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House of Commons

Tuesday 9 December 1997

The House met at half-past Two o'clock


[Madam Speaker in the Chair]


Scottish Agricultural College Order Confirmation Bill

Considered; to be read the Third time.

Oral Answers to Questions


The Secretary of State was asked--

Primary Care

1. Mr. Pond: What proposals he has for increasing the role of primary care within the NHS. [18227]

12. Mr. Prosser: What proposals he has for promoting the role of primary care. [18240]

The Secretary of State for Health (Mr. Frank Dobson): The development of primary care is one of the Government's medium-term priorities for the NHS. We recently launched a salaried doctor's scheme which will improve the quality of services and help tackle health inequalities. From 1 April next year, health authorities will be able to fund local development schemes to improve general medical services. We also intend to proceed with pilots under the National Health Service (Primary Care) Act 1997 to explore more flexible ways of delivering primary care. Our further proposals will be set out in the White Paper to be published at 3.30 pm today.

Mr. Pond: I thank my right hon. Friend for his reply. Is he aware that general practitioners in my constituency of Gravesham and in the constituency of my hon. Friend the Member for Dartford (Dr. Stoate) have recently developed a highly successful scheme of co-operation? Is he further aware that we have recently opened a minor injuries unit in Gravesend and North Kent hospital, again managed by nurses and GPs, as the first stage to establishing a proper community hospital in the borough? Is not the way forward for the health service putting GPs and nurses in the driving seat and ensuring that they can match local decisions to local needs?

Mr. Dobson: What my hon. Friend says is true and very welcome. Such developments, which we have been looking at and studying, make us confident that the proposals that

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we shall be introducing this afternoon are going with the grain of the people within the NHS, who are trying to develop better and better services for local people.

Mr. Prosser: Does my right hon. Friend agree that most patients look upon their local nurses and health care professionals as the linchpin of the NHS? Can he assure me that he wants to see places such as Aylesham health centre, Deal hospital and Buckland hospital in my constituency flourish and expand?

Mr. Dobson: What is wanted is a first-class health service, close to home so that people do not have to travel long distances to find primary care, community care and community hospitals. That is what is wanted increasingly by local people and the profession, and we want to help them bring it about.

Mr. Rowe: Is the Secretary of State aware that his emphasis on primary care will be widely welcomed? At a time when the responsibility for developing the health service is shifting increasingly to primary care, is there not something absurd about carrying on the kind of rationalisation of hospitals that is going on now, without any reference to GP preferences? For example, in Kent, the Kent and Canterbury hospital and others are under threat.

Mr. Dobson: As everyone knows, the number and nature of hospitals in the NHS has been changing since the NHS came into being. We are determined to ensure that any changes reflect the needs of people living in a particular area. As I understand it, in the area represented by the hon. Gentleman, the proposals are out for consultation. The new Government want to move to a situation where consultation is genuine and not just a period of time.

Mrs. Virginia Bottomley: Is the Secretary of State aware that Professor Howard Glenerster has suggested that GP fundholding has caused a shift in the balance of power back to GPs for the first time this century? Is the right hon. Gentleman committed to doing everything that he can to build on the success of GP fundholding and extend those opportunities to others?

Mr. Dobson: When our White Paper is published this afternoon, the right hon. Lady will see that we are trying to build on the parts that have worked and dispense with the parts that have not worked.

Ms Blears: My right hon. Friend will be aware that Salford has one of the new GP commissioning pilot projects. Despite its unfortunate acronym, the Salford health action group is working tremendously hard to improve the health of the people. Will my right hon. Friend tell us how important he thinks is the voice of patients and users in such projects?

Mr. Dobson: There are some who suggest that I am noted for my vulgarity, but never in the Chamber--or at least, not this Chamber.

My hon. Friend has made a crucial point. We need a national health service that is moulded to the needs of the patients, and the medical and nursing professions are as wedded as anyone to that concept. They are trying to liaise with local people to ensure that the services that

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they provide meet the needs of local people. We are determined that our changes to the national health service will help to achieve that. I am sure that everyone will be better off as a result.

Herefordshire Health Authority

2. Mr. Keetch: What plans he has to reduce bureaucracy in the Herefordshire health authority. [18228]

The Minister of State, Department of Health (Mr. Alan Milburn): Herefordshire health authority has recently announced that it will be implementing a new management structure which will save at least £100,000 per year. That sum will be available for investment in direct patient care to improve the health of the local population.

Mr. Keetch: I thank the Minister for his answer. Does he agree that the Herefordshire health authority has the widespread support of the people of Herefordshire? Does he further agree that the implementation next April of the Herefordshire unitary authority, with boundaries coterminous with the health authority, will provide an opportunity for excellent co-operation between the local authority and the health authority? Will he give a commitment that his Department will do everything it can to support such co-operation?

Mr. Milburn: We certainly shall--co-operation is in; competition is out. Co-operation is in especially at the boundaries between health and social care. We want there to be much more closely integrated care between health and social services to ensure that people on the boundary of the interface, who are the most vulnerable members of our community--the mentally ill, the disabled and the elderly--get the care and attention that they deserve.

Mrs. Anne Campbell: Is my hon. Friend aware of the warm and widespread support for the Government's proposals to reduce bureaucracy and administrative costs in the national health service, which has already contributed to additional money being made available for the treatment of breast cancer? That is very warmly welcomed in my Cambridge constituency.

Mr. Milburn: My hon. Friend is absolutely right. Simply by cancelling the eighth wave of fundholding, we were able to free up £20 million for investment in front-line patient services, £10 million to improve breast cancer services and £5 million to improve children's intensive care services. I hope that all right hon. and hon. Members agree that those are the right priorities for a national health service.

Mr. Maples: We share the hon. Gentleman's objective of channelling any savings on bureaucracy that he can achieve in the Herefordshire health authority into improving care for people in Herefordshire. By what criteria would he want people in Herefordshire to judge and evaluate his party's stewardship of the national health service?

Mr. Milburn: The people of Herefordshire will be able to judge our stewardship of the national health service very simply--on the proportion of investment that goes

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into front-line patient services rather than into bureaucracy; on the basis of whether there is an improvement in patient services in Herefordshire and elsewhere year on year; and by whether waiting lists are shorter, as they will be, by the end of this Parliament.

Mr. Maples: I was interested to hear the Minister talk about funding. Will he promise the people of Herefordshire that the Government will beat the previous Government's record of increasing funding annually on average in real terms by 3.1 per cent?

Mr. Milburn: If the hon. Gentleman had bothered to look at the figures for Herefordshire health authority, he would have noticed that, for the next financial year, the allocations made by this Government will mean an increase in cash terms of 4.69 per cent., compared to 3.38 per cent. for this year under the previous Government.

Distribution Formula

3. Mr. Clifton-Brown: What representations he has received on changes to the distribution formula for allocating resources to local health authorities. [18229]

Mr. Dobson: The allocation formula for 1998-99 was changed better to reflect the health needs of local populations in every part of the country. That was announced on 29 October 1997, Official Report, columns 828-29. I have received no representations on that matter since that date.

Mr. Clifton-Brown: I am about to make a representation. Will the Secretary of State confirm that the formula was altered according to deprivation, the effect of which is to channel resources away from rural areas towards urban areas, with the result that the increase for next year will be only 1.35 per cent. in my constituency, as opposed to 2 per cent. nationally? That led to a public meeting in Cirencester, which was attended by 500 people, to protest about cuts in the accident and emergency department. Is it not wholly unfair that resources are being channelled from rural areas towards urban areas? My constituents should have a fair share of the national cake.

Mr. Dobson: As the elected Member for Holborn and St. Pancras--there are few more urban constituencies in the world--I can tell the hon. Gentleman that my health authority received exactly the same percentage increase as his. The changes were made in an effort to introduce more fairness into the allocation. The hon. Gentleman apparently does not know that, for the first time in the history of the national health service, an element of rurality was added to the formula to benefit rural areas. No Conservative Government ever did that, so the hon. Gentleman should be grateful.

Mr. Olner: I welcome the changes that the Secretary of State has announced. Will they work their way through to Warwickshire health authority where for many years the south of the county, where morbidity figures are low, has received more funding than my constituency

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of Nuneaton in the north, where morbidity figures are high? Are morbidity figures being taken into account in the new review and the reallocation of resources?

Mr. Dobson: Mortality and morbidity statistics obviously formed a major part of the formula. However, we are not satisfied with the present formula and have set up a group to study it in time for further changes. The aim must be to allocate funds to those areas most in need, and the areas with high levels of mortality and of morbidity--in other words, sickness--must take priority.

Mr. Ian Bruce: I am sure that the Secretary of State will agree that the national health service has been a leader in information technology and getting information to Ministers so that they can deal with problems. Has he read the Financial Times this morning in which professors suggest that the year 2000 problem will affect the NHS badly, and could cause deaths? Is he aware that the IT systems are already overloaded by the work being done on that problem, and that the announcement that he is to make at 3.30 pm in relation to more changes to the IT systems will cause a crisis in IT departments in the NHS?

Mr. Dobson: For a start, only a fool would regard the information technology systems in the NHS as satisfactory. I should certainly not address any laudatory remarks to them. They are incapable of supplying some of the most basic information that people might require. We want the health service to have information systems that help patients and help clinicians to provide better, quicker and more effective treatment. We shall get on with that. Since coming to power, we have taken action to deal with the 2000 problem. The main problem is not in the information technology systems, but in the embedded chips in all sorts of health service machinery, including scanners and other vital equipment in operating theatres. That is being addressed. It will be dealt with, but it will cost money.

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