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NHS Drugs and Treatment
12. Mrs. Virginia Bottomley (South-West Surrey): What recent representations he has received on the unavailability of particular (a) drugs and (b) treatments to patients in certain health authorities. [67170]
The Secretary of State for Health (Mr. Frank Dobson): I have received representations about availability on the national health service of certain drugs in certain parts of the country. The current situation is quite unsatisfactory, which is why we are establishing the National Institute for Clinical Excellence--NICE--chaired by Professor Sir Michael Rawlins, to assess new drugs and new treatments and to issue authoritative guidance. NICE will ensure faster access to modern treatment right across the health service--which is why it has the support of doctors, nurses, midwives and other NHS staff.
Mrs. Bottomley: Many people hope that the new National Institute for Clinical Excellence will indeed encourage innovation and change. However, people are not prepared for the institute to act as a straitjacket, dampening down innovation and making it more difficult to develop and make available new drugs. Recently, the Secretary of State was condemned by the British Medical Association for an inequitable and irrational approach in reaching his rationing decisions. Health authorities are in despair about how on earth they are to meet the new pay awards. Will the Secretary of State now accept the offer of my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) and lead a mature debate on the establishment of rationing and on how decisions are made in the national health service?
Mr. Dobson: All I can say in response to that is that the professions welcome the establishment of the National Institute for Clinical Excellence. The BMA chairman was chairing the meeting at which I announced the appointment of Sir Michael Rawlins, and said that I had been as good as my word in appointing to chair the institute someone who commanded the professions' respect. The professions welcome the establishment of the organisation, which I am sure will do a good job. I am sure also that, if anyone is in despair running parts of the national health service, I should not want them to be working in despair--they can go work somewhere else.
Mr. Andrew Miller (Ellesmere Port and Neston): Did not my right hon. Friend inherit a situation that included restraints--which varied across the country--on the availability of some drugs, such as beta-interferon, and huge disparities in the availability of some treatments because of huge waiting lists? Will he ensure that NICE maintains need as its primary criterion when it considers some of the alternative treatments that may become available because of genetic and other treatments?
Mr. Dobson: Certainly, NICE will examine all new treatments and new pharmaceutical products, and it will issue authoritative advice. In some cases, it will be saying,
"Get on with it, quickly. This is a good development, and you should introduce it right across the country." Currently, no one performs such a function. In other cases, NICE may say, "We are not too sure about this. The results of its effectiveness testing may not be as good as we should have liked." If so, NICE may recommend that the treatment or product should be made available systematically in only one part of the country, so that further proper tests and assessments can be performed.
The object of the exercise is to have fast access to modern treatment right across the national health service, and not to maintain the ridiculous current situation, in which some drugs are available in one part of the country but not in another, because of the lack of clear advice given under the system that we inherited from the previous Government.
Mr. Peter Viggers (Gosport):
Is the Secretary of State aware that 22,000 of my constituents made active representations about the closure of the Royal Haslar hospital in my constituency which would be a disaster for the defence medical services and a catastrophe for local residents? Will Ministers take a personal interest in the disaster that would result from the closure, particularly as the hospital in question is close to the constituency of the Minister of State, Department of Health, the hon. Member for Southampton, Itchen (Mr. Denham), and the closure would have reverberations there too?
Mr. Dobson:
It is clear that the closure of the Royal Haslar hospital will have an impact on health care in Portsmouth and in Hampshire generally and we are looking into that. I intend to meet the admiral who chairs the Portsmouth acute trust to discuss the matter. He is a most admirable admiral and probably carries a little more weight at the MOD than an ex-civilian.
13. Mrs. Louise Ellman (Liverpool, Riverside):
What assessment he has made of the role primary health care plays in improving health service provision in Liverpool. [67171]
The Minister of State, Department of Health (Mr. John Denham):
More than 90 per cent. of patient contact in the national health service takes place in primary care. In Liverpool, general practitioners and primary health care teams have a major role to play in improving the health of local people and in further developing services. That includes participation in the primary care groups where a key priority will be improving access to local services closer to where people live, rather than in a hospital setting.
Mrs. Ellman:
Does the Minister agree that in areas such as Liverpool, where many people suffer chronic ill health, it is absolutely essential that all parts of the health service work together effectively and co-operate with social services? How will his Department encourage the health authority in Liverpool to ensure that primary health care is used to its maximum, working together with community hospitals so that the pressures of chronic ill health do not concentrate solely on the acute hospitals such as the Royal Liverpool and Broadgreen University Hospitals NHS trust?
Mr. Denham:
A series of measures is already in hand, or will be introduced in the Health Bill, and will produce precisely the result that my hon. Friend would like. Already, in addition to the development of primary care groups, which we encourage to enable the health authority to grow and develop, there is a health action zone, and the health authority, in co-operation with others, will
NHS Direct
3.32 pm
The Secretary of State for Health (Mr. Frank Dobson): I wish to make a statement on the development of NHS Direct, the nurse-led 24-hour helpline.
In March last year, we launched three NHS Direct pilot schemes in Milton Keynes, Preston and Newcastle upon Tyne. Between them, they covered more than 1.5 million people. They have proved a great success--up to the end of December, they had taken over 60,000 calls. Independent research has revealed that 97 per cent. of users are satisfied with the service provided, which they find prompt, friendly and professional. It has been particularly popular with young mothers and around40 per cent. of calls have been about children.
Callers get through at first to a call handler, who takes their details and deals with any requests for basic information. Callers who have a specific health problem are then put through to a nurse. The nurse listens to the caller, assesses the case using what is called an expert computer-based decision-support system, and then recommends what action the caller should take. That can range from immediately summoning an emergency ambulance to advising callers to visit their general practitioner or the accident and emergency department, giving advice on how to treat someone at home, and offering simple reassurance.
A detailed survey of the three pilots showed that, for the latest quarter, 80 per cent. of callers were advised to do something different from what they had intended before they rang NHS Direct; only 9 per cent. of callers had intended to look after themselves at home, but after calling NHS Direct 38 per cent. of them were enabled to do so; 20 per cent. of callers were directed to more urgent care and 40 per cent. to less urgent care; and 530 people were transferred to the 999 service.
It rapidly became clear that the pilot schemes were a success, so last summer I authorised the extension of the scheme, with 13 call centres to cover 40 per cent. of the country--20 million people--by April this year. The first of those opened last month, covering 1.1 million people in the black country. Yesterday, a further scheme covering almost 1.6 million people opened in Essex. A further service covering Nottinghamshire opens next week and the first service in London opens in parts of west London early in March.
The other areas to be covered by about Easter are in the west country; Manchester; West Yorkshire; Hull and East Yorkshire; Hampshire; north-west Lancashire; Birmingham as well as the black country; Lambeth, Southwark and Lewisham; Buckinghamshire, Northamptonshire and Oxfordshire; and Newcastle and the north-east. Most of the services will be provided by the local ambulance trust, but they usually involve the local GP co-operatives, other NHS trusts and voluntary bodies. In some cases, local social services are involved as well.
The success of NHS Direct springs partly from the use of modern technology, properly managed and staffed by top-quality professionals with a sympathetic ear. It also depends on commanding the support of the NHS in each locality, particularly the professions involved in providing primary care. At my personal insistence, there will be a
major role for GP co-operatives in the delivery of the service in many parts of the country. I am pleased to be able to report that the west London call centre, to be located in Southall, will be run by a local GP co-operative.
Our original intention was to extend NHS Direct to cover 60 per cent. of the country by April next year. However, in view of its growing success and my concern to help the NHS cope with the special problems that it is likely to encounter over the millennium period at the turn of the year, I have decided that the programme should be brought forward to aim to cover at least 60 per cent. of the country by the beginning of December this year. In some cases, that will be achieved through extensions to existing centres where the service is well established and in others it will be achieved through opening new centres. We intend to cover South Yorkshire, Leicestershire, Derbyshire, Liverpool and parts of London. NHS Direct could be particularly valuable in all those areas next winter. To achieve that, we shall be investing an additional £10 million from the NHS modernisation fund on top of the £44 million from the fund already committed to NHS Direct in the coming financial year.
NHS Direct is proving to be a modern, additional, convenient and dependable service for the people who turn to it. It is also proving to be popular and professionally satisfying with the nurses who staff it. One centre recently received more than 300 applications for 50 jobs. Applications for nursing jobs with NHS Direct have come from other parts of the NHS, from the private sector and from those returning to nursing. With the support of the Royal College of Nursing and Unison, I am keen to encourage applications from experienced nurses who have left nursing because of, say, a back injury that left them unable to carry out routine nursing tasks. Working in NHS Direct could give them the opportunity to continue to put their hard-won professional skills and experience to good use to the benefit of patients.
The new schemes should provide the basic NHS Direct advice and information service that has proved so successful in the three pilot areas of Newcastle, Preston and Milton Keynes. From July, the Newcastle centre will be working with local doctors, A and E departments and other services to provide one gateway for out-of-hours services, with a single number for patients to call. That shows the huge potential for using NHS Direct to develop new and better services for patients in a way that is also popular with the professionals involved. Building on the experience of that pilot, I will be prepared to consider similar pilots where NHS Direct has shown that it can deliver the basic service and where there is a joint commitment by NHS Direct and the local doctors and other professionals involved to deliver services in that way.
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