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12.2 pm
Mr. Simon Hughes (Southwark and Bermondsey): I am happy to start by taking up some of the remarks of the hon. Member for Chislehurst (Sir R. Sims). I wish to endorse some of them. My colleagues and I welcome, as the hon. Gentleman did, the idea that we should have Bills in draft. It is a good idea and I hope that it will become the normal established practice of this place from now on. The proposed Bill on long-term care for the elderly is one of two measures referred to in the Queen's Speech which is especially suitable for the House to receive in draft.
If Parliament is to legislate anew for long-term care for the elderly, it is essential that we seek to get that legislation right on a cross-party basis, as the hon. Member for Chislehurst rightly said.
I endorse also the hon. Gentleman's comment that we have a different responsibility in dealing with those who have made arrangements in the past from our responsibility towards those who, like some of us in the Chamber who are slightly younger than the hon. Gentleman, have time to make arrangements for our own long-term care when we become elderly. It is inevitable that the goalposts and rules will be changed.
The welfare state has to adapt and move on but we must not change it to the detriment of those who will find it too late to make alternative arrangements. Our first concern must be for those who are now in or approaching old age who do not have the assets and facilities to look after themselves in any new way that Parliament might decide for the future.
It seems clear that in future there will have to be the assumption that, as people earn, the employer and the employee together will help to make arrangements for residential provision in old age. There will be a different and more complex debate on who takes responsibility for health and social care provision. I vote for the health service and its funds to look after health care. I recognise, however, that there will always be a grey area when it comes to determining where health care ends and social non-health care begins. Such a debate should be conducted carefully and conscientiously on a cross-party basis.
The hon. Member for Chislehurst also rightly alluded to the commission of inquiry upon which he sat, which published its report this week. I had the benefit of reading it on its publication and, as my party's spokesman on such matters, I was alerted to its findings shortly before publication. Like the hon. Gentleman, I was encouraged by the seriousness of the report and by the commission's careful deliberative method. It sat for two years and it did its job extremely thoroughly. I was encouraged also by the broad range of its recommendations.
One finding complemented the rather alarming fact that, within a broad definition, there are 1 million youngsters who are the subject of abuse--which is extremely worrying. Even if we break down that figure into sub-categories, including those who are clearly abused in various forms, abuse takes place at a horrifying level. It is encouraging, however, that the report concludes that most child abuse is preventable. It appears that most child abuse is committed by those who have a close relationship with the children concerned. It often happens, however, that those outside that relationship do not blow the whistle as early as they should. I hope that, before there are any further knee-jerk reactions, we can have a debate on the report in Government time during this Session.
Like the hon. Member for Chislehurst, I was disappointed to hear the Under-Secretary of State who has recently assumed responsibility for these matters so summarily and, it seemed, grudgingly, reject both the report and some of its recommendations. That did him no credit. Similarly, it did the Government, the report and the National Society for the Prevention of Cruelty to Children, which commissioned the report, no credit. If we can have a Minister with responsibility for disabled people and a Minister with responsibility for the youth service--who in my view should be the Minister with responsibility for young people--surely we can have a Minister with responsibility for children's issues. It is nonsensical that we do not have a Minister responsible for co-ordination in this area.
I accept, of course, that we are participating in a wide-ranging debate. However, the right hon. Member for Brent, North (Sir R. Boyson) talked specifically about education policy, which I know will be the subject of debate next week. That is why I raised questions about his speech earlier. But the themes to which he drew attention, and those referred to by the hon. Member for Birkenhead (Mr. Field), are clearly both among those that underlie how we respond to the social issues of the day.
One of the great social concerns is the future of the NHS. It is an overwhelmingly held view that the NHS represents one of the most civilised acts achieved in this country since the second world war. We created the NHS and we have sustained it. It is something that makes us all more equal, or it should do. It makes for the better health and welfare of our nations, and many of us want to ensure its secure future. For it to be in the Government's programme, for there to be a large degree of consensus about proposed legislation and for there to be a willingness to make primary care better and more accessible are all good things. My colleagues and I, subject to finding that the Bill does not say what we expect, will vote for the Second Reading of the Bill that has been announced. We shall support it and generally welcome it, as I said last week.
Two particular issues, which were touched upon earlier, will be important in relation to primary care. First, if we do not improve it, we shall be desperately short of GPs. I have one figure to illustrate that. Until about five years ago, when practices advertised for trainee GPs they would often receive between 10 and 20 applicants. Today, many practices are lucky if they have one applicant. General practice should be built up, as it is already in some places, to become a viable, valuable and valued part of the
national health service so that trainee medics--and trainees in other allied professions--want to enter primary care as much as they want to enter the acute sector. There will be a great GP crisis ahead unless we do something, because many of the large number who started to practise in the 20 years after the war are coming up to retirement, and because GPs around the country are demoralised.
Next, there is a smaller issue to do with registration. The Secretary of State rightly said that we have a system based on the fact that it is the right of every citizen to register with a GP, who is then the person principally responsible for his or her care. When GPs say that somebody can no longer remain on their list, which happens increasingly, finding another GP who will take them is not always easy. Some patients are difficult, but by definition they are probably the ones who need a GP the most. We need to ensure that the procedures for re-registration and finding another GP work properly. They certainly do not at the moment.
On the specifics of the Bill that we anticipate--we are all working on the basis of the White Paper of last week rather than anything else, other than one sentence in the Queen's Speech--I accept and endorse, as the White Paper does, the fact that the purchaser-provider split should be retained and that health authorities should therefore not employ GPs but should exceptionally be responsible for appointing them where no other GPs are willing to do the job.
Secondly, it is nonsense to appoint an incompetent person to be a GP in a single-handed practice. When I was elected, I was told by the local health authority that more than half the practices in my area were below standard. Sadly, that has been the case in the inner city for far too long. We need to ensure that single-handed and multi-GP practices have GPs of a decent standard. Our patients must not be prejudiced by anything else.
There is another concern. Here I need to deal with the point that was in dispute last week and today between the Secretary of State and the hon. Member for Islington, South and Finsbury (Mr. Smith). There is a difference between a commercial employer employing a general practitioner and a commercial employer, such as Boots, employing a pharmacist. The general practitioner is the personal professional with whom someone registers for their general health care. The GP is their gateway and point of access. The pharmacist is not. I am not signed up to one local pharmacist, to whom I go for all my pharmacy requirements. I go to Boots the chemist in Westminster Bridge road if I need something while I am here, but I will also go to any other pharmacist throughout the land. That is the difference. Just as the hospital--I see that the hon. Member for Peckham (Ms Harman) agrees--to which someone goes when they are suddenly taken ill or need an acute service has to deal with all that person's acute needs, so a GP or practice--it may be a practice nurse--has to deal with a whole range of needs. They really cannot have a double loyalty to the patient and a commercial employer. Of course, GPs are private practitioners and have a contract with the national health service, but their loyalty is to their profession, their ethical code and their patients, and not to anybody else who might be pulling the strings. That is why we want some reassurance.
I am in favour of pilot schemes, and we welcome the provisions in the Bill, but I cannot believe that the Secretary of State does not understand the difference--there is a big difference--between privately employed general practices and general practitioners and GPs who are employed by local community trusts.
Having a general practice in the high street or in Victoria station is a good idea. I am absolutely not opposed to it. Indeed, I am positively in favour of putting practices where the people are. I see no reason why GP practices should not be in shopping malls and shopping centres. In Victoria station there is a private practice. That is the difference. I hope that, in time, we may have public practices in main line railway stations, shopping centres and elsewhere. The hon. Member for Vauxhall (Miss Hoey) and I, who share responsibility for Waterloo--her constituency includes the station itself--would like one in Waterloo station, but run by the national health service. We had better consult our local GPs before we get too enthusiastic about it, but we would be happy to pilot a scheme there.
We also welcome the imminent measures on social security, which will be supported by my colleagues and me as the Bill passes through the House. Reforming the compensation recovery unit is a good thing, and shifting the burden of benefit recovery from the victim to the person responsible for the accident makes more sense.
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