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Miss Anne Begg (Aberdeen, South): I welcome my right hon. Friend's announcement today that NHS Direct will give jobs to nurses who have found it difficult to continue on the wards because of, for example, a back injury. I ask him to go further and draw on a pool of nurses who have left the profession, perhaps some time ago, because of encroaching disability or an illness, such as multiple sclerosis, and nurses who may have taken early retirement because the physical aspects of the job had become too much for them. Such people have much relevant expertise and making use of that would not exacerbate existing nurse shortages.
Mr. Dobson: I can honestly say to my hon. Friend that that is the very point that I have been making to departmental officials for a long time and I am disappointed with their performance in seeking and securing the recruitment of people who are disabled. The proportions are no greater than for the general recruitment of disabled people, despite the fact that that point has been drawn to officials' attention time and again by Ministers. It is an ideal situation to enable people with immense practical skills and experience acquired in nursing to make use of them, despite having a disability that makes it impossible for them to work on the wards.
Rev. Martin Smyth (Belfast, South): I welcome the NHS Direct scheme, and also look forward to reports covering the peripheral regions of the kingdom. I underscore what has been said about the ambulance service, which has years of experience of such work and alongside which GPs have been employed to give really professional guidance. However, may I advise the Secretary of State to be careful about using one telephone number for the whole nation, given BT's lamentable failure to cope with the recent storms in Northern Ireland?
Mr. Dobson: I shall bear in mind all the points that the hon. Gentleman has made.
Mr. Kevin Barron (Rother Valley): I thank my right hon. Friend for his statement and for the success that NHS Direct has achieved already. The extension of the scheme into South Yorkshire will be warmly welcomed by the people there, who will regard it as a further investment in our national health service. Given what the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) said, may I, as a resident of Southwark, thank my right hon. Friend for extending the scheme to my neighbours in London as well?
Mr. Dobson: As with everything else that we have done, we have tried to ensure that the new developments in the national health service are concentrated initially on the most deprived areas, as part of our general effort to raise the standard of health of people who are the most badly off more quickly than we raise the standard of health of the rest. That very proper and reasonable priority includes the introduction of NHS Direct, and we shall stick to it through thick and thin.
Mr. John Bercow (Buckingham): Although the statement is welcome, how can the Secretary of State
guarantee that nationwide implementation of the NHS Direct scheme will not be compromised by the Government's decision to raid the so-called modernisation fund to pay for the welcome increase in nurses' salaries?
Mr. Dobson: There are terms of abuse that one is not supposed to use in the House, but let us assume, for the purposes of answering his question, that the hon. Gentleman is fully equipped with all his senses. He might have noticed that the day after announcing the biggest real-terms pay increase for nurses for 10 years, I am announcing that further expenditure is to be brought forward from the modernisation fund to deal with another aspect of modernising the national health service. The modernisation fund will continue to fund all the other aspects of modernisation to which we are committed. It can do so because, as I explained earlier, we have ensured that it contains a sum to cover the likely additional increase in pay for nurses.
While we are talking about helplines, I can tell the House that the latest figure for people ringing in to express an interest in returning to nursing is 3,400--a rise of 600 in the hour that we have been talking.
Mr. Tam Dalyell (Linlithgow):
Can I ask an awkward--although I hope not malign--question? Does my right hon. Friend recall that I sent him a long and complex paper by Lord Justice Sir Philip Otton on the question of medical negligence? What happens when, in good faith, a person rings up for guidance and, in equally good faith, is given that guidance over the telephone? If that guidance turns out to be disastrously wrong, could NHS Direct be sued in the courts? Does not the potential exist for a legal nightmare, even though people might act in the best of good faith on the basis of what they are told? What is the legal position?
Mr. Dobson:
As my good and hon. Friend knows, I have discussed the paper with Sir Philip Otton, and we are holding discussions with other people about the problems of litigation for the health service. However, there is no difference, in terms of liability, between advice given over the telephone through NHS Direct, advice given face to face and advice given over the telephone by anyone else. Liability would depend on whether there was a degree of negligence. That is the legal position and we cannot change it. At some point, something will go wrong--that is inevitable; face-to-face advice goes wrong, and operations go wrong even when they are carried out by the finest surgeons in the land. It is no good our pretending that that does not happen. We must try to make sure that the best-quality advice is available. but the liability for NHS Direct is just the same as it is in any part of the national health service.
Dr. Evan Harris (Oxford, West and Abingdon):
May I congratulate the Secretary of State on the apparent success of the pilots, and welcome their extension to Oxford? It remains to be seen whether my constituents will welcome our pilot or see it as adequate compensation for the millions of pounds worth of social services cuts forced on the local authority by the Government.
What research is the Secretary of State commissioning into whether the pilot schemes have already reduced attendance at A and E departments? Are the figures for
Milton Keynes A and E attendances lower than the figures for surrounding areas, or has their rise been smaller? There is a danger that schemes such as the pilots, which appear welcome and worth while, may in fact increase attendances by finding untapped demand.
Mr. Dobson:
We must look at the net effect. Clearly, some people who would be reluctant to dial 999 for an ambulance or to try to get their doctor out in the middle of the night will ring up NHS Direct in the knowledge that a 24-hour helpline exists for them. As I have said, one survey shows that 530-odd people were immediately put in touch with an emergency ambulance when they called. It is almost impossible to calculate how many of those people were additional to those using the ambulance service or going to accident and emergency departments.
There have been attempts to analyse the figures, but the relationship between them and what happens on, for example, Tyneside--involving, say, the Royal Victoria infirmary or the Freeman hospital, which are both in Newcastle--and NHS Direct is difficult to discern. I have told the people involved in the schemes that we do not want to come up with a lot of false claims, and, at present, any direct claims could be false and misleading. Roughly speaking, 40 per cent. of calls have involved people who were advised to do something less than they had intended, and 20 per cent. resulted in people being told to do something more. There may be a net gain, but that is not the object of the exercise: the object is to make top-quality advice available on the phone for people who are bothered about their health.
Dr. Phyllis Starkey (Milton Keynes, South-West):
May I pass on the warm feelings of the people of Milton Keynes about the success of the national health service pilot in our area, which is efficiently run by the Two Shires Ambulance NHS trust? I accept the point that my right hon. Friend the Secretary of State made in his reply to the hon. Member for Oxford, West and Abingdon (Dr. Harris) about the difficulty of analysing different uses of the service. However, will the analysis of the use of NHS Direct in Milton Keynes be made available to Buckinghamshire health authority, so that it may use the information as one of its indices of health care need in the area and ensure that the needs of Milton Keynes are rather more fairly funded within the county than they have been heretofore?
Mr. Dobson:
Certainly, all the information will be made readily available. There is nothing commercially secret about it. When I went to the opening ceremony at Milton Keynes, I was somewhat disturbed to observe that the local coroner turned up.
Mrs. Virginia Bottomley (South-West Surrey):
Like others, I wonder why we are debating NHS Direct, not the acute problems caused by the nurses' pay award. Will NHS Direct help my authority, which has received less than 1.7 per cent. growth money, and which has an inflation allowance of 2.5 per cent? The pay award will cost twice that, and the authority's share of the modernisation fund, which is apparently intended to pay for NHS Direct, will cover less than 25 per cent. of the cost.
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