House of Commons
Tuesday 2 February 1999
The House met at half-past Two o'clock
PRAYERS
[Madam Speaker in the Chair]
PRIVATE BUSINESS
City of London (Ward Elections) Bill
Order for Second Reading read.
To be read a Second time tomorrow.
Read a Second time, and referred to the Examiners of Petitions of Private Bills.
Read a Second time, and committed.
Read a Second time, and referred to the Examiners of Petitions of Private Bills.
1. Charlotte Atkins (Staffordshire, Moorlands):
How many dentists there are per head of population (a) in the UK and (b) in North Staffordshire health authority; and what impact Government policies are expected to have on these figures. [67159]
The Minister of State, Department of Health (Mr. John Denham):
The number of general dental service dentists per 100,000 of the population at the end of September 1998 was 35 for England and the United Kingdom, and 24 for North Staffordshire, excluding salaried dentists. The Government are funding six Investing in Dentistry bids in North Staffordshire, which will increase the number of dentists by six and allow 16,000 people to receive national health service care.
Charlotte Atkins:
I thank my hon. Friend for that answer. I was horrified, when I was elected in May 1997, to find that there were no NHS dentists in my constituency. Since then, the very good work of John
Mr. Denham:
A number of initiatives are under way to meet that need, and I congratulate my hon. Friend on her close involvement in this matter in her constituency. One of the most important initiatives is the Investing in Dentistry process, from which North Staffordshire has benefited already, and I know that two further bids are under consideration in my hon. Friend's constituency.
So far, 242 Investing in Dentistry bids have been funded across the country, enabling another 600,000 new patients to receive national health service care. It is also possible, of course, to develop salaried dentist services in areas where other dentists cannot be attracted to practise.
Mr. Michael Fabricant (Lichfield):
Is the Minister aware of the scandal that has developed over the past few months which means that people in Staffordshire have to wait 15 months or two years for dental and other operations at Good Hope hospital? In contrast, people in Birmingham have to wait only five or six months for the same operations.
Will the Minister guarantee that he will look into that scandal and find out exactly why such a discrepancy has developed under this so-called "caring" Labour Government?
Mr. Denham:
Inequities in health care between different parts of the country were a feature of the development of the national health service under the previous Administration. I shall, of course, be more than happy to look into local cases brought to my attention by any hon. Member, but I assure the hon. Gentleman that, with the extra investment through modernisation to tackle the pressure of waiting lists, the national health service in his area will do far better than it did under the previous Conservative Government. That applies in all other parts of the country as well.
2. Mr. Paul Flynn (Newport, West):
What proposals he has to reduce the use of neuroleptic drugs in care homes. [67160]
The Parliamentary Under-Secretary of State for Health (Mr. John Hutton):
We are aware of concerns that have been expressed about the possible over-use of neuroleptics, and several current initiatives will help to address them, including the National Institute for Clinical Excellence and the national service framework for older people.
Mr. Flynn:
I thank my hon. Friend for that helpful reply and for the action that his Department has taken to deal with a distressing problem. The symptoms of senility displayed by many people in care homes are the result not of old age but of the misuse and over-use of neuroleptic drugs.
May I urge my hon. Friend to copy the initiative of the school of old-age psychiatry in Manchester, under which independent pharmacists and doctors were taken into homes? As a result, the use of such drugs was reduced, people's lives were lengthened, money was saved for the NHS and many elderly people were rescued from much unnecessary misery and confusion.
Mr. Hutton:
I am grateful to my hon. Friend for raising that very legitimate concern about the use of neuroleptic drugs. I shall certainly look into the work that has been done in Manchester.
My hon. Friend may also like to know that we have commissioned the Centre for Policy on Aging to draw up new national standards for residential and nursing care homes. The use of medication in care homes will be covered by the new standards.
Mrs. Jacqui Lait (Beckenham):
The Minister referred to draft national standards. Will he confirm that there will be formal consultation on them?
Mr. Alan Duncan (Rutland and Melton):
Is it not ironic that, while residents of care homes may be over-medicated with neuroleptic drugs, there is massive rationing of psychoactive drugs for people with mental illnesses? What does that imbalance say about the Government's priorities and values? Will the Minister at least admit that that imbalance exists?
Mr. Hutton:
I must tell the hon. Gentleman that the use of neuroleptics is very serious, and we are determined to address the issue. He has conveniently forgotten that, as part of our strategy to modernise mental health, we are releasing significant new resources to help purchase new anti-psychotic drugs.
3. Mr. Andrew Dismore (Hendon):
How many primary care groups he expects to commence during 1999. [67161]
8. Mr. Jim Dobbin (Heywood and Middleton):
How many primary care groups he expects to commence during 1999. [67166]
The Minister of State, Department of Health (Mr. John Denham):
Some 481 primary care groups will commence on 1 April 1999, and they will have the capacity to commission services from that date. The degree of responsibility for commissioning services will be agreed between the PGC and the health authority.
Mr. Dismore:
Last week, I met representatives of Barnet West primary care group, who stressed the importance of recognising local factors in the work of PCGs. Does my hon. Friend share that PCG's desire for flexibility both in the setting up of PCGs and in ensuring that our doctors, our nurses and our community are in the driving seat when it comes to planning health care for our local area?
Mr. Denham:
I can certainly assure my hon. Friend that we have established PCGs covering all the general
It is important that local factors and judgment are taken into account. That is why we have made it clear that the pace of development of PCGs over such matters as how quickly they take on the commissioning of services is a matter for local judgment and agreement.
Mr. Dobbin:
Can my hon. Friend reassure GPs who are working hard to set up the primary care groups, and to make them work, that clinics and out-patient services provided for their local communities will be adequately funded by each health authority?
Mr. Denham:
I acknowledge my hon. Friend's tribute to the active role that GPs are playing in ensuring that primary care groups will work. We have made it clear to health authorities that, where cost-effective and good services have been developed at practice level, we wish to see them continue. We also want to see plans drawn up to spread the benefits of those services to other patients in the PCG area.
Mr. Ieuan Wyn Jones (Ynys Mon):
Will the Minister acknowledge concerns about the extent of lay representation on PCGs? Will he undertake to reconsider lay representation if it is shown that it would be of immense benefit to the PCGs, particularly if it brought in wider expertise from outside the medical profession?
Mr. Denham:
I have looked at proposals for membership of primary care groups, and my view is that the different factors involved have been appropriately balanced. It is understandable that people are examining the formalities of PCG constitutions at this stage, but, given existing flexibility, primary care groups will develop effective partnerships to provide primary care at the local level. I am sure that health professionals will draw on the expertise of others, including lay people who are not themselves members of the PCG, to develop effective services. As PCGs evolve in practice, effective working partnerships will be created, and that is most important.
Miss Ann Widdecombe (Maidstone and The Weald):
Does the hon. Gentleman agree that, even by the standards of a Government who arrogantly sideline Parliament as much as they can, it is amazing, when the Secretary of State has published a Bill within the past few days to enable the abolition of fundholding, that fundholding has already been effectively abolished, and that arrangements are in place to dragoon GPs into collectives on 1 April, by which time the Bill will not have achieved even parliamentary consent, let alone Royal Assent?
Mr. Denham:
The right hon. Lady has failed to notice the enthusiasm, commitment and dedication with which so many fundholding GPs have committed themselves to primary care groups. They see that this is the right way to develop the national health service. Professional GPs are working in co-operation with other health
Miss Widdecombe:
I am wholly in touch with the timetable: primary care groups are to be set up on 1 April and the Bill has not even commenced its passage through the House. I am aware that the Minister has dodged my question--he is so ashamed of his arrogance that he will not address it. Will he now answer me?
Mr. Denham:
The right hon. Lady does not understand either the legal or the parliamentary situation--although it has been set out very clearly and is evident from the Bill. Primary care groups can be, and are being, established under existing legislation. Fundholding will be abolished when the Health Bill achieves Royal Assent--assuming that that occurs. We shall make provision in the Bill--it should be perfectly clear to the right hon. Lady--for a residual fundholding scheme to operate from 1 April. I believe that the vast majority of fundholders will dedicate their energies to developing primary care groups and accept that fundholding will end on 1 April. It is there in the Bill. There will be a residual scheme for fundholders which will continue until the health legislation receives Royal Assent. I have answered the right hon. Lady's question, but she does not like my answer.
Mr. Andrew Reed (Loughborough):
The majority of Labour Members warmly welcome the establishment of primary care groups. Will the Minister join me in welcoming the establishment of such a group in North Charnwood--which covers the Loughborough constituency--which builds on existing co-operation between general practitioners in the area? However, will the Minister look closely at the management responsibilities of the group? It does not wish to appoint a manager but wants to allocate existing resources among the general practices in the group. Does that send the wrong signal to others who are involved in the PCG, for example, non-GPs--that it is GP-led?
Mr. Denham:
It would be wrong to comment on the particular local example to which my hon. Friend referred, although I shall be happy to look into the situation. We have published guidelines about the way in which we expect primary care groups to develop that strike the right balance between central encouragement and local flexibility. I shall look into the case that my hon. Friend has raised.
Mr. Robert Walter (North Dorset):
When the Government were elected, they claimed that they would save £100 million on administration in the national health service. The Government have already allocated a massive sum for the administration of primary care groups and they have stated that health authorities will also have to make money available to that end. The Government also expect GPs and other health professionals to give freely of their time to help with that administration. Have the Government assessed the total cost and effectiveness of primary care groups?
Mr. Denham:
The hon. Gentleman fails to realise that, by introducing primary care groups, we will be able to cut
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