6 December 2007
Health Secretary Alan Johnson spent over an hour answering your questions this afternoon in our live webchat.
Alan dealt with questions on the new Cancer Reform Strategy and the National Stroke Strategy, as well as hospital aquired infections, obesity and breastfeeding.
Read the full transcript
Moderator says: Health Secretary Alan Johnson will be here taking your questions on the NHS and healthcare issues on Thursday 6th December from 17:00 GMT.
Submit your question now by using the box below.
Moderator says: Alan has just arrived so we should start in a few minutes.
Alan says: Welcome to the Number 10 webchat. It is a pleasure to be involved again. I engaged in this as Education Secretary and found it interesting and stimulating. There have been three important developments this week on health - on Monday we launched our cancer reform strategy, yesterday we announced a huge investment in medical research and today we unveiled our stroke strategy. On these and any other health issue I would be very pleased to receive your questions.
Iris Cooper: I am a staff nurse in a specialist hospital on an oncology ward and would like to ask the Health Secretary how he will ensure that money provided for staff training will be used for this and how will he monitor the amount and quality of training given to health professionals?
It has always been difficult to get hospitals to pay for training or to give study time even for those paying for the own training and development. Can he ensure this will not now be the case?
Thank you
Iris Cooper
Alan replies: As part of the cancer reform strategy, we are setting aside money to ensure we have more staff better trained at all levels. You raise an important question about how we can, from Whitehall, ensure that the money is spent on what we intend it to be spent on.
We have been criticised for top down targets and ring fenced funding, both of which we feel were necessary to address the huge problems we found in the health service when we came into Government. Now we believe that, with the additional capacity and addtional investment in place, we can in a sense let go from the centre provided we have a set of indicators in place that focuses on the actual outcomes in terms of improved patient care. The Operating Framework will set this out in more detail and the National Clinical Director of Cancer Services will be making an annual report on the progress made on all issues of the strategy including staffing and training.
Dr Ali Akgun: Dear Secretary of State for Health;
In the CRS document, I am please to see the statement that the NHSBSP will be taking on the implementation of the updated new guidelines issued by the NICE for the screening of women at genetic risk of breast cancer. It is also stated that this new system (involving the integration and use of MRI modality) is expected to be in place from 2009. QUESTION: Could you please give us more details of the NHSBSP’s plans of integration of the the MRI modality with the X-ray mammography … What form this will take ? Will all the Breast Screening Centres have their own ‘dedicated’ MRI scanners under one-roof ? When exactly is this new screening service will start and how will it be rolled out ?
Alan replies: The commitment to expand the screening programme to women between the ages of 47 and 73 has been widely welcomed as has the purchase of digital mammography equipment.
I feel that your technical questions deserve a full response and I am referring them to Professor Mike Richards, our National Clinical Director for Cancer Services. The strategy was drawn up with the input of a thousand individuals and organisations, including the Royal Societies and many practising cancer specialists and I really think you need the benefit of their expertise through Professor Richards which is why, as I say, I will pass your questions on to him.
sharon baxter: as a patient with advanced breast cancer which has now spread to my liver ,id like to ask about treatments and why some patients have to fight for life lengthening treatments in the courts , what does the new cancer reform strategy means for us patients already classed as terminally ill, we hear of treatments for advanced cancer having good results in other countries and upcoming cancer fighting treatments but for us who wont be around when these have been introduced why cant we be allowed to use these drugs when we are dying anyway . i do feel from what i know about it that this strategy,it is a good start to help those like me going through the roller coaster journey of living with cancer .but how will if affect me personally ? thank you
Alan replies: You raise one of the key questions in relation to the new drugs that become available. What the cancer strategy seeks to do is to coordinate the licensing of such drugs much more closely with the procedure for approval by the National Institute of Clinical Excellence (NICE).
We believe that there is a problem in respect of how quickly we can get these new drugs through the system and available across the country. I believe that part of your question may however be related to a separate question, which is how we use pre-licensed drugs (this is the question raised by Mike Tomlinson, the husband of Jane Tomlinson who wanted to access a pre-licensed drug that was not being trialled in her area).
The Cancer Reform Strategy doesn’t address this point but in discussion with Mike Tomlinson, my minister Ann Keen is looking into this whole question on whether, given that a patient has a short life expectancy, such drugs can be availalbe in relation to some factor other than geographical location.
This is a very difficult area because, until a drug has been licensed, we cannot be confident about patient safety but I do take the point that you make in respect of your desire for some kind of cure and the fact that you have very little to lose by taking such drugs.
Alex: I wonder why no mention is made of the ‘cancerous’ food issue - acrylmide - which has been in the press this wee. Surely getting this stuff out of foods must be essential in oder to prevent or reduce the risk? As a parent we need to know more about this issue. Thanks.
Alan replies: This was a report in the Daily Telegraph that referred to a piece of research carried out in Holland. The Food Standards Agency has made the point that there will always be an element of cooked food that contains acrylamide. The question of its carcinogenic nature is being studied by the FSA and this piece of new research will add to our knowledge. I appreciate that you, as a parent, want to know more about the issue. As yet there is no scientific or medical consensus about if and how we could ensure that no cooked food contains the drug acrylamide.
Brian Archibald: Will the funding for stroke be ring fenced for protection,
How are you going to change the work practices within the NHS to bring the much needed changes into being, or will will be here in 2015 still talking about this?
Alan replies: Good to hear from you Brian. You’ve been an excellent campaigner for stroke care in Hull and you will know how closely the Stroke Association worked with us to develop this strategy.
In relation to the increased funding of £105m we are dedicating to implementing this strategy over the next three years, it will, I assure you, be spent in the way we all want it to be. The days of top-down targets and ring fenced funding are almost over, which is why our new approach is to concentrate on a set of indicators and outcomes that will be set out in the Operating Framework. This is the crucial document that sets priorities for the NHS every year.
In terms of changing the work practices, you will know that Professor Roger Boyle has introduced a number of quality measures as part of the strategy. Thanks to campaigners like you and the Operating Framework, stroke care now has a much higher priority and profile. The wide consensus behind the strategy and the fact that both myself, my ministers and Professor Boyle will be watching this strategy on every step of its implementation means that we really will make progress in ensuring that deaths and disabilities from strokes reduce by 6,800 over the coming years.
Jane Plumb: And what about training on subjects other than cancer? The level of knowledge about preventing group B Streptococcal infections in newborn babies amongst the relevant health professionals is shocking, and yet all that seems to be available to them is an online resource. What action is the Government taking to ensure the relevant health professionals are fully trained in this important issue?
Alan replies: We are aware of the need for greater training in relation to this and other areas. Training budgets were pruned when the difficult task of moving trusts from deficit to surplus was underway. That money is now being restored and it’s important that we concentrate our attention on this as well as other important areas.
sanjay: Will GPs to incentivised to help carry out the proposals listed in the Stroke Strategy? For example, prescribing statins to at risk patients and increasing smoking cessation. Mr Tanday
Alan replies: The answer is yes, GPs will be incentivised to concentrate on prevention and early diagnosis. The introduction of the Quality and Outcomes Framework (QOF) dimension of GP pay in 2006 has had a real beneficial effect because for the first time GPs are incentivised and rewarded for these preventatitve measures. This is a crucial part of the stroke strategy but also essential to so many other illnesses and in our objective of ensuring that we do not have a national sickness service but a genuine health service where prevention is as important as cure.
philip brooks: As chair of local stroke group, I welcome the new national stroke strategy and would like to ask how it will be ensured that new funding reaches the appropriate services to enable much needed development in order to achieve world-class care.
Alan replies: I welcome your support. I was in Harrogate this morning at the National Stroke Conference and was really moved by how supportive everyone was. On the question of ensuring that funding reaches the appropriate services, can I refer you to the answer I gave Brian Archibald.
Richard: Why don’t all UK hospitals screen patients for C.difficle and MRSA as a matter of routine? Mr. Lansley asked you this question in the House of Commons the a couple of weeks ago, but you didn’t answer it then, perhaps you’ve got an answer now? Perhaps it would help to break it down. Do you believe C.difficile and MRSA screening would be help deal with these infections? Does the NHS have the ability to respond appropriately to the results of such screening (isolation facilities, ability to deep clean)? Is any group resisting such screening?
Alan replies: I do believe that screening for MRSA is crucial (you cannot screen for C. difficle as it is a completely different infection that actually develops in the gut of very sick patients). We announced in November that we would screen all elective patients for MRSA by the end of next year and all emergency patients by 2011.
You ask why this hasn’t been done already. For elective patients, screening is almost universal. This is, of course, much easier if you screen a patient and they test positive, you can re-set the date for their operation (this is why the prevalence of MRSA is low in private hospitals, which primarily and almost exclusively deal with elective surgery).
The problem comes from emergency where, if someone has been involved in a road accident, you cannot turn them away and you have to have a method of testing that does not interfere with their treatment and then allows them to be isolated with cohort nursing if they test positive. This takes investment and also a testing procedure that can be done quickly and effectively.
The technology and procedures to do this are just emerging, and as mentioned, we are now providing the funding. It’s a huge step and one that has not taken place in many countries around the world but will be established here over the next three years.
Adam Harding: Is the NHS going to meet its target for halving MRSA infections by March 2008?
Alan replies: Yes we will.
Richard Watts: Given our current problems with childhood obesity, the Government must do more to protect children from junk food marketing. Will you introduce a 9pm watershed for junk food TV adverts?
Alan replies: In response to the Foresight Report we will be looking again at this issue, but the current restrictions on television advertising in children’s programmes only came into effect in January this year and we need to analyse how this is working before considering what new steps to take. We have no plans currently to ban junk food TV adverts prior to 9.00pm.
Andrea : What is the government planning in the next decades to combat the obesity problem in the UK ? Clearly policies have not been successful to date.
Also what is the government doing to actively promote good sexual health ? its still a taboo subject, the mesage is not getting across and there is a severe shortage of easily accessible GUM clinics - would GPS be able to deal with STDs without further referral ?
Alan replies: It’s true that no country has tackled this problem effectively, as the Foresight Report (carried out by 200 of our leading scientists) confirmed. We have taken measures to introduce healthy school meals, to ban junk food from vending machines in schools, to increase the amount of exercise that children undertake and to regulate TV advertising and food labelling.
It’s clear that we have to do much more. And in response to the Foresight Report, we will be setting up a cross-Government committee looking at all aspects of this issue including sport, transport, local authority planning as well as health and education.
Ed Jacobs: How do you believe we can reduce the increase number of cases of Sexually Transmitted Infections?
Alan replies: The problem of increasing sexually transmitted diseases is unfortunately focused on young people. There seems to be a level of complacency that has led to an increase in STIs that we thought were on the way to becoming extinct.
Obviously education is important here but there is also an issue about how available and accessible advice and guidance is for young people, which is why we have introduced a pilot in four cities across the country where prevalence of STIs is particularly problematic. The pilots use the internet, text messages and new technology such as Bluetooth, to deliver messages designed by young people for young people, to emphasise the importance of avoiding unprotected sex.
Anita Cartlidge: Breastfeeding rates in England are amongst the lowest across the world. As a result children’s and women’s short term and long term health is suffering. Supporting Breastfeeding is mentioned in many health documents some several years old yet there has been no significant long term investment in supporting initiatives to increase breastfeeding rates. Why is the Government not following a similar model to Norway who had similar breastfeeding rates to us in the 1960’s but due to a concerted whole systems approach to change now has breastfeeding initiation rates above 95% and high continuation rates? And why is the Government not implementing the full WHO Code on breastmilk substitutes. Thanks
Alan replies: Breastfeeding initiation rates have been rising across all socio-economic groups in the UK and currently stands at 78% in England. We have a commitment arising from our NHS Plan in 2000 to increase support for breastfeeding. Through schemes such as the National Breastfeeding Awareness Week, Healthy Start and working with UNICEF to encourage hospitals to implement Baby Friendly Initiative policies, we are looking both to incentivise and encourage women to breastfeed.
It’s also important to mention the huge increase in statutory paid maternity leave from 14 weeks to 9 months under this government, recognising that if women have to return to work in the first six months, they cannot commit to breastfeeding.
Finally on the issue of milk substitutes, my Department and the Food Standards Agency have set out stricter controls on the promotion, labelling and composition of infant and follow-on formula milk.
barbara: If the government proposes to protect infants fed on formula milk, why then is it proposing only a voluntary agreement to improve the information on the labels with the formula companies rather than a mandatory requirement, since it is clear that the companies will not comply with such a request?
Alan replies: After consideration of all the comments received druing a 12-week public consultation on infant formula regulations, we are proposing new measures which include updating the rules on the composition of all types of formula, tighter rules on labelling, tougher restrictions on advertising and robust guidance for industry and enforcement authorities to use to correctly apply this new law. The regulations will be laid before Parliament shortly with a view to being on the statute books by January 2008.
Dr R Moore: The Minister of State told the House of Commons on July 23, 2007 that the Government would hold a consultation on proposals regarding prescription charges. A further statement was due after the summer recess giving details of the consultation. Could you advise when details of the consultation will be available? Thank you.
Alan replies: There has been some delay but the consultation will start at the beginning of next year.
Gary Paragpuri: Hi Alan,
Looking ahead to the white paper on pharmacy services due out early year, what three new services for patients would you like to see pharmacies offering and why?
Many thanks
Gary Paragpuri
Alan replies: I will resist your offer to pre-empt the White Paper, but what I can say is that we can use pharmacies to a much greater extent in order to provide wider access to primary care. Many pharmacies have rooms available for consulting purposes, very few are actually used. Encouraging greater access would therefore be my priority, although the White Paper will cover a whole series of new opportunities in this very important area of health care.
Jay: Do you agree that all long-term care of those with health problems should be funded entirely by the NHS?
Alan replies: I think the big issue for government is how can we meet the needs of an ageing population who wish to lead independent lives for as long as possible. As the Wanless Review pointed out, the status quo is unsustainable, not least because it does not give a consistent level of care across the country to those in need.
We are committed to publish a Green Paper next year to spark a debate around how we tackle these issues. People with long-term conditions are of course funded by the NHS, but the integration of adult social care and the NHS is becoming increasingly important, and the economic ramifications of how to do this successfully will be at the heart of the Green Paper debate.
Katherine Murphy: Why are people still cared for on mixed sex wards?
Alan replies: In all the new hopsitals we are building (in the biggest hospital building programme since the NHS was created) we are avoiding mixed sex wards. The number of such wards in existing hospitals has reduced.
However, there are really difficult problems in many hospitals that cannot be overcome quickly, not least of all because of the need to ensure isolation facilities as well as other necessary aspects of hospital care in buildings that weren’t designed for patient convenience.
I do understand the indignity that many people feel at having to be treated on mixed sex wards, and I am looking again with my ministerial team at how we can resolve these entrenched problems where there is no rebuilding plan in place.
Dr Ben Ross: Petitions have shown that patients in Mid Sussex want the A and E and maternity services to continue at Princess Royal Hospital. Your government says they should have choice. Will their declared choice be permitted?
Alan replies: The central requirement in respect of local plans to re-configure health services is that they are clinician-led and based on improving patient care. The local consultation period is crucial. Following this local councillors, who make up the local authority Overview and Scrutiny Committee, will make a decision as to whether to agree the plans or to refer them to the Secretary of State.
I have made it clear that any such proposals that come to me will be immediately referred to the independent Reconfiguration Panel which is not only as its name suggests, independent, but is led by clinicians. I can think of no circumstances in which I will not accept their final recommendation.
Read the Government’s e-petition response
Mrs Alison Hunter: You have launched the new strategy for stroke but does this strategy actually mean anything to us stroke survivors and carers. i ask this as I have found out this week that our local primary care trust plans to close our stroke rehab unit and treat people in the community hospitals on general wards. This is a huge step backwards for stroke in our area and we are very worried.
Alan replies: I understand your worry although I don’t know the details. The fact is that prior to 1997 very few hospitals had a stroke centre. Now 97% of hospitals have this specific centre for stroke victims.
The strategy puts great emphasis on what Macmillan calls survivability, which means that the aftercare for both the patients and their families is an important part of an integrated system for stroke victims.
Rehabilitation is central to that, although the philosophy is that it should be carried out as close to home as possible. Using a community hospital does seem to me to be consistent with that philosophy, although the care should of course be focused on stroke patients.
Nathan Matthew: Having worked in the NHS I feel the heirarchical nature of it (Doctors at the top,domestics at the bottom) often blocks innovation and improvement and that this has been a recurring issue that Health secretaries from Bevan to Castle to Hewit have come up against. More funding can easily be snatched up by the most powerfull Professional groups.
What are views on greater use of the Co-operative model in the NHS ?
Alan replies: We are looking very closely at the role of social enterprises in delivering health care. In some parts of the country this is already happening, but I believe there is a far wider role for such initiatives recognising that the NHS is an integrated service, and not a set of competing organisations.
Alan says: I very much enjoyed these exchanges. I am sorry I didn’t have time to do more but I can be contacted through the Department of Health.
Moderator says: Our thanks to Alan for coming to answer all the questions today. Keep an eye on pm.gov.uk for more webchats.
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