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Mr. Simon Hughes: My hon. Friend and I probably represent the most different species of constituency in the United Kingdom. Mine is in the heart of London, and my hon. Friend's is in the most remote rural part of northern Scotland. Does he agree that one of the real concerns that affect us both is that, unless a real effort is made and funds are allocated to recruit people to general practice, there will be a shortage of general practitioners in all parts of the United Kingdom, in a way that none of us have known in our adult lives?

Mr. Maclennan: I agree with my hon. Friend, and I call in evidence in support of what he has said what I was told by general practitioners I recently met in Thurso

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in Caithness. They drew my attention to the substantial number of general practitioners who chose to emigrate to Australia and other countries not entirely different from our own. That is a disturbing factor, which requires advanced consideration. It will not do for us to be scraping around in other countries in five or 10 years' time trying to induce practitioners to come to Britain. That would not be a reasonably priced, cost-efficient option.

Mr. Gallie: The hon. Gentleman comes from Scotland, as I do. Is it not a fact that Scotland has the greatest teaching hospitals in the world, and Scots have always taken their excellent skills worldwide? Should we not be proud of that rather than bemoaning it?

Mr. Maclennan: I take great pride in that fact. My father was a teacher at one of those great teaching hospitals. He was president of the Royal College of Obstetricians and Gynaecologists, which was a Commonwealth college. Of course I welcome to the United Kingdom doctors from abroad, as I understand the impulse of those who want to find their fortunes elsewhere. I hope that the hon. Gentleman will accept that I was seeking to make not a partisan point, but the point that doctors in Scotland have told me that their numbers are becoming dangerously depleted. They are worried about the effect on the service in future. It right for me to convey that anxiety to the Minister.

Many general practitioners, particularly in rural areas, feel that their job has expanded in recent years, not because of the influx of new patients or the necessity of keeping abreast of the latest developments in medicine--although that may be true--but because of the requirements of form filling and meeting the demands of the health authorities to provide information for which they receive no additional emolument. That is another factor that is not adequately taken into account, particularly in rural areas with single-handed or small practices with few partners.

I am not suggesting that the work should not be carried out. Some of it is necessary to provide a proper audit of health treatment and to enable the formation of policy to adequately meet the demands of health in Scotland today. However, it is not adequately taken into account in evaluating the service of doctors.

I now turn from doctors to other servants of the public, in ancillary and related spheres. In the north of Scotland, there is great pressure from the lack of certain services, some of which may be regarded as paramedical, such as speech therapists, of whom there is gross under-supply. That can create serious medical problems. I have to ask the Government why we have been aware of the problem for so long, yet the demand is still unmet. I feel that it has much to do with the inadequate reward offered to people providing those services.

I now draw the Minister's attention to a matter with which he is familiar. Although many ambulancemen provide an excellent service, as I found out 20 years ago, when I fell off the edge of my constituency in north-west Sutherland and was taken some 120 miles over fairly rough terrain by an ambulanceman and have been grateful ever since, there are considerable anxieties in the north of Scotland about the management of the ambulance service.

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The hon. Member for North Tayside (Mr. Walker), my hon. Friend the Member for Ross, Cromarty and Skye (Mr. Kennedy) and I have expressed those anxieties to the Minister. We have amassed a number of cases that show that there is something seriously rotten in the management of the service, particularly in Inverness, and we look forward to the possibility of discussing our concerns. Although they involve management issues, they raise extremely grave matters that cannot be tackled without ministerial intervention.

I turn from various tributes and concerns to some of the priorities that we have highlighted in today's debate, not because we consider that they are the only issues that matter, but because they touch immediate needs that can be addressed effectively and immediately.

The first requirement that we have put forward, to which I was rather surprised to hear the Minister taking such extraordinary exception, and to which he reacted in such a partisan fashion, is that there should be a proper independent survey and an analysis of the needs of the NHS. He treated that suggestion as though it was somehow impugning the statistical integrity of officials.

The reality is quite different: it appears that Ministers are indicating that there are certain statistics in which, for whatever reason, they are not interested. They apparently do not want to know about hospital closures on a nationwide basis. That is to do not with the integrity of statisticians, but with political bias, the purblind attitudes of those in charge. For such reasons, it is necessary to conduct an independent survey--one that is not capable of being pushed around by Ministers who are anxious to cover up the defects of our NHS.

There are two reasons why such a survey is necessary. The first is that we need to know the outturns of the services that are being provided. That they are different in different parts of the country is absolutely clear. I serve on the council of the Cancer Research Campaign, which spends substantially more money on cancer research every year than the Government.

One of the things that the council put its hand to was a survey of the outturns of cancer treatments in different parts of the country. It revealed quite disturbing figures, of which the Government are aware. Such work should not be left to charitable organisations to fund, albeit in conjunction with particular health authorities. Such work needs to be done all the time if we are to continue to ensure that our treatments and the delivery of services meet the challenges and standards that we demand and expect, especially in a technologically rapidly advancing area of society.

The second reason is the cognate one that it is important that we know where to invest. That should not be a matter of happenstance or of political pork-barrelling, with Ministers looking favourably on their friends' constituencies, or anything of that kind. It should be decided according to need. We need independent facts and figures to calculate that need. Although we certainly have to aggregate and accumulate those figures locally, they must be interpreted nationally. That was missing from the Minister's response.

I turn to the other proposals in the motion. We should recognise that the imposition of prescription charges is becoming so punitive that impoverished people--there are a substantial number of them, perhaps 10 per cent. of the population--are seriously deterred from going to the

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doctor because they know that they cannot afford what they may be required to pay. We believe that there should be a standstill on prescription charge increases. We have costed that at £9 million per annum, which we believe can be funded by a portion of our proposed tax on cigarettes.

We have also recognised two other specific areas of importance: dental and eye checks. There is very great anxiety that the failure to provide free dental checks is leading to a general deterioration of the dental health of the community. That can have effects far beyond teeth. It can lead to the general debility of an individual. Reinstating free dental checks is a form of preventive medicine that can be extremely cost-effective, and I therefore commend it strongly to the Government. It is not one of the more expensive measures that one might propose. It adds up to £60 million per annum at current prices.

Eye checks are of such importance. There is evidence of people failing to have their eyes checked. There is concern among eye specialists about the spread of glaucoma and preventable diseases due to inadequate cover. I have no doubt from surveys in my constituency that there has been a substantial downturn in attendance in doctors' surgeries for such things of late.

We also recognise the need to increase the number of nurses, and, in some cases, the numbers of doctors. The shortages of doctors have been rather haphazard and very disturbing. I know that one of the great shortages we have suffered in the highlands is among orthopaedic surgeons. We began to catch up after some years of acute shortage, and we now have five orthopaedic surgeons at the Raigmore hospital. They are trying to deal with a great backlog and a long waiting list of people whose operations may be described as elective but who have been suffering great pain. I know, because they come to my surgeries and ask if there is anything that I can do about it.

It has been deeply depressing that, in the past five years, so many medical cases have been raised in my constituency. People used to ask about lawyers, doubts about legal matters or housing, and they still do, but medical matters for a Member of Parliament are something of a new phenomenon. It is due in part to the disturbing medical shortages. We have proposed 10,000 additional nurses and 5,000 additional doctors, and costed that, too. The recommendations are not irresponsible: they are particular.

I draw attention to the rather striking empty assurance from the Labour party that all that is required is the return of a Labour Government. The only money about which the hon. Member for Dulwich (Ms Jowell) was prepared to speak was £100 million that would be drawn from some putative savings in administration costs. I should be delighted if we could make such savings. I hope that it is not just whistling in the wind.

There is an argument that, on occasions, administration is a little top-heavy, but, until the Labour party makes available more particulars, we must view the assurance as rather small beer, especially set against the announcement two weeks ago by the right hon. Member for Dunfermline, East (Mr. Brown) that Labour accepts the Government's budgetary targets for health spending for the next two years.

The hon. Gentleman made that announcement without even bothering to wait to open the books or having the opportunity to examine whether the health administration

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savings can be made. He has bound his party and his Government-to-be, if there is to be a Labour Government--heaven forfend, if that is to be their policy--to accepting the Conservative party's views. That is a sad thought for the country, which is left with a choice to support the Liberal Democrat party, which has been clear, prioritised and firm about things that need to be done.

I should like to cite a couple of examples of issues that have arisen in my constituency that I think need attention. The example of the Migdale hospital, to which I referred at Question Time today, encapsulates one of the pressure points on the health service: the treatment and care of the elderly. I am not attributing blame either to the health service or to the social work department. It is not satisfactory for health service hospitals to seek to edge out those who have been living there for some time, either into social work departments' non-existent care provision or into private nursing homes.

Those are hospitals which bring together, as the Migdale does, specialisms of many kinds to ease the lives of the individuals resident there and of their families. They give respite care, physiotherapy and occupational therapy, as well as specialist treatment. The health board's proposal to consider depriving Sutherland of that hospital is a retrograde step, which I hope will not be taken.

I am conscious of the fact that this is rather a short debate, so, although there are many other matters of general interest that I should love to raise, I shall follow the example of those from my party who have spoken earlier, and confine my remarks to the priority issues. As I have already said, I am grateful to the Minister for being here, and I hope that his response to the debate will be positive.

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