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6.22 pm

Mrs. Marion Roe (Broxbourne): First, I must congratulate my right hon. Friend the Secretary of State on his White Paper, "A Service with Ambitions". Like the chairman of the British Medical Association council, Dr. Sandy Macara, I welcome the document as a commitment by the Government to the continuation and development of a comprehensive and truly national health service. It is appropriate that, following the implementation of the reforms of the early 1990s, a focus is given to delivering a better quality of NHS care year after year, and I am sure that we would all endorse the Government's far-reaching ambitions for the national health service and the steps that they believe must be taken if they are to be achieved.

I also want to place on record a welcome for the Prime Minister's health guarantee, which he gave at this year's Conservative party conference, when he pledged that the next Conservative Government would increase the real resources available to the NHS every year for the five years of the next Parliament. I therefore believe that, under a Conservative Government, the NHS can look forward to an excellent future.

Unfortunately, when I intervened on the Leader of the Opposition during the debate on the Queen's Speech a few weeks ago, inviting him to match the Prime Minister's pledge, he refused to do so. Not only that, but it would appear that the Labour party is unable to give any policy commitments, either.

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I have listened carefully to the contributions to the debate and I fear that the Opposition parties seem to prefer always to give the impression that the national health service is terrible, that patients are being neglected and ignored, and that there is always a crisis around the corner. That is a slur on all those who are working within the health service.

A few months ago, I conducted a survey in my constituency and found that, of those who responded to the 38,000 questionnaires circulated, just under 80 per cent. treated by the NHS within the past two years were either satisfied or very satisfied with their treatment. Of those who were dissatisfied, the complaints were mostly minor, and have since been addressed. Over and over again, the high quality of care was remarked upon.

One reason is that there is no doubt that East Hertfordshire NHS trust, which serves my constituents, has progressed enormously since achieving trust status in April 1992. Its substantial achievements in patient services during that time exemplify the sort of developments throughout the country in recent years.

I have drawn attention in the House to the notable advances in acute hospital care that have benefited patients in east Hertfordshire as a result of the NHS reforms, which enabled local doctors, nurses and managers to meet health care needs swiftly, flexibly and with outstanding value for money. That increased ability to respond puts the NHS in a strong position to face the pressures of current demands.

It is undeniable that hospital services are under pressure, but nor can it be denied that the NHS has always worked under pressure, from its earliest days. As the demands on our health service have increased, so too have the ability and determination of our health workers to meet those demands. They are supported in this by the substantial improvements that the Government have made in the structure of our national health service--for example, the enormous advances in community health services in the past few years. Whether run by family doctors or by community trusts, community health services are vital to everyone. They are the services to which we all need access more frequently than any other.

In east Hertfordshire, we are fortunate to have a network of general practitioners who have used the freedoms and opportunities given them by recent legislation to provide vastly improved patient services. New and enlarged premises now give space and facilities for hospital consultants to come away from the large district general hospitals to see patients in their neighbourhoods.

Patients can see their hospital specialists in the familiar surroundings of their family doctors' surgery, close to home, at a time that fits in with their work and family commitments. They receive quick assessment, with the confidence that more comprehensive treatment will be made available to them back at the general hospital if it is needed.

GP fundholders have used the flexibility of holding their own budgets to pay for those services direct, as their patients require them. Many family doctors are also using their new potential to offer minor surgery and diagnostic facilities in their premises.

Since the inception of fundholding in 1991--for example, at the Stockwell Lodge medical centre in Cheshunt in my constituency--the level of secondary care

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delivered in a primary care setting has gradually increased such that, at present, each month 20 new clinics are provided on the site in the specialties of general medicine, general surgery with two consultants, gynaecology, orthopaedics with two consultants, ear, nose and throat, psychiatry, psychology, dermatology, counselling, and ophthalmology. There are also six minor surgery lists, with four audiometry sessions, one coloscopy session and four ultrasound sessions.

That has all been achieved with a minimum saving of £250,000 in the year 1995-96, which is subject to review, with further considerable savings forecast in the next 24 months. The secondary benefits include shorter waiting times for all patients, fundholding and non-fundholding; the provision of services in an acceptable location; better communication between primary and secondary care doctors; and greater patient and doctor satisfaction.

In east Hertfordshire, the trust hospital and community services work closely with local family doctors to deliver those improvements. The continuing advances in the trust's community services are a further indication of the benefits that patients now enjoy on a daily basis.

For example, I was recently delighted to open the newly refurbished Waltham Cross community clinic, which represents a significant development in community services for people in my constituency and in east Hertfordshire. A clinic has been on the site, providing a range of services for local people, since 1938, but the major new development will enable patients to obtain a wider, more diverse range of services than before.

Services available include a multi-disciplinary child assessment team with a speech and language therapist; a consultant community paediatrician; and a physiotherapist and occupational therapist who will visit the clinic weekly. Audiology, family planning, chiropody, continence, dental, orthoptic, ante-natal and post-natal services are also available.

The clinic is one of the many community units being developed throughout Britain as our health services meet the challenge of the primary-care-led NHS. Local access is essential, especially for the elderly, the disabled, families with young children and those with mental health problems, for all of whom a long journey to a distant district general hospital is daunting and difficult, if not impossible. The clinic and others like it ensure that health care is much more easily accessible to all.

The Waltham Cross clinic scheme was approved in 1994, with money from the North Thames region that forms but a small part of the £40 billion spent on health services in the past year. Improvements in community services result not only from better premises but from a host of advances that the Government's initiatives are helping to create.

Further examples of benefits are listed in East Hertfordshire NHS trust's recent application for charter mark status--itself a reaffirmation of the Government's policy to provide objective analysis of achievements in public service.

Those benefits include the introduction of a maximum 15-minute wait for out-patient appointments in community clinics; Saturday clinics for working parents

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who are unable to attend during the week; the introduction of a night nursing service; and an improved wheelchair service that will provide at the assessment clinic routine chairs that patients will be able to take away, thus providing an immediate benefit from visiting the clinic, before the customised wheelchair is delivered by the approved supplier within five to 10 days.

Among the further benefits listed are improved car parking, with facilities for wheelchair users and the provision of outside covered pram shelters and safety gates for small children; an improvement in the range of information available on a wide range of health issues; the introduction of a user committee to ensure that patients and their carers can contribute to the scrutiny and development of community services; a standard policy that, whenever possible, the needs of patients are given top priority and staff are encouraged to arrange appointments and visits that minimise disruption; and, finally, the development of a community child protection team, based in a community clinic to facilitate access for all staff and clients using the service.

There are examples throughout the country of the genuine benefits experienced by patients as a result of the Government's initiatives to improve the national health service. All those benefits have been achieved cost-effectively, with key improvements directed to patients' needs. In east Hertfordshire, benchmarking reviews show that all the improvements have taken place in an area where staff numbers are lower than average, but total patient contacts higher.

East Hertfordshire NHS trust is an outstanding example of how the Government's reforms, put properly into practice, can daily provide genuine improvements for patients.

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