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Mr. Simon Hughes: The Liberal Democrats are.
Mr. Hendry: Certainly the minority Opposition party is, but it is willing to commit to spend money on absolutely everything. It is a shame that the Labour party has not been willing to repeat that commitment and show its commitment to the future funding of the health service.
Our policies have enabled us to improve the service as it is delivered in doctors' surgeries and hospitals throughout the country. There are 55,000 more nurses than there were 18 years ago, and there are 22,500 more doctors and dentists--including 3,500 more NHS dentists, which is often overlooked--than when the Government came to power in 1979. There has also been a significant onslaught to reduce the weight of administration, accepting that there has to be good administration but recognising that it should not be at the cost of patient care.
On average, there is now one senior manager to 77 other members of staff working in medical provision in the health service. That ratio is very low and it should be recognised as such. It is unfortunate that the Opposition seek to make cheap points out of that and undermine the good and important work that is done by a very able team of administrators in our health service.
It is also a fact that, over the past 10 years, some 750 schemes costing more than £1 million each have been completed. That is more than one a week, and it is testimony to our determination to continue to create an improvement in the physical presence of the health service in our communities by improving buildings and building new hospitals to meet future needs.
We have seen a dramatic drop in waiting lists. In 1987, 200,000 people were waiting more than a year for treatment on the health service. That has now dropped to
just 15,000. That is a fantastic testimony to those who work in our health service. They deserve our credit and thanks for what they have done. It is also true that half of those who need hospital treatment are seen at once. Half of the remainder are seen in five weeks. Only a minute fraction wait for 12 months or more. The reality is that we are now treating some 4 million patients a year more than in 1979, and we are treating 2,250,000 more than in 1991 when the health service reforms started.
We should remind ourselves of the words of the right hon. Member for Livingston (Mr. Cook). It was he who said that the acid test of health service reforms would be whether they treated more patients. I notice that the shadow spokesman on health tried earlier to dismiss the words of the right hon. Member for Livingston, because if they were made by his predecessor by four they were of no relevance. We should go back to those words. If the acid test is whether the reforms will treat more people, we are now treating 2,250,000 more patients than when the reforms were started.
Ms Tessa Jowell (Dulwich):
Does the hon. Gentleman accept that it is extremely difficult to know whether the NHS is treating more patients, because, under the Conservative Government, the NHS counts not patients but "finished consultant episodes"?
Mr. Hendry:
The reality is that under the last Labour Government we had no idea whatever of the level of activity, because the figures were not collated. We did not know how much operations or drugs cost, because Labour did not believe in measuring such costs. It is only because of the measures put in place by the Government that we can make such comparisons and realise that we are making improvements in the number of patients being treated.
I accept what the hon. Member for Dulwich (Ms Jowell) is trying to get at, but the reality is that we are treating more patients, treating them faster, and bringing down waiting lists; and we have almost completely done away with waiting lists of 12 months or more.
The issue of fundholding is at the core of the debate. By April this year, 60 per cent. of the country will be covered by fundholders. That is disappointing in a way; it represents significant strides, but in my constituency more than 90 per cent. of patients are covered by fundholders. Because that percentage is so high, the benefits that fundholders have achieved for their patients have been enjoyed by all members of the community, regardless of whether they are personally covered by a fundholder.
I want to take the House on a tour of some of the new facilities in my constituency, to bring home how the changes have benefited us. In Glossop, in the very north of my constituency, the Manor House surgery run by Dr. Oldham and his colleagues has been transformed. It has developed into one of the most outstanding doctors' practices anywhere, and was recently voted the fundholding practice of the year.
All the doctors' practices in High Peak are breaking new ground and providing better services. In New Mills, a town of almost 10,000 people, Dr. Williams and his colleagues have developed a stunning new surgery, one of the most modern and elegant that I have seen. Patients
feel that they are being treated like human beings, with respect and dignity; they feel that they are getting the best possible treatment, because they are not in shabby and rundown surroundings.
The same doctors' practice has opened a new surgery in Hayfield, which did not previously have a surgery, providing better facilities for people in small villages. In Chapel-en-le-Frith two new surgeries have been constructed: one by Dr. Bartholomew and his colleagues, and one by Dr. Oliver and hers. Dr. Bartholomew has also built a new surgery in Whaley Bridge. Those doctors are extending and improving the facilities that they offer and delivering better health care.
In Hope, Dr. Moseley and his colleagues have built a new practice; and there are new premises in Buxton. As my hon. Friend the Member for West Derbyshire (Mr. McLoughlin) is on the Front Bench today, I should mention the facility at Eyam, which is in his constituency but serves some of my constituents. Right across the area there has been new investment in better surgeries, run by a team of young, dynamic, go-ahead general practitioners who are determined to make fundholding work and who want to build on the success of our health service with the best-equipped surgeries that the country has ever known.
Last September, I brought the Prime Minister to my constituency and took him to one of those doctors' surgeries. The day did not start off terribly well: I asked some of the people standing outside the surgery, who had clearly seen that something was going on, why they had turned up. They said that they had been looking out of their window and, seeing all the police cars converging on the surgery, had come down because they thought that a drugs raid must be--
Mr. Deputy Speaker (Mr. Michael Morris):
Order. The hon. Gentleman must relate his remarks to the Bill. He has certainly not done that for the past couple of minutes.
Mr. Hendry:
My comments, with great respect to you, Mr. Deputy Speaker, are designed to show how fundholding is benefiting our patients and our constituents and--
Mr. Deputy Speaker:
Order. If the hon. Gentleman knew my antecedents in relation to general practice, he would not need to make that remark.
Mr. Hendry:
I accept your guidance, Mr. Deputy Speaker.
The Bill, which is so important, seeks to build on what has been achieved. We have a tremendous amount to be proud of. Like other hon. Members, I have consulted general practitioners in my area about the way in which they want matters to proceed. They recognise the progress that has been made and that it would not have been possible without the changes introduced by the Government; but they also recognise the need to take matters further in the future.
Practitioners talk about how they have developed new services, such as a drugs cabinet in the hospital at Tameside; the unused drugs of patients being discharged are placed in the cabinet to be re-used, rather than being wasted as they were before.
There is a tremendous list of new facilities; my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) referred to some in his constituency, and it is the same in mine: today, we have audiology in Glossop; direct listing of gynaecology services; new dermatology teach-ins; an additional district nurse; physiotherapy and occupational health services; direct links with the pathology laboratory; complementary therapy, such as Alexander treatment and acupuncture; new chiropody services; and something called sigmoidoscopy, about which you, Mr. Deputy Speaker, probably know more than I do--it does not sound awfully nice.
Through fundholding, general practitioners have been able to bring down the waiting lists for everybody in the community--not only for fundholders' patients, but for all who use the services. Previously, the wait for dermatology was two years; now it is only four weeks. For gynaecology it was up to 20 weeks; now it is only four. For ear, nose and throat treatment, it has been reduced again, from 20 weeks to four. The average waiting time for in-patient treatment has been brought down from 18 months to 3.7 months.
That does not apply only in the large practices; progress has been made in small practices, too. Dr. Cox, who runs a surgery in Tideswell, says:
I hope that the Bill will build upon such changes. We must address the concerns that exist and recognise that some improvements need to be made. I have concerns about the way in which doctors' practices sometimes work in relation to the district health authority, when it appears that their budgets are easy pickings. I am concerned that North Derbyshire health authority, having top-sliced 5 per cent. off its budgets last year, is planning to do the same again this year.
For a relatively small surgery, that could mean a reduction of £40,000 in one year. I hope that the Minister will bear such practices in mind and reassure the House that he will try to ensure that they have security in their budgeting plans for the future.
We need to reconsider the efficiency index, whereby GPs are expected to improve their levels of activity by 2.75 per cent. each year. They are well able to meet that: one GP's practice in my constituency was able to increase its efficiency by more than 34 per cent. in one year alone. I hope that my hon. Friend the Minister will examine the ratio set by the Department of Health, whereby one episode in secondary care equates to 54 in primary care. I think that he would accept that that represents a big disincentive to health authorities to reconfigure their services, and that it should be reassessed.
I am concerned also about the point raised by my hon. Friend the Member for Chislehurst (Sir R. Sims), who spoke about the recruitment of new GPs. There appears to be evidence that we are finding it difficult in many parts of the country, and especially in inner cities, to recruit new people to general practice.
I hope that my hon. Friend the Minister will consider how the problem can be tackled head on. I thank him for his help, on a visit to my constituency a year or 18 months or so ago, in the matter of out-of-hours support. He directly addressed the concerns of GPs and enabled a formula to be found whereby their needs, in a generally rural area, could be met. It is clear, however, from other GPs' practices, that they have not all been able to find solutions, and I hope that we will continue to examine the matter to ensure that we can deal with it effectively and for all.
The key point regarding all such concerns is that the Government are addressing them; they know that they exist and they are seeking to build on what has been done, to make the health service better for the future.
The core of the Bill--this is why I support it so strongly--is that it reflects patients' wishes and recognises that GPs know what is best for their patients. They know that patients would like to be treated closer to home if that is possible. They know that patients would be happy for their GPs to carry out minor surgery, if that is possible. The principle is that, where appropriate, care should be carried out at primary, not secondary, level. That is important in a constituency such as mine. Many of my constituents are referred to general hospitals some miles away in the big cities. They may have to go to Tameside, Stockport, Manchester, Macclesfield, Sheffield or Chesterfield because they come from a spread-out rural area. The more that we can enable things to be done in people's localities, the better it is for us all.
We should give GPs the opportunity to advance the pilot projects that they believe are possible because they know better than we ever could--and better than health authorities or any elected body, whatever the Liberal Democrats may suppose--what is possible. They have the vision to make it happen. It is vital that we impose as few restrictions as possible on what can be done. We need to encourage GPs to think widely. That is why I read the Opposition's reasoned amendment with sadness. It states that the Bill
"In our case we now have numerous outreach clinics involving consultants from Sheffield and Chesterfield. Thus our patients are saved long journeys and waiting lists are greatly reduced.
In addition, we have introduced physiotherapy, dietetics and recently Citizens advice into our surgery. We may have introduced these services in time but there is no doubt that the internal market has empowered fundholders and providers now listen with an open ear."
"fails to require health authorities to consult with patients and professional groups on pilot projects before submitting proposals to the Secretary of State".
I do not believe that that should be a requirement, because it is GPs who are most trusted.
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