Swine Flu

David Tredinnick Excerpts

Monday 10th January 2011 Commons Chamber

[Mr Lansley]

The hon. Gentleman’s question is based on a false premise, because the level of vaccine uptake this year among over-65s is 70% and among under-65s is 45.5%, which is comparable to previous years. He did not refer to this, but because we made savings we provided the NHS with considerable additional resources in the last three months of the year precisely to manage winter pressures and ensure that beds in hospitals are available.

[David Tredinnick (Bosworth) (Con)]

I congratulate my right hon. Friend on the increase in the critical case capacity and in the number of extra corporeal membrane oxygenation—ECMO—beds from five to 22, which has made a difference. Will he also pay tribute to others who help in these situations, such as the manufacturers of homeopathic medicines and homeopathic chemists? They provide preparations that may be suitable for people, such as the constituent of my hon. Friend the Member for Rugby (Mark Pawsey), who are unable to take flu vaccines and others who choose not to do so.

[Mr Lansley]

I am grateful to my hon. Friend for that question. His local hospital, the Glenfield in Leicester, leads on specialised ECMO bed services. In this country, we have increased the number of ECMO beds; we have more per head of population than any of the developed health economies, including the United States. As for treatments and vaccinations, I continue to rest upon the scientific and expert advice. Indeed, I hope that patients will consult their clinicians about their treatments.

Oral Answers to Questions

David Tredinnick Excerpts

Tuesday 7th December 2010 Commons Chamber

[Paul Burstow]

In the not-too-distant future, we will publish the refresh of the cancer reform strategy. That will demonstrate how the Government will continue to build on past success while ensuring that we reduce and improve the survival rates for cancer. One of the real problems in this country is that we have some of the poorest survival rates for cancer. We will ensure that the networks’ expertise is incorporated into the way in which the reformed system will work.

[David Tredinnick (Bosworth) (Con)]

Is my right hon. Friend aware of the rally being held here in Westminster tomorrow by qualified herbalists who are coming to lobby for statutory regulation, which my right hon. Friend is obliged to provide under European law? When will he do that, please?

[Mr Lansley]

I am indeed aware of that, as my hon. Friend would expect. He will know that we are considering how we can give effect to the proper regulation of herbal practitioners and we will make an announcement shortly.

NHS Reorganisation

David Tredinnick Excerpts

Wednesday 17th November 2010 Commons Chamber

[John Healey]

It is a very good thing that the Royal College of General Practitioners is trying to bring the skills of many GPs up to speed because this is a big job for which GPs are not trained and not equipped, and which many do not want to do.

[David Tredinnick (Bosworth) (Con)]

Does the right hon. Gentleman recall that we had GP fundholders during the previous Conservative Government, and the doctors managed the budgets all right and increased choice for patients?

[John Healey]

The GP fundholding experiment took place in a completely different context—within an NHS that still had an area-based plan and still had bodies accountable through the Secretary of State to Parliament. In the end, however, it did not work and we stopped it.

--- Later in debate ---

[David Tredinnick (Bosworth) (Con)]

I support the Opposition’s motion in one respect: their call on the Secretary of State

“to listen to the warnings from patients’ groups, health professionals and NHS experts”.

I want to address particularly the issues affecting those in integrated health care. I speak as the chair of the integrated health care group—the old complementary medicine group—and as someone who has the honour of serving under my right hon. Friend the Member for Charnwood (Mr Dorrell) on the Health Committee. I wish to look at the regulation of herbal medicine, the possibility of complementary medicine leading to cost reductions in the health service and the choice of services.

As my right hon. Friend the Secretary of State knows, we will have a problem next year with the implementation of the traditional herbal medicines directive, about which many colleagues have been approached by constituents. From April, practitioners will no longer be regulated under section 68 of the Health Act 2009, so my first plea to my right hon. Friend is to come up with a solution to this problem ahead of time—ahead of Christmas, I hope. Otherwise, from April, practitioners will be unable to prescribe the herbs they have been prescribing under the section 68 derogation. The best course of action is the Health Professions Council, because that is the only body—

[Madam Deputy Speaker]

Order. I should remind the hon. Gentleman that we are not discussing the directive, amendments to the directive or herbal medicine. We are discussing the reorganisation of the health service, to which he needs to direct his points to make them relevant to the motion.

[David Tredinnick]

Thank you, Madam Deputy Speaker. What I am talking about is relevant to cost savings, choice and the use of existing practitioners. I hope that my right hon. Friend will deal with that issue; otherwise it will cause him major problems next year. I will now move on.

The other, related problem is that, under this arrangement, unless my right hon. Friend acts, we will lose many available products from the shelves, which will affect health service costs and what practitioners can do. Yesterday, I went to Brussels to discuss the issue as it affects health service, which we are discussing, and related cost savings. I spoke to Elena Antonescu, a Member of the European Parliament, who advised me that if the health service is to continue with traditional Chinese and Ayurvedic medicines, the Secretary of State will have to lobby Members of the European Parliament to go to the Commission to produce a report that they first proposed in 2008.

[Madam Deputy Speaker]

Order. The hon. Gentleman is pushing at the margins. We are not discussing European directives; we are talking about reorganisation of the health service in line with the White Paper. He must put his comments in that context.

[David Tredinnick]

I am most grateful to you, Madam Deputy Speaker, for your help. I have made my point about Europe having to be involved.

I also want to comment on the points made by my hon. Friend the Member for Basildon and Billericay (Mr Baron) and others about cancer care. Cancer patients can be much helped by integrated health care practitioners. I could cite many different hospitals, but I shall mention just one—Royal Surrey County hospital, which is a national health care award-winning hospital. It includes St Luke’s cancer centre, which offers a wide range of complementary therapies in support of the health service. I want to see such choice widened. If herbal and nutritional medicines are used, that will reduce the costs of the health service referred to in the motion. Many institutions abroad, such as Australia’s National Institute of Complementary Medicine, have shown Governments the way and enabled them to restructure services and provide cost savings.

With those remarks, I very much hope that my right hon. Friend the Secretary of State looks with care at what I have said about these benefits.

[Madam Deputy Speaker]

Order. The hon. Gentleman, who is a very experienced Member of this House, has been pretty close to not being in order. I take it that he has now resumed his seat, and I will move on to the next contribution.

Oral Answers to Questions

David Tredinnick Excerpts

Tuesday 7th September 2010 Commons Chamber

[Mr Lansley]

It in no way undermines the role of NICE, which continues to play a very important role in giving advice to the NHS on the relative clinical effectiveness and cost-effectiveness of drugs. However, there are many circumstances at the moment whereby patients are not getting access to medicines. NICE, through its thresholds, is setting limitations on access to new cancer medicines. The hon. Lady should know, because the research was commissioned under her Government, that we need to look at international variations in drug use across health economies. Her Government did not publish that information; we have published it. It demonstrates that in this country we have relatively poor access to new cancer medicines, often before the point at which NICE has undertaken a full cost-effectiveness appraisal. We are going to ensure that patients in this country do not lose out as a consequence of those delays.

[David Tredinnick (Bosworth) (Con)]

When considering the drugs fund, will the Secretary of State bear it in mind that many patients who have had chemotherapy find relief from using herbal medicine and acupuncture? When will he come forward with proposals to interface with next year’s European directive so that herbal and acupuncture practitioners can conform to the law?

[Mr Speaker]

I know that the Secretary of State’s response will relate to the cancer drugs fund.

NHS White Paper

David Tredinnick Excerpts

Monday 12th July 2010 Commons Chamber

[Mr Lansley]

I am sorry, but when the right hon. Lady was a Minister, she should have talked to more GPs. Overwhelmingly, they would have told her that they do not feel that the PCTs listen to them. They feel that the PCTs tell them what to do and get in the way. We are going to empower GPs to deliver services for their patients.

[David Tredinnick (Bosworth) (Con)]

I, too, congratulate my right hon. Friend on his statement. If he is going to get more choice for patients in treatment options, he will have to expand integrated health care so that herbal medicine, acupuncture, back treatments and homeopathy are more widely available across the country. Will he look at the American model of the consortium of 44 academies that has been considering integrated health care? Can he reassure me that his NHS commissioning board will not block options for integrated health care across the country?

[Mr Lansley]

The job of the NHS commissioning board will be to inform GP-led commissioning through scientific evidence, clinical evidence and guidelines, but it will be for GPs themselves, managing their budgets, to enable patients to exercise greater choice. The working out of what that choice looks like should not be dictated by politicians, but should be determined by patients and their clinical advisers.

Oral Answers to Questions

David Tredinnick Excerpts

Tuesday 29th June 2010 Commons Chamber

[Mr Lansley]

What we have done in London is to give those who would be most affected by decisions to reconfigure services the opportunity, where decisions have not already been made, to have a local say. That includes patients, the public and GP commissioners. The delay, in so far as there is any delay, need not be great if those proposals are fully subscribed to by local people and by their GPs as commissioners.

[David Tredinnick (Bosworth) (Con)]

Would my right hon. Friend accept that there is widespread anecdotal evidence of the effectiveness of homeopathic medicines? There are 500 doctors in this country who use them, and nobody is obliged to have them if they do not want them. Will he therefore heavily discount the illiberal views of our hon. Friend the Member for Cambridge (Dr Huppert)?

[Anne Milton]

May I thank my hon. Friend for his question and pay tribute to him for his continued and persistent lobbying on this subject? I gather that he has been elected a member of the Select Committee on Health, so I welcome him to that position and I am sure that we will meet again at some point.

What is important is that decisions about treatment are made by clinicians, and they will base their decisions on the safety, efficacy, efficiency and outcomes that a particular treatment will provide.

Integrated Health Care

David Tredinnick Excerpts

Wednesday 2nd June 2010 Commons Chamber

[David Tredinnick (Bosworth) (Con)]

I count myself lucky to have secured this debate on the day that we have debated health matters in the Queen’s Speech, and to discuss integrated health care for the first time in this Parliament. I am fortunate to be—[Interruption.]

[Mr Speaker]

Order. I apologise for interrupting the hon. Gentleman. This has been a stimulating and, for many, a rewarding day, but if Members who are leaving the Chamber could please do so quickly and quietly, the House will benefit from the words of the hon. Gentleman.

[David Tredinnick]

I am flattered to have the Secretary of State for Health on the Front Bench, the shadow Secretary of State for Health on the Opposition Front Bench and, to my left, a former Secretary of State for Health, my right hon. Friend the Member for Charnwood (Mr Dorrell). It is perhaps pertinent that it was him—then the Member for Loughborough—who, as an Under-Secretary, first made it possible for GPs to refer patients to practitioners who were regarded as complementary and alternative, if they took clinical responsibility. That was the Conservative policy that he instituted way back in 1990.

This debate fits so well with my right hon. Friend the Secretary of State’s determination that, in the words of Queen’s Speech,

“The voice of patients and the role of doctors will be strengthened”.—[Official Report, 25 May 2010; Vol. 510, c. 31.]

This evening I would like principally to address three related issues: the situation regarding homeopathy and homeopathic hospitals; the regulation of herbal medicine and acupuncture; and the consideration of other available models, particularly in Australia and the United States.

Let me start by welcoming my hon. Friend the Under-Secretary to her place. In a sense, this was an integrated health care general election, because the arch-opponent of anything to do with non-orthodox medicine, the former Member for Oxford West and Abingdon, was defeated and the gentleman who stood against me on an anti-alternative medicine ticket lost his deposit. That was because people are increasingly in favour of having alternatives in the health service. Indeed, 50% of the population have at some stage tried one form of integrated health care or another—acupuncture, herbal medicine or homeopathy—or a back treatment.

The Secretary of State’s proposal for an independent national health service board to allocate resources, provide commissioning guidance and allow GPs to commission services on behalf of patients is the ideal vehicle to give guidance. The first point that I would like to make to my hon. Friend the Under-Secretary is that the new board, when instituted, should offer guidance, through the primary care trusts, on what is available in the health service and stress why integrated health care is so important, for which I would suggest there are three principal reasons. First, people often turn to the alternatives when mainstream medicine has not succeeded. Secondly, conditions often fall into what is known as the effectiveness gap—that is, a category that conventional treatment is unable to help. Thirdly, people might not have benefited from conventional treatments or they might have experienced adverse effects owing to drug reactions.

Another important point, which fits the new coalition Government’s proposal for cost-effectiveness, is that the alternative disciplines—herbal medicine, aromatherapy, homeopathy, osteopathy, chiropractic—are very cost-effective. They are often cheaper than other treatments and, if used in conjunction with mainstream medicine, can be very effective in reducing the effects of heart disease, asthma, back pain and stress, for example. An integrated approach will offer my hon. Friend the Minister and my right hon. Friend the Secretary of State new weapons in the armoury of health care.

In the past few years, there has been a concerted attack on the homeopathic hospitals in this country, which go back to the formation of the health service, and on homeopathic treatments generally, on the ground that the science is weak and does not demonstrate that they are effective. This has manifested itself in bogus Department of Health circulars, in the fact that the British Medical Association’s conferences have tabled motions on the subject, and in the Science and Technology Committee’s recent highly controversial report claiming that homeopathy was a placebo.

The effect of that has been to reduce the number of referrals from primary care trusts in London, particularly to the Royal London Homeopathic hospital. The hon. Member for Hampstead and Kilburn (Glenda Jackson) took up that matter. In other parts of the country, pressure has been put on training. I encourage my hon. Friend the Minister to make a statement tonight that the Government are supportive of the homeopathic discipline, as they said they were before the general election.

The problem with the report that the Science and Technology Committee produced was that it did not take evidence from primary care trusts or from the Society of Homeopaths, and it ignored completely the evidence from abroad, which shows a greatly increased use of homeopathic treatments. For example, in France, homeopathy is taught in seven medical schools and practised by 25,000 doctors. In India, it is part of the health service. There are 180 colleges teaching homeopathy there, and more than 300,000 practitioners. Whatever the merits of the scientific research, the fact is that there are 500 doctors in Britain who choose to use homeopathic treatments as part of their work. Whatever the science says—whether it is proven or not—those people believe that homeopathy works, and that is important.

The costs involved are absolutely minimal. The cost per year to the national health service of homeopathic medicines is £152,000, out of a budget of £11 billion. Over the three years from 2005 to 2008, the hospitals themselves cost the nation £12 million—£4 million a year. These are very small costs, and we really need to take that on board. We must also recognise that there are new approvals coming on stream. At Sao Paolo university in Brazil, homeopathic treatments have been found to be effective in treating depression, instead of Prozac, and the university of Texas has shown the positive effect of homeopathic treatments in killing cancer cells while maintaining good cells. There is a lot to look at there, and the message should be that doctors who wish to use these therapies should do so and should be free to refer. If we can get that simple message across, we will have performed a great service. I am of course speaking to my hon. Friend on the Front Bench.

The regulation of herbal medicine and acupuncture is a crucial area. The previous Government spent for ever debating the matter and calling various professors to look into it. They asked for more and more information, and the final recommendations, produced by Professor Pitillo and Lord Chan, were that these areas should be regulated by the Health Professions Council so that there could be an interface with European legislation next year. However, the recommendation of the outgoing Government was that these matters should be regulated by the Complementary and Natural Healthcare Council instead. I think that that would be a mistake; I believe that we should go for stricter regulation. All the other disciplines could join the 3,000 now registered on the CNHC register. That would be the way forward. Certainly, all the organisations in the field—including the Association of Traditional Chinese Medicine and the European herbal medicine and acupuncture societies—want statutory regulation.

Finally, I turn to deal with what is happening in the rest of the world. I have already referred to the fact that we should take note of the widespread and increasing use of homeopathy in France—I did not mention Germany —and India, while we should also look at what is happening in Australia, which has been a leader. In Australia, according to Government reports, 50% of the population are now using herbal or complementary medicines. There are a number of colleges where these disciplines can be studied and a Complementary Medicine Evaluation committee has been set up; the Australians also have a Therapeutic Goods Administration committee. Herbal medicines are considered by the TGA of Australia to be

“reasonably safe with less adverse reactions than conventional pharmaceutical treatment”—

this is the big hint that we should look seriously at these treatments—and Sydney university has established the herbal medicines research and education centre

“to promote high-quality scholarship and research excellence in herbal medicines through teaching, research and international linkages.”

In fairness to the former Secretary of State, the right hon. Member for Leigh (Andy Burnham), who has just left the Chamber, I should say that he introduced a number of surveys, through the National Institute for Health and Clinical Excellence, which was a welcome development. I think, however, that my hon. Friend the Minister could do more, and I hope that she will. The Australian institutions were given a lot of money. I am not suggesting that there is a lot of money around at the moment, but if Australia can provide $4 million to start up and get going its National Institute of Complementary Medicine, it is something that we should also consider doing.

The other country way ahead of us is the United States of America, which now has a National Centre for Complementary and Alternative Medicine, the federal Government’s lead agency for scientific research on complementary and alternative medicine. It is one of 27 institutes that make up the National Institute of Health in the US and it is statutorily regulated. The mission is to explore

“complementary and alternative healing practices in the context of rigorous science… train complementary and alternative medicine researchers and… disseminate authoritative information to the public and professionals.”

It conducts research using scientific methods and advanced technologies to study CAM. I believe that we should follow that model.

During my time in the House, I have had the honour to chair and be an officer of the parliamentary group for integrated and complementary healthcare and the old parliamentary group for alternative and complementary medicine. Over a period of more than 20 years, we have seen these disciplines come in from out of the cold to complement and augment the wonderful work of our national health service. With our very liberal approach to empowering doctors and to giving patients greater choices in what they want, we have a great opportunity to draw on the wonderful resources we now have vested in our homeopathic hospitals, which offer many other treatments besides homeopathy, and in our 20,000 to 30,000 practitioners out there in the field who can offer herbal medicine and acupuncture.

The Minister now has a great opportunity to grasp the nettle and complete the great work that was started when my right hon. Friend the Member for Charnwood—originally the Member for Loughborough—agreed that doctors taking clinical responsibility could refer to these practitioners. We need to move 20 years ahead, and complete this process with statutory regulation for herbalists and acupuncturists, proper referrals and an acceptance that our 500 homeopathic doctors can refer patients if they want to do so. If we do that, my hon. Friend the Minister will be well remembered in years to come.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I congratulate my hon. Friend the Member for Bosworth (David Tredinnick) on securing this Adjournment debate on complementary and alternative medicine and integrated health care—a subject that I know is close to his heart. His continued interest and continued efforts to raise the matter in this House, as well as his determination to keep the issue alive and uppermost in our minds, is legendary. He commented himself on his 20 years of campaigning on this issue. It is important to note that it is the efforts of individual Members—their continued efforts, sometimes against the odds—that keep these issues uppermost and alive in our minds.

My hon. Friend may be interested to know that although I trained as a nurse and worked in the NHS for 25 years in conventional medicine, my grandmother trained at the homeopathic hospital in London, and was herself a homeopathic nurse. Later, she became a Christian Scientist. I am therefore not without my own roots in alternative therapies. My hon. Friend may also be interested to know that my grandmother never, until her death at the age of 89, took any conventional medicine.

My hon. Friend raised the issue of homeopathic hospitals and his concern about them. I understand that there are five such hospitals in the United Kingdom, based in London, Bristol, Tunbridge Wells, Liverpool and Glasgow. However, the Tunbridge Wells homeopathic hospital stopped providing services in March 2009 owing to the primary care trust’s decision to end funding. All the hospitals have experienced a reduction in the number of referrals over the past three years, and it has been claimed that all of them are now in a precarious position as a result of such significant funding losses. That is a matter of concern, given that they have clearly offered valuable treatments to patients.

My hon. Friend said that a number of people turn to alternative therapies when they have either been failed by conventional medicine or have adverse responses to it. Although he referred to the current position, it may help if I make some more general points connected with our approach to health care.

Decisions about patient care are best made by clinicians. Local practitioners are best equipped to decide which therapies will ensure the best outcomes for individual cases, and are best placed to decide which services can cater for their areas’ health needs—in conjunction, of course, with patients themselves. The Government’s role in all that is to empower patients and professionals to take control of the funding and provision of health services in their areas, to encourage further research on new treatments and therapies, to support the local NHS by providing information on the clinical effectiveness and cost-effectiveness of various treatments, and, of course, to protect the public by ensuring that those treatments are safe. We do that through the National Institute for Health and Clinical Excellence, which is responsible for making recommendations on treatments to the NHS, and through the Medicines and Healthcare products Regulatory Agency, which is responsible for regulating the safety of medicines and treatments. The Government also encourage research on new medical treatments and technologies, primarily through the National Institute for Health Research. Research proposals are assessed in open competition, on the basis of scientific quality, and are subject to peer review.

My hon. Friend raised the issues of choice and cost-effectiveness. He observed that complementary and alternative medicines were often very cost-effective, and that the methods of treatment often involved limited invasiveness. It may be useful to deal with those two issues together, as they go to the heart of my hon. Friend’s concern: the fact that PCTs are not commissioning or fully using complementary and alternative medicines.

As I stated earlier, we believe that local practitioners are best placed to make decisions about individual care, and that GPs are often most in touch with the health needs of their local populations. That is why it is so important that this Government will seek to give GPs more power to commission services, and patients more power to choose health care providers. By bringing together groups of general practitioners and giving them direct control over the health budgets of their patients, we will push the decision-making process closer to patients—closer to the heart of the problem. GPs will have the power to choose how to spend resources in order to achieve the best health outcomes, and we will ensure that PCT boards include directly elected individuals who can speak for patients at board level so that local people have a voice when decisions are made about local health provision.

Giving GPs more responsibility and more control over how NHS resources are used in their areas, and giving patients the power to choose any provider that meets NHS standards, will result in a health service that is not only more flexible, which is what my hon. Friend wants, but more responsive to patient need. As he will be aware, the decision to commit NHS resources cannot be taken lightly, especially during a period when the NHS as a whole must find considerable efficiency savings. Commissioners must be sure they are funding treatments that will result in the best health outcomes. That is what we all want. They must be sure of the safety, clinical and cost effectiveness, and availability and evidence in support of any therapy, and they must be sure that there are suitable practitioners in their area to deliver it.

The issue of regulation was raised, and it is a thorny one. When I was a shadow Health Minister, I met on numerous occasions psychologists, psychotherapists and counsellors who were very concerned about the regulation of their professions. Across the professions allied to health care, there are those who are keen on regulation and those who feel regulation would be wrong and would be unable to deal with the intricacies of their work. There is no doubt that vulnerable people are often preyed upon by unskilled and unscrupulous practitioners, and I think that professions wanting to achieve the highest standards will welcome proper regulation. The issue for Government is always whether statutory regulation is the most appropriate way of dealing with that risk, or if a lighter-touch approach would be more appropriate. That is why, as I understand it, last year the Department of Health, along with devolved Departments, consulted on the regulation of practitioners of acupuncture, herbal medicine and traditional Chinese medicine. As my hon. Friend will be aware, the consultation closed in November, and more than 6,000 responses were received. The high response rate is a testament to the strength of feeling about public access to complementary and alternative medicines; I am sure I am not alone in having received a huge number of letters on the subject.

The consultation examined in detail the options for regulation, including alternatives to statutory regulation. Once the Government have considered the consultation responses, we will make clear the next steps in the regulatory process. In acknowledgment of my hon. Friend’s keen interest in the matter, I am very happy to keep in touch with him about it. In the meantime, the Complementary and Natural Healthcare Council provides for voluntary registration for practitioners from nine complementary therapy disciplines. I appreciate that my hon. Friend feels that that is not sufficient, but that is in place for the moment while we consider the consultation that has taken place and make a decision on what the next steps should be.

I note my hon. Friend’s comments on the Lords Science and Technology Committee report on homeopathy, and I am aware that it caused quite a lot of concern. It was published on 22 February, and we are still considering it and will formally respond in due course. He raised considerable concerns about the report, and highlighted the low cost of many alternative therapies and the important contributions they make. He also made reference to experiences from around the world—he mentioned Australia in particular, and also the USA—and he made an important point about the open-mindedness of some countries to alternative therapies.

In considering outcomes, patient-reported outcome measures must be an important factor. As my hon. Friend rightly said—and as I mentioned—individuals’ own experiences are very important, and if we want to achieve the best outcomes, one step we must take is to ask the patient whether they actually got better.

In conclusion, I wish to thank my hon. Friend for his contribution to the debate and to suggest that perhaps the picture is not as bleak as he fears—I noted a certain weariness in his voice; he feels that he has raised this issue on so many occasions and it has fallen on deaf ears.

[David Tredinnick]

As I have been in this position before, I was nervous that the Minister might sit down before I had the chance to make a final intervention. I wish to make one plea to her. I listened carefully to what she said in the past five minutes and I wish to suggest to her that it would be enormously helpful if the Department were to issue a circular to primary care trusts saying that it is not against these therapies and it is up to doctors to decide whether or not they can be used, that it has no bias against them and that it is leaving it to the clinicians to decide whether or not they wish referrals to be made to PCTs and on to hospitals. A great fog surrounds this issue. Nothing may come out of tonight’s debate apart from the fact that we have discussed the matter, but it would be very helpful if she could consider issuing a direction saying, “It’s over to you. We are not objecting to this.”

[Anne Milton]

I thank my hon. Friend for that intervention. As the new Minister in this post, I am hesitant to commit to things that I feel might be above my pay grade.