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Mr. Robathan: I have listened to the hon. Gentleman's comments with interest. Having regard to his own experience as a GP in west Belfast, does he not think that improvements could be made? It is all very well to claim that fundholding has led to discrimination, but does he not think that we should make progress? Does he agree that fundholding has proved generally beneficial to practices that have selected that option, and that we should proceed
down that road rather than saying, "Fundholding is discriminatory and some practices are not doing so well"? We should encourage all practices to do better.
Dr. Hendron: Fundholding will work only if all doctors become fundholders and if we have an equitable system for doctors and patients. I do not have the figures for fundholding and non-fundholding GPs in Northern Ireland. I did not agree with the principle of fundholding when it was introduced, but it is here to stay so there is no point arguing about the fundamentals. The system will work properly only if all doctors are fundholders--no one can deny that fact. In Belfast, the patients of fundholding GPs are often treated first while those of non-fundholders remain on the waiting list. That is wrong.
I pay tribute to the Royal College of General Practitioners, which has played a major role in elevating general practice within the national health service in the past 20 years. Some 20 or 25 years ago, doctors used to make jokes about general practitioners. That does not occur any more, and the standard of general practice is very high. We have some difficulties encouraging doctors to train in that area, but that is an extremely complex problem that I cannot explore now.
Mr. Andrew Robathan (Blaby):
I apologise to the House for not being present for the beginning of the debate. My absence was due partly to my busy schedule and partly to the fact that I went to look at a school for my son, who is now nine weeks old. Like most people in their early or mid-forties, I have not had great experience of the national health service. However, I recently experienced its primary care services at first-hand with the birth of my son. I was extremely impressed, as was my wife--which is perhaps more important--with the service provided.
My wife received excellent pre-natal care from her GP and from the hospital. During the delivery at St. Thomas's hospital--I shall briefly digress from primary care provision--two midwives, a doctor, a senior registrar, a paediatrician and an anaesthetist were present in the delivery room. I was proud to be known as a Conservative MP, just in case some of the staff were not particularly happy about it. However, I discovered later that one midwife had trained in Leicester at the time of the last election and had voted for me--which is a feather in my cap. My wife and son received excellent treatment, which was very reassuring.
Dr. Tony Wright (Cannock and Burntwood):
Another victory for Labour.
Mr. Robathan:
No, it is not. Since the delivery, my wife has received post-natal care, and the standard of
I cite that personal experience because it has given my wife and I great confidence in the NHS and in its primary care provision. Our experience counter-balances the stories that one reads from time to time--which usually appear in the cheaper press--claiming that NHS treatment is not good. Primary care--which I hope will benefit from the pilot schemes mentioned in the Bill--should aim to prevent disease and maintain health standards. I hope that my hon. Friend the Minister for Health will refer to that point in his winding-up speech.
Primary care is about general health and fitness. That is not to say that we want a nanny state to determine the fitness or health of every individual. The Evening Standard refers to an advertisement for eggs with runny egg yolks, and says that some people are already complaining about it because those are bad for us. With all due respect to my hon. Friend the Member for South Derbyshire (Mrs. Currie), those of us who like our egg yolks runny do not need the state to tell us, in the cause of prevention, that they are bad for us.
I do not want a nanny state, but I would like a greater concentration on health and fitness promotion. Leicestershire health authority is to be congratulated on the information that it provides, even if it sometimes strays a little towards the nanny state.
Being a 45-year-old male, and having had very little medical treatment during my life, I am a classic example of a person who does not often use primary care or the NHS until the age of 50. Apparently, from the age of 55 I will become a bit of a liability to my GP and to the health service as a whole. That is the usual pattern: if one is fortunate enough to be healthy, one does not use health care services until one is about 55.
Mr. Richard Spring (Bury St. Edmunds):
My hon. Friend demeans himself, because he is one of the more energetic Members of the House. He is well known for riding his bicycle. I feel sure that the first time that he will have any real involvement with the NHS will be at the age of 65, rather than 55.
Mr. Robathan:
I am grateful to my hon. Friend, but I rather hope that I will stay out of hospital altogether, as I sometimes feel shaky at the knees just walking into a hospital.
We have seen the Government's White Paper, "The Health of the Nation", and we have seen the way in which local health authorities pursue preventive measures: it could be called health encouragement. My hon. Friend mentioned cycling. If children walked or cycled to school, they would remain healthier. I am sure that the hon. Member for Belfast, West (Dr. Hendron), who was a general practitioner, would agree with me that we must encourage our children to be fit and healthy. The discouragement of competitive sport in school has made children less willing to take to the playing fields, but I am glad to see that the Department for Education and Employment is now putting that right.
Gyms are a flourishing commodity around London and elsewhere: there is one in the House of Commons, and one nearby, which I use. The use of gyms shows that people are concerned about their health. By staying healthy and fit, they reduce the burden on the NHS. I have seen reports that GPs may now be able to prescribe courses at gymnasiums for their unfit patients.
Being healthy and fit starts at school. Health promotion in schools can be particularly useful, especially in primary schools. I went to a primary school in my constituency on Friday. I saw the lunches that the children were bringing from home instead of having the lunches provided by the school. They must have been just as expensive as the £1.15 that the school charges for lunch, but they contained food that was not the most healthy.
Mrs. Mahon:
Is the hon. Gentleman aware that the former Prime Minister, Baroness Thatcher, was responsible for abolishing nutritional aspects of school meals?
Mr. Robathan:
I recall hearing the chant, "Maggie Thatcher, milk snatcher" in the High street at Oxford when I was at university. Free milk in schools can still be obtained. I also remember that milk used to be delivered to our school.
Mrs. Mahon:
Milk is nutritional.
Mr. Robathan:
Yes. It was delivered to our school, but it was always tepid and no one drank it. Many of those third-pints of milk were taken away undrunk, because no one liked the stuff. The hon. Lady is right in that we should encourage a greater nutritional content in school meals. I think that we agree entirely on that.
If health professionals and teachers develop an awareness in schoolchildren of the importance of eating the right food, and not just crisps and chocolate, less of a burden will be placed on primary health care.
People in Leicestershire are concerned about air quality. Air quality in London, Leicester or wherever affects the number of asthmatics who go to their doctors or have to attend hospitals. We should examine this problem, and take a holistic approach to health care and prevention. If we could reduce the pollution in our cities, fewer children and others would go to their doctors. I am keen for some of the pilot schemes proposed in the Bill to work hand in hand with other agencies towards that end, and I hope that something along those lines will be discussed in Committee.
Fundholding is growing in popularity. Doctors in Blaby have said to me that they do not like fundholding, but the next year they have decided to become fundholders because of the benefits, and the following year they have said that there are also benefits for their patients. As I said to the hon. Member for Belfast, West, that is how to make progress. We must ensure that the service is getting better, and that improvements are always being made.
I recently went with my wife, who was then pregnant, to a fundholding surgery in Blaby. It was a bit of an emergency: my wife was concerned. We went there at short notice--we are not registered with that practice, because we are registered in London. We received excellent treatment. I say to those who knock fundholding practices, "What were things like 30 years ago? Indeed,
what were they like 18 years ago?" The treatment that one receives in a national health surgery is better than it was before, and one should think back before criticising and harping on about what may not always be perfect now.
Two fundholding surgeries in my constituency--a health centre in Blaby and one in Countesthorpe--have recently installed ECG machines. The Blaby Lions organised sponsored walks to raise the money for those machines. I see no reason why local people should not help raise money for local health centres. I should pat myself on the back, because I took part in both sponsored walks, although I did not complete one of them.
If we were to abolish GP fundholding, as some Opposition Members want--I am not sure about members of the Opposition Front Bench, who seem to vary slightly--what would we lose? What facilities would we lose? What freedom to employ additional staff and to use alternative treatments would we lose? From my limited personal experience, I think that we would lose a great deal.
We should also consider the rising expectations of patients. Patients are no longer happy to put up with the grotty GP surgeries that they have perhaps had to put up with in the past. One may say that patient expectations are too high, but I do not agree. We should expect decent, well-run, clean surgeries, with the latest equipment if possible. We should be working towards achieving that where it does not exist.
Patients must also take responsibility for their own primary health care. If a heavy smoker--this also relates to health promotion--is not given all the treatment that he wants, we should say to him, "Surely you too are responsible for your health, not just the doctor or the hospital. You are responsible for looking after yourself." Otherwise, we become a nanny state that says to people, "Whatever you do, we will look after you," and I do not think that that is right.
I went to the casualty department at St. Thomas's hospital with my young son just before Christmas--treatment in casualty is primary health care. I was appalled by what the excellent staff of the hospital had to put up with on a Thursday evening before Christmas. It was quite shocking. I shall not be too rude about the people, except to say that they were drunks, layabouts and louts, and were being extremely rude to one another and to the staff. We should tell them that they are responsible for what happens to them, especially those who were dripping with blood, having fallen over in drunken stupors. As many doctors have pointed out to me, those are the same people who call doctors out in the middle of the night to say that they have a bit of a sore throat. We must make individuals more responsible for their own primary health care.
Linked to that is the question of compensation. I hope that, in Committee, we shall consider giving more protection against vexatious litigation. Once, when someone fell ill, the standard cry would go up, "Is there a doctor in the house?" I fear that we are now approaching the situation that exists in America, where doctors pass by on the other side because they are frightened of being sued. That is dangerous: doctors who have taken the Hippocratic oath, and are interested in the well-being of their fellow man, should not be subject to that fear.
Leicester is fortunate in having three general hospitals--Leicester royal infirmary, Glenfield hospital and Leicester general hospital. All have good reputations,
and a great deal of money has been spent on them recently; but a project is now under way to establish whether it would be better to concentrate the care that they provide on two sites. I shall not comment on whether that would be desirable, because I am not a health professional. I shall say, however, that I think it right to allow the professionals who are most closely involved--surgeons, consultants, nurses and managers: those who must provide the care--a decent say. I regret to say that at least one Labour Member representing Leicester has said that that is wrong. We should view the position in its entirety, and consider what is best for the people of Leicester.
While it has been increasingly difficult to obtain dental care on the NHS in the recent past, I am delighted to note that it now seems to be becoming easier. Not long ago I registered with an NHS dentist in Leicestershire, and, although it is true that one has to wait for a while for treatment, I commend the dentist who has treated me on several occasions. I suspect that the cost of crowning two teeth was relatively inexpensive. People say that NHS dentists are useless, but I was able to sign up with that dentist in an emergency, and he has given me excellent treatment.
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