| Previous Section | Index | Home Page |
Mr. Peter Thurnham (Bolton, North-East): Before speaking to amendment No. 9, I should like to add my congratulations to the hon. Member for Wirral, South (Mr. Chapman) on his excellent maiden speech. The
Minister may recall that I made my maiden speech on the British Telecom Bill, and shared many hours on Committee with him.
I should like also to endorse the eloquent testimony given by the hon. Member for Birkenhead (Mr. Field) to the late Barry Porter. I remember my shock on learning that he was so ill. I know that he fought his illness bravely up to the last weeks of his death. The sense of loss is shared not only by North-West Members, but, I am sure, by all Members on both sides of the House.
Amendment No. 9, which stands in my name and that of my hon. Friends, is similar to an amendment that we debated in Committee. I hope that the Minister will be able to give a slightly fuller reply than he was able to in Committee to the points I raised. The amendment has been changed to make it, I hope, more acceptable to the Government. It calls for an annual report to Parliament of reviews of the pilot schemes in England, Scotland and Wales, including an overall summary of the pilot schemes' effect on the distribution of both general practitioners and dentists.
The amendment is strongly supported by the Consumers Association. It is a sensible addition to the Bill to see whether it is achieving its aims. One of the Bill's principal purposes is to achieve more even and equitable distribution of primary care. Clause 5(4) ensures that the Secretary of State must have regard to the effect that pilots are likely to have on the distribution of GPs when he approves pilot schemes, so it seems only sensible that Parliament should be given the opportunity to find out whether pilots are being successful in achieving that end. The amendment provides for an annual report to Parliament on the effect of pilot schemes on the distribution of primary care services.
The Minister will, I am sure, recall that, during the debate in Committee, I touched on some of the regional variations of which we are only too well aware in the north-west. In 1980, the Black report highlighted many of the unfavourable variations there. Sadly, many of those variations are still with us.
In Committee, I discussed three examples concerning children's services, renal services and dental health. I could, of course, discuss others, including heart disease. The north-west has the worst record on early heart disease of any district in England.
I remind the Minister of the points that I made in Committee about perinatal mortality rates in Bolton, which are substantially above the national average. The figures for the past five years show that, in Bolton, still births and deaths within one week, which are, of course, tragic events, are 40 per cent. above the national average. There has been no improvement in the past five years, and the national average is deteriorating, so I call on the Government to encourage pilot schemes that would particularly address that issue, and to find out whether we cannot have some improvement in that respect.
On the same subject, there is considerable concern in Bolton about the future of the specialist children's hospitals at Pendlebury and at Booth Hall. I hope that the Minister will say how the Government will come to a decision about the future of the services in those two hospitals. Both face closure proposals. I hope that a decision will be made at an early date to concentrate the services at Hope hospital, for the benefit of my constituents.
The other point I made in the Committee's debate on the Bill was on renal services. I was very shocked to learn that the north-west has the worst renal services in the country. I learned, in a letter to me from the director of the Salford Royal Hospitals NHS trust, that there could be many benefits from an improved service and that, currently,
Mr. Thurnham:
The consultation documents mention the proposals' benefits to primary services. I think that it is most important that we have primary services that deal with the concerns of renal patients. The disconnect service, for example, is not available in the north-west, and it would be of great benefit to many people there. Moreover, primary care services require that such services should be located within the reach of constituents. We could have twice-weekly renal clinics, dialysis within the district and a specialist renal physician working closely and often daily with clinicians and other health care professionals in the community and in hospitals.
I call on the Minister to make an early decision on the future of those services, and to provide them at the Manchester Royal infirmary and at the Hope hospital. I hope that he will tell us in his reply how he will deal with the issue.
We have also been concerned about the north-west's very poor record on dental health. The Minister is aware of my concern on that matter, and he will remember the White Paper "An Oral Health Strategy for England", which contains a map clearly showing that the north-west region is much the worst region for dental health. The figures on the map are supported by tables published by the British Association for the Study of Community Dentistry, which, sadly, show that Bolton is at the bottom of the national league table, with north and central Manchester. It is significant that the bottom 12 areas, all of which are in the north-west, suffer--
Mr. Deputy Speaker:
Order. I hesitate to stop the hon. Gentleman again, but new clause 4 deals with pilot schemes. I hope that he will confine his remarks to that matter, and that I do not have to pull him up again.
Mr. Thurnham:
Mr. Deputy Speaker, the point on which I wish to press the Minister is that he should encourage the establishment of pilot schemes that will deal with the regional differences that I have mentioned, which are acute in the north-west. My constituents are anxious that there should be improvements in dealing with those differences, and that pilot schemes should be established which deal with the differences.
I ask that the Minister tell us in his reply what can be done with pilot schemes to deal with those severe differences, which have developed not only generally in the north-west but specifically in dental health in Bolton. In Committee, I quoted figures that showed that children's dental health in my area has deteriorated to a point at which it is now the worst in the UK.
I do not wish to press my amendment to a Division, but I hope that the Minister will either accept it or provide a very full explanation of the Government's feelings on the matter.
Dr. Tony Wright (Cannock and Burntwood):
From the moment that the Bill first appeared--even before, during its gestation period--everyone who was involved in thinking about it and commenting on it said that the process of evaluating pilot proposals would be the most crucial factor in its success. There could be no objection--indeed, there was wide welcome--that the Government were proceeding to develop primary care on a pilot basis. The important questions, however, were, how were those schemes to be evaluated, against what criteria, who would be involved in the consultation process, and how were reports to be made on the outcome of the projects?
In Committee, those questions were repeatedly asked of the Minister. His answer has always been to trust him to take a view on the matter. He has a committee, and, although it is a splendid little committee, he seems to be saying, "We will make judgments on those matters, and the House need not trouble itself with them." The House must decide whether it is satisfied with that arrangement, or whether it wants to impose framework obligations on the Minister.
It is quite routine in legislation empowering Ministers to require them to report on the discharge of those powers. Scarcely a day passes without the House producing a document--which is avidly read by all hon. Members--requiring Ministers to account for the powers provided by legislation.
It is very strange that at the centre of this legislation are the questions of what type of evaluation will occur, against what criteria, and who will be involved? From the beginning, the Government did not think that it was important to insert that type of criteria into the Bill. I am sure that the Minister will tell us again today that it is not the House's job to specify the criteria or to specify in detail what should be taken into account in evaluating specific pilot projects. I agree with that. However, the House should insist that there is an identified and established process by which pilots will be evaluated, and it should specify who will be involved in them.
I think that the failure to take that action will eventually be regarded as the Bill's major omission. It is important that Ministers did not feel it necessary to correct the omission. Moreover, as I look at the acres of emptiness behind the Minister, I can only remark that the House has not felt itself obliged to remedy it.
Mr. John Heppell (Nottingham, East):
I think that the Minister knows that I am rather keen on passing this legislation, which is why I hope that I can persuade him that it is a good idea to support new clause 4.
I am keen on the Bill because, unlike many hon. Members, I live in an area in which the majority of doctors--in a ratio of 4:1--have not become fundholders. Those non-fundholders, as they call themselves, set up a scheme of their own by which they could be involved in commissioning work. They would have liked to go further with the scheme and achieve total commissioning instead of total fundholding, because it had all the benefits of fundholding without all the bureaucracy. Therefore, this legislation would allow non-fundholders to take their scheme one step further in providing a better services to their patients.
As many of my hon. Friends have said, the Bill's one omission concerns clause 4, because pilot schemes become almost useless without proper evaluation and consultation. If there is no evaluation, how will we know what is the best practice or what has failed? How will we pass on information from good schemes to GPs in other parts of the United Kingdom? Without proper evaluation, pilots become pointless or merely local exercises. They may fail or they may succeed, but they will be concerned with only one area. Even if a scheme is successful, similar schemes may be started from the beginning in other areas, again and again, because information from pilots has not been evaluated and passed on.
People say that the Minister never considered the idea of evaluation criteria at the Bill's inception, but that is not true, because the idea was spelt out clearly in the Government's White Paper "Choice and Opportunity", which expressed a general approach to piloting. The paper contained about seven or eight bullet points, all of which I will not read out. The first was:
The point that is particularly relevant--it has been mentioned already in the debate--states:
In addition, the White Paper identified safeguards for patients and practitioners. It said that the Secretary of State should be able to make arrangements for the evaluation of a pilot, including
I have made my position clear to the Minister in other discussions, but I should like to draw attention to the provision in new clause 4 to ensure that local medical committees can continue to act as watchdogs. I am confused about why the Minister will not put that on the face of the Bill.
Perhaps the Minister recalls the words of the Chancellor of the Exchequer on a BBC 2 programme "Safe with Us" in respect of previous NHS reforms:
Local medical committees have been operating since 1911, well before the formation of the national health service. Since 1911, they have been consulted by NHS executive councils, health authorities and, before them, insurance committees. Why should the Minister suddenly decide that local medical committees should no longer have a role in these matters?
My local medical committee represents all the doctors in the area--fundholders and non-fundholders. It speaks for all general practitioners and should be consulted. If local medical committees are not consulted, we shall lose out in terms of the professional advice that general practitioners can offer in medical and administrative matters.
Baroness Cumberlege stated in another place that consultation in the NHS was standard practice. As far as I am concerned, there is no standard practice of consultation at any level in the national health service. Nowadays we have public relations. People produce glossy brochures telling us all the good points of any proposal. It happens at every level--in trusts and health authorities. We never hear the bad news until it is too late. Nor are we told about any proposed changes to the health authority until they are so advanced that we can do nothing about them.
"only half the patients who could benefit from life-saving dialysis therapy are on treatment"--
Mr. Deputy Speaker:
Order. The hon. Gentleman is straying rather wide of new clause 4 and amendment No. 9.
8 pm
"ideas for pilots will be formulated locally"--
and so they continue.
"pilots will be evaluated against the criteria established at the start and taking account of the views of those involved and affected."
That is quite clear, and I thought that it was the Government's intention.
"approving the criteria and process",
requiring health authorities to monitor the quality of the service provided and to provide information locally about the pilot to those affected, particularly on the quality, volume and cost of services to ensure that patients were protected and taxpayers received value for money and on the
"criteria for evaluation and the process for doing so."
Very few of those commitments are on the face of the Bill, which is weakened by their omission. New clause 4 also makes provision for proper consultation with a range of bodies, including community health councils, professional groups and the Medical Practices Committee.
"I was sure if you isolated a few places as pilots, all the best efforts of the BMA element in the medical profession would be bent to ensure that it failed."
That may be part of the problem. The Government treats local medical committees as if they were trade unions. I do not dispute the fact that local medical committees look after the interests of general medical practitioners.
That is part of their role, but they also look after the interests of general practice. There is a difference: they look after the interests of patients as well as doctors.
| Next Section
| Index | Home Page |