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Mr. Alan Duncan (Rutland and Melton): It is a happy task to give today's announcement on NHS Direct a general welcome from Conservative Members. Our objective always is to improve patient care and to see continuing improvements in the NHS. When the Government do the right thing, we will say so--and this appears to be just such a case. I hope that my warm reception for today's statement does not so shock the Secretary of State that he becomes an early user of the hotline. NHS Direct stands to be popular with nurses, patients and doctors alike. We are pleased that the Secretary of State has decided to build on a project which--as I am sure he is prepared to confirm--we started when in government.
Does the Secretary of State agree that a patient's GP should know of the advice given by NHS Direct to his patient, and by whom that advice was given? Does he accept that the success of the service will depend on the model that is adopted? Is he aware that there is some concern that ambulance trusts may not be the most appropriate providers of the service? Does he envisage lots of local units, or a few larger units? Is it not true that small and local is desirable, but that larger and more central is more economic? How will he strike the balance between the two? Will there be a single nationwide telephone number for the service?
We note that there is already evidence that nurses who have left the NHS will be attracted back to NHS Direct, but what percentage of nurses are applying from other areas of the NHS, given that there is already a shortage of nurses in those other areas? What is the right hon. Gentleman's assessment of any legal liability that might attach to the advice given by NHS Direct? What guidelines and safeguards will be put in place?
We wish NHS direct every success and we want it to add to patient care. We will watch closely the exact way in which it is implemented.
Mr. Dobson:
It would be churlish not to welcome the general welcome from the hon. Gentleman--although it may be the sort of general welcome that could be matched by the Russians, who would say that their main general was "General Winter".
GPs will be informed of approaches made on the helpline, provided the person who has rung in gives permission. Confidentiality must work both ways. It applies not only to GPs patients, but to people who ring in to NHS Direct--and so it should. I have made it clear that, so far, ambulance trusts have been the principal suppliers of the call centres because they have the necessary experience and, sometimes, some capacity.
I have made it clear to GPs--and, in particular, those who are behind the GP co-operatives--that I want a greater involvement of GP co-operatives. That is why I say that it is at my insistence--rather against the advice of some of my officials--that GP co-operatives are now
so extensively involved. It is also why at least one of the new centres that will come into operation shortly will be run by a GP co-operative. Whoever provides the service, co-operation among all those involved locally is crucial.
The size of units will vary from one part of the country to another. I am a great believer in horses for courses: in some places there will be large horses and in others there will be small horses, because those who are responsible for providing the service locally will decide how best to do it.
We are trying to get a single telephone number, but that is proving more difficult in our relations with BT than we or, I would have thought, most people in the country would have expected, and we will have to do something about that.
We have not as yet set any national performance standards for NHS Direct, because if we are to set sensible standards we will have to draw on the experience of the set-up. Legal liabilities for NHS Direct staff will be the same as those for all other national health service staff.
Mr. David Hinchliffe (Wakefield):
I welcome my right hon. Friend's statement. NHS Direct will seem to most people to be common sense, so it is strange that such a system was not introduced a long time ago. I welcome the fact that one of the inquiry centres will be in Wakefield.
Bearing in mind the fact that NHS Direct is about enabling people to make the best use of the NHS, will my right hon. Friend consider the marked differences in the use made of A and E departments from area to area? A while ago, my right hon. Friend the Chief Secretary to the Treasury, who was then a Health Minister, told me that more use is made of A and E in my area than in most other areas. There are reasons for that. I hope that calls to NHS Direct will be analysed and that we can examine the way in which people make different use of facilities in different parts of the country and tackle the discrepancies and the reasons for them.
Mr. Dobson:
Again, as a believer in horses for courses, I note that, for example, when there is a large and famous hospital in a deprived area--such as the centre of Manchester, Newcastle or Leeds, or in certain parts of London--it has been traditional that people who wanted to be attended to went to that hospital rather than to their GP. Generally speaking, it is up to the national health service to adjust itself to people's needs rather than asking people to adjust themselves to the NHS. There may be variations, but we should not necessarily seek to eliminate them; we should simply try to cope with them.
There are large variations in all forms of use of the health service, be it in the proportion of people resorting to A and E or the state of people who are put in intensive care beds. That varies from one tradition to another throughout the health service. We need more uniformity in some aspects of NHS practice.
Mr. Simon Hughes (Southwark, North and Bermondsey):
The Liberal Democrats, too, welcome the extension of NHS Direct and the fact that it will be more integrated with GP co-operatives. We are a bit suspicious that the announcement was made today because the Secretary of State felt that he needed a good news fig leaf to cover the rather less good news on which we would otherwise have been concentrating.
How many nurses will be engaged in NHS Direct? Will integration with primary care groups, trusts and GPs throughout the areas to which the service is extended be guaranteed? Have the pilot schemes demonstrated any impact on the rising tide of emergency admissions or on the demands on consultants and other practitioners? Have the pilots already shown money to have been saved and pressure moved from other places in the health service?
Mr. Dobson:
It is difficult to determine the causes of all sorts of complex shifts in the national health service, especially in winter, but, roughly speaking, twice as many people are advised to do something that is less demanding on the health service as are advised to do something that is more demanding on it than they would have done had they not telephoned. The rest of the hon. Gentleman's points are all part of the Liberal Democrat leadership campaign. We are used to him spending at least a penny every Health questions and such like, and now I suppose it is "Three Coins in a Fountain".
Kali Mountford (Colne Valley):
I add my congratulations to my right hon. Friend on his announcement, especially as it includes my constituency of Colne Valley, which he visited last year at the time of a meningitis outbreak. How does my right hon. Friend envisage NHS Direct integrating with the other services that support schools, parents and hospitals at such times?
Mr. Dobson:
For a start, NHS Direct is supposed to be relatively free-standing and to do its basic job of receiving calls from people who are concerned about the health of themselves, their relatives or neighbours, and giving direct advice. It is likely that, eventually, its functions will be extended to other spheres, but it is crucial that each local service demonstrates that it can do its basic task before it seeks the agreement of the other professionals in the area to extend into more complex spheres. If there were an outbreak of meningitis or something else that is very frightening for parents, the people working at NHS Direct, like everyone in the front line, would be all the more vigilant, and I am sure that arrangements would be made to inform other people in the health service if issues cropped up unexpectedly or needed to be drawn to the attention of people with greater expertise.
Mr. Stephen Dorrell (Charnwood):
I join in the general welcome for the national launch of NHS Direct. The Secretary of State's proposal will make an important contribution to the more effective use of NHS resources. He is right about that, but I have one niggle in my mind. Can he explain to the House how he has persuaded himself that an idea, the piloting of which started a year before he took office, is his idea?
Mr. Dobson:
The pilot schemes for NHS Direct started after we came into office, in Milton Keynes--[Hon. Members: "Wiltshire."] The pilot schemes started in Milton Keynes, Newcastle upon Tyne and Preston and Chorley. They drew on bits of experience--[Hon. Members: "Ah!"] Do you remember, Madam Speaker, going to the doctor when you were a lass and he said, "Say ah"? They cannot stop doing that on the Opposition Front Bench. Obviously, the pilot schemes drew on bits of information and experience that had been gathered in this country and others. That was the only sensible thing
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