.
It is also worth pointing out that nearly half of all adults suffer from depression at some point in their lives. We know that 60% of adults in hostels and the homeless have some form of mental health condition, while 90% of prisoners are estimated to have one too, so there is a big issue. We know that intervening and helping those individuals earlier in the disease process—through exactly the sort of commitments that the Government are making, with their £400 million commitment to talking therapies, and through commitments on a local level throughout the country—would make both a difference to health care economics, by driving down the cost of care for mental health patients later on, and a huge human difference to the patients themselves.
In the time available to me, I want briefly to call on the Minister to reconfirm the Government’s commitment to early intervention. We know that too many people are presenting with mental health conditions in the acute sector too late, when they are already in crisis, which is expensive for the NHS and bad for those people. The failure of mental health services has been to become a responsive service, rather than what we need, which is a service focused on patients and developing a properly community-sensitive approach, particularly in isolated rural areas and areas of high population churn, such as the inner cities over the river from this place.
I am not going to say much more; there is no time to develop a full argument. What I would like to hear from the Minister—I am sure that he will do this—is a confirmation of the Government’s commitment to one of the key reasons for the NHS reforms that we are putting through, which is that we need much more of a community focus to mental health services, much less reactive mental health services and a much more proactive focus on helping people early on in their conditions. Such a service would be good for them and good for the NHS, not only because it would reduce the cost to the taxpayer, but primarily because it would be good for the patient.
I really enjoy these pre-recess Adjournment debates, which give us Back Benchers such a useful opportunity to raise issues that otherwise might not get discussed. However, this is a slightly bizarre pre-recess Adjournment debate, given that we are back tomorrow to discuss phone hacking.
I want to talk about an issue that is pretty topical, given today’s reports about the Government reviewing private finance initiative contracts to save the taxpayer
£1.5 billion. I pay tribute to my hon. Friend Jesse Norman, who has been a thoughtful and tireless campaigner on the issue. We have all heard stories of the catastrophic mistakes made in relation to PFI that have resulted in astronomical costs to the taxpayer. We should also have a debate about another classic example of Labour’s poorly executed attempts to bring the private and public sectors together. I want to talk about private sector contracts with the NHS.
The Cheshire and Merseyside NHS Treatment Centre was located in my constituency, in Runcorn. It was run by private company Interhealth, on a fixed-term, five-year contract between Interhealth and the Department of Health. The contract ended on
That shows that, given the rights conditions, the private sector can work with the NHS for the benefit of both organisations and the patients. Indeed, I agree with Andy Burnham, who said when he was Labour’s Health Secretary that we should celebrate the role of the private sector in the NHS. Even if orthopaedics do not return to the treatment centre site in Halton Lea, patients are almost certain still to be treated in the private sector under the “any willing provider” guidance.
However, it is essential that any private sector contracts with the NHS are undertaken for the benefit of the taxpayer. Due to Labour’s poorly thought-out contracts, treatment centres under private ownership were paid a fixed amount regardless of how many patients they treated. The Runcorn centre did okay, and the local primary care trusts did their best to fill it to capacity, but others paid out millions for operations that were never carried out. Private providers were also paid a premium above the national NHS tariff. This is why I strongly welcome many of the aspects of the coalition’s NHS reforms, which will prevent the taxpayer from getting ripped off in bad private sector deals and ensure that patients get better choice and high-quality treatment.
Going back to the local case in Runcorn, the treatment centre building has now reverted to the ownership of NHS Halton and St Helens PCT, which is running a consultation on its future. It is vital that this world-class facility should continue to be used for the benefit of the local area, and I continue to urge my constituents to respond to the consultation to make certain that their voices are heard.
I should like to start by responding to Mark Hendrick, who talked about the impact of shisha water pipes. I entirely agree with his comments about the need to dispel the myths surrounding them. They do endanger health, and it is not the case that they are less harmful than smoking cigarettes. The flavours might hide it, but they can still kill people. The hon. Gentleman was right to bring this matter to the House’s attention today. Water pipe use might actually increase exposure to carcinogens by smokers and those exposed to second-hand smoke. The evidence is clear that water pipe usage can increase the risk of cancers of the lung, mouth and bladder. It is also associated with markers of cardiovascular and respiratory diseases and an increased risk of mouth and gum disease.
A number of local councils are already doing work in this area, not least the London borough of Tower Hamlets and Coventry city council, which are implementing enforcement strategies that include information and advice on the health hazards from smoking water pipes. We believe that, as local authorities take on their new public health responsibilities over the next few years in conjunction with Public Health England, they will be well placed to improve awareness of the risks of these practices, and I commend the hon. Gentleman for bringing the matter to the House.
My hon. Friend Mr Streeter raised two issues. He highlighted the work of the Hannah Rogers Trust on speech and language therapy, and I can tell him that Health Ministers have been working closely with their Education colleagues on the production of the Green Paper on special educational needs that was published earlier this year. We are now looking at the results of the consultation. He included a well-delivered joke from Ben in his speech, which demonstrated compellingly the importance of ensuring that people have access to appropriate communications technologies, so that they can fully express their views, wishes and feelings and live full lives.
My hon. Friend talked about the differential fee levels that are paid—on the basis, it seems, of ownership rather than anything else. The Government have set their face against that when it comes to the NHS. My hon. Friend rightly raised some issues that need to be looked at. Particularly when local authorities are facing resource difficulties, they need to look challengingly at how they use resources to ensure that they deliver quality, while also delivering value for money for the taxpayer. In that regard, we will certainly look at such issues as part of the work we are doing on the White Paper.
That brings me to Tony Lloyd and his questions about Southern Cross. Here, too, we have work in hand around the need to reform social care in England to make sure that it is genuinely fit for the 21st century. Earlier today, I laid before Parliament a written ministerial statement to update hon. Members on further developments in the restructuring of Southern Cross. The Government’s overriding concern is and remains the welfare and safety of the 31,000 residents in Southern Cross care homes. Whatever the outcomes of the restructuring processes to which the hon. Gentleman referred, no one will find themselves homeless or without care. We expect Southern Cross, its landlords and lenders to continue to work together to secure a consensual, solvent restructuring of the business that meets their collective responsibilities to secure the welfare and care of residents.
My officials continue to maintain close contact with Southern Cross, its senior management, lenders and landlords. We continue to stress to them the need for timely announcements of the sort we saw from NHP yesterday about who will be taking on the operation of homes as we go forward. We need the necessary work to be done by the Care Quality Commission to ensure that the operators meet the necessary standards to be able to operate these homes in the first place. I entirely understand the concerns of hon. Members of all parties about this matter. That is why I have undertaken to keep Members informed while we are in recess. I will do just that as matters progress.
My hon. Friend George Freeman raised issues about the NHS’s contribution to economic growth. As he rightly says, the NHS has huge potential for supporting UK innovation and research. We are increasing investment in health research by more than 8% in real terms over the next four years. That includes the £775 million that we are providing to promote translational research and development through biomedical research centres and units, and an additional £220 million for the construction of the Francis Crick Institute. My hon. Friend is right to say that we are, in a way, passing from the era of industrialised medicine into one of personalised medicine; that will certainly transform these things.
The Health and Social Care Bill, which has been a subject of much of my life over the past few months, includes measures to place duties on commissioners to promote and drive forward innovation and research. We think that that is a crucial way of unlocking the potential of the NHS to secure the full benefit for patients of research in that regard.
Barbara Keeley talked about social care funding and resource allocation in the NHS. She will know that in last year’s spending review, the Government identified the need to support the fragile social care system that they inherited. That is why by 2014-15 an additional £2 billion of support will be going into social care. In fact, over the next four years, £7.2 billion extra—over and above what was committed previously—is going into social care.
We recognise that local authorities have to make tough decisions, but some of them ought to be about ensuring real efficiency in the way social care services are delivered. That means looking at things like telecare and reablement, and looking critically, as my hon. Friend the Member for South West Devon said, at the way local authorities procure the services they provide for people in need. I think I need to write to the hon. Lady in more detail about the questions she posed about the working of the fair shares toolkit in active case management and the Little Hulton walk-in centre. I will write to her about that.
Chris Skidmore raised issues about foreign nationals’ use of the NHS. While we have a clear entitlement to a free NHS based on current residency in the UK, it is not based on nationality. There are exemptions for some categories of visitor, which are set out in the arrangements that have been in place since the 1980s. I commend the hon. Gentleman's research, and, along with my ministerial colleagues, I look forward to seeing the results of his freedom of information requests. As he said, the Government announced back in March that we would conduct a fundamental review of current rules and practices. That work is just beginning, and I am sure that the hon. Gentleman will contribute to it.
Nick Smith—I apologise for my mispronunciation of his constituency—made a compelling case for the benefits of exercise. We know that the taking of more exercise is linked to a reduction in the risk factors connected with coronary heart disease, strokes, type 2 diabetes, cancer, obesity, musculoskeletal conditions, and much more besides. Some of the issues raised by the hon. Gentleman should be addressed to the devolved Administration in Cardiff, but the Government remain aware that a cross-Government approach is needed to issues that involve transport, planning and housing if we are to secure the public health dividends that we need to see.
My hon. Friend Pauline Latham raised an important point. Notwithstanding the success of the cancer drugs fund, which has already delivered relief to 2,500 patients, it seems that the situation is different in her local strategic health authority in the east midlands. I will look into the matter carefully, and will seek explanations for the difference. I shall also want to be assured that these processes are genuinely transparent, so that justice is seen to be done and people can gain access to the benefits of the fund.
My hon. Friend Dr Poulter talked about mental health. In February, my right hon. Friend the Deputy Prime Minister and I launched “No health without mental health”, a cross-Government strategy. I believe that our “life course” approach sends the clear and powerful message that prevention and early intervention are key mental health priorities for the Government. The strategy also recognises the critical interdependencies between physical and mental health. The bulk of the strategy will have to be delivered by experts on the ground working with service users and their families and carers, but the Government are absolutely committed to integrated services. On the day on which I have launched the consultation on our new suicide prevention strategy, I should make clear the need for us to ensure that we no longer have a health service that patches people up physically while leaving them struggling mentally.
We must tackle stigma. Given that one in four of us suffers from mental health problems, this is not about “them and us”; it is about all of us. We need parity of esteem between physical and mental health services, and that is a task for commissioners as well as those who provide services.
My hon. Friend Graham Evans raised the subject of the independent treatment centre in his constituency, and the consultation that is currently under way. I will certainly undertake to look at the report of that consultation. My hon. Friend rightly raised some of the downsides of “one size fits all” contracting, which cost the taxpayer large sums under the last Administration without delivering any benefit for patients.
This has been a good debate. I will look again at the contributions made by all Members, and if I have not responded to all their points, I will write to individual Members about those points. Let me end by wishing all Members and Officers of the House a healthy, productive and refreshing recess.
On a point of order, Madam Deputy Speaker. The Minister has just replied to the debate very fully, and I thank him for responding to my points and those raised by other Members. A while ago, however, his hon. Friend the Under-Secretary of State for Health, Anne Milton, was answering a debate in Westminster Hall, ran out of time, and said what Ministers frequently say: “I will respond later to the points with which I have not managed to deal today.” I have received no replies to the questions that I raised on that occasion, and I wonder if you can advise me, Madam Deputy Speaker, on what we can do when Ministers make pledges of that kind and do not follow them up.
That is not a point of order for the Chair. However, the hon. Lady has taken the opportunity to make the point directly to the Minister. I am sure that he has heard what she has said, and that he fully intends to reply to the points that have not been dealt with today.
I entirely take the hon. Lady’s point. I will certainly ensure that I respond to the questions that I did not cover in the debate, and I will ask colleagues in the Department what has happened to the replies to the hon. Lady’s earlier questions.