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Mr. Philip Hammond (Runnymede and Weybridge): Is the right hon. Gentleman aware that his right hon. Friend Baroness Jay told me, in the presence of her civil servants, that it was no part of the function of the national health service to regulate the private sector?
Mr. Dobson: And my right hon. Friend is absolutely right. It is not a function of the national health service to regulate the private health care sector, it is a Government function, and we should distinguish between them here and now. If an NHS body was responsible, the first time that it criticised a private hospital or said that something was wrong, some bleating Tories would leap up and say that it was prejudiced.
At the election, we promised to establish independent regulation of all residential care, and we shall. The body that regulates private hospitals will need to license the
hospitals, act as a registrar, have a right of access to carry out regular inspections, publish inspection reports and enforce any licence conditions that have been laid down for the protection of the public. As the Commission for Health Improvement will not have any of those powers, it is unlikely to be suitable for the role. Action is clearly necessary to prevent a recurrence of the situation that, as the right hon. Member for Maidstone and The Weald (Miss Widdecombe) knows, arose in Kent under the Tories when a gynaecologist who had been banned from the NHS for sub-standard work was able to continue to practise at private hospitals.
The Bill also deals with shortcomings in the pharmaceutical price regulation scheme, which sets the price of drugs used by the NHS. Some companies were refusing to comply with the existing scheme. The estimated cost to the NHS was £30 million a year and rising. Under our proposals the scheme will remain voluntary, but the Bill provides powers to make all concerned comply with the terms of the voluntary agreement. That is fair to the taxpayer and to the majority of pharmaceutical companies, which have always met their obligations under the scheme.
Mr. John Bercow (Buckingham)
rose--
Mr. Dobson:
Before anyone leaps up to defend the pharmaceutical industry, I must point out that the Bill, as amended by the Government in the Lords, meets the requirements of the industry. The reputable companies are satisfied with what we are proposing, because they are as sick to death as we are of the freeloaders who are not playing the game. The Tories support the freeloaders who do not play the game. I am confident that the renegotiated PPRS and the new legal powers will offer a good way forward for that highly successful industry, the NHS and the taxpayer.
Mr. Bercow:
Will the Secretary of State give way?
The Bill provides new powers to help tackle fraud against the NHS by a small minority of patients and practitioners at the expense of the honest majority. It also modernises the framework under which trusts operate. That reflects their status as public sector organisations. High-security hospitals will become NHS trusts.
Our approach is to set quality standards nationally, deliver improvements locally and monitor performance externally. That is why, with the support of the professions, we set up the National Institute for Clinical Excellence, to provide authoritative guidance to all parts of the NHS on the effectiveness and value of new treatments.
We are introducing national service frameworks to set national standards and spell out the models of treatment and care that should be provided in every part of the country for particular conditions or groups of patients. The first national service frameworks will cover coronary heart disease and mental health, followed by one covering the treatment and care of older people and then one covering diabetes.
Placing a duty of clinical governance on NHS trusts will help to deliver improvements locally. The Commission for Health Improvement will provide the external monitoring, advice and help that will be needed if targets are to be achieved.
Mr. Bercow:
I am sure that the Secretary of State would not want in any way to give incorrect information to the House. He said that the pharmaceutical industry was entirely content with his proposals to revise the voluntary scheme. Why, then, is the Association of the British Pharmaceutical Industry objecting to several clauses, and not least to clause 30 because it does not provide explicit criteria or any express requirement of reasonableness?
Mr. Dobson:
The association said that the changes made in the House of Lords have, by and large, met the needs of the industry, and so they have. [Interruption.] If the hon. yapper wants to do something useful, I suggest that he gets on the Standing Committee and tables amendments to deal with the companies that have not been complying with the terms of the PPRS.
By our extra investment, we are ensuring that the effectiveness of staff is not undermined by out-of-date equipment. We are determined that in future the excellence of staff will be matched by top-quality buildings and reliable, up-to-date equipment and pharmaceuticals. Nothing less will do, for patients or for staff.
We are committed to investing £1 billion in a long-term strategy to provide the NHS with a top-quality information technology system that works, and to develop an electronic record for every patient that can be accessed by all professionals who need to use it. That way, GPs, practice and community nurses, accident and emergency staff, out-patient clinics, hospital specialists and, eventually, even ambulance paramedics can have access to a reliable, accurate, up-to-date picture of the health record of every patient who comes their way.
All those improvements in treatment and care are being developed with resources from the modernisation fund that we established as part of the comprehensive spending review. That fund is financing the rapid development of NHS Direct, a 24-hour nurse-led helpline that has proved an enormous success in the three pilot schemes that have now run for more than a year in the north-east, in north Lancashire and in Buckinghamshire.
NHS Direct now covers roughly 40 per cent. of the country, and by December it will cover 60 per cent. It provides a popular service, especially for older people and young parents. Some 97 per cent. of the users surveyed were satisfied with the service. At my insistence, it offers opportunities for trained nurses who, because of injury, have had to give up work, to use their skills again for the benefit of patients and for their own job satisfaction. I was delighted that several nurses in that group had been taken on by NHS Direct in west Yorkshire, which I visited last week, including one paraplegic nurse in a wheelchair who now feels that there is some purpose back in her life.
Dr. Jenny Tonge (Richmond Park):
I appreciate the good intentions of NHS Direct and of the scheme that has been announced today, but the Secretary of State must be aware that it can be difficult to give accurate information without physically examining a patient. Members of Parliament often get complaints from patients who have
Mr. Dobson:
All the evidence is that it is possible for the finest, most expert clinician, doctor or nurse to give a misdiagnosis face to face. I do not suggest that it is easy to give a diagnosis over the telephone, and other problems arise from that situation, but diagnosis is a relatively imprecise science, or art, at the best of times. The cover that we provide for NHS Direct staff is the same indemnity that is provided for any employed member of the NHS staff. We will clear up any difficulties that arise from advice being given over the telephone which are discovered when the patient visits a GP.
Some people, including some in the medical profession, expressed doubts about diagnosis over the telephone. In Preston and Chorley, where the scheme has been running for a year, the distinguished director of nursing is using the protocols used by the local NHS Direct scheme for training nurses to work in the accident and emergency department because, she tells me, those protocols are more rigorous than anything that has been used in the past. She knows what she is talking about because she has been involved in the project from the start. I repeat that 97 per cent. of the users are satisfied with the service.
Dr. Howard Stoate (Dartford):
The real issue in giving telephone advice is not so much whether it is right or wrong, but when it is appropriate to advise the patient to take other action. I am sure that my right hon. Friend agrees that advice given over the telephone could include a recommendation to the patient to see a doctor face to face, or a decision to send an ambulance to take the patient to an A and E department. Provided the person at the end of the telephone is trained correctly in decision making, there should be no problem.
Mr. Dobson:
I almost entirely agree with my hon. Friend, but something will always go wrong. Things go wrong in every bit of the health care system and always will, but through training and substantial effort we can keep problems to a minimum. If someone gets through to the nurse, sometimes they are given reassurance and sometimes they are given advice. Sometimes that advice includes a warning to see a doctor straight away and sometimes a warning to attend A and E as soon as possible. Occasionally, the advice is to stay and wait for the ambulance that is being sent. Generally speaking, most of the clinicians in those parts of the country with an NHS Direct scheme are highly satisfied with the arrangements. That is why several areas are asking for NHS Direct to extend its functions beyond the 24-hour line.
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