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House of Commons

Tuesday 4 May 1999

The House met at half-past Two o'clock


[Madam Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked--

NHS Direct

1. Mr. Patrick Hall (Bedford): How many people are covered by NHS Direct; and what is his programme for expansion. [81807]

The Secretary of State for Health (Mr. Frank Dobson): Following the success of the three pilot schemes, NHS Direct has been extended to cover around 20 million people. By December this year, a further 10 million people will have access to this highly successful new service, which will cover the whole country next year.

Mr. Hall: I thank my right hon. Friend for that answer. I welcome his announcement that Bedford will be home to a new NHS Direct call centre in the autumn of this year. Will Bedfordshire benefit from Sheffield university's evaluation of the early experience of NHS Direct, particularly with regard to local publicity and the apparent under-use of the service by those over 65? Will my constituents benefit from NHS Direct outreach and the proposed new information points?

Mr. Dobson: We were determined from the start to ensure that we learned from the pilot schemes in the gradual extension of NHS Direct. That is why we established the pilots. We have made every effort to ensure that the system expands as quickly as is sensible and that the initial volume of calls can be coped with, gradually building up so that the staff can learn from experience. A surprisingly low proportion of calls have come from old people, although some old people have called. We shall extend the publicity to try to ensure that enough old people are aware of the service. On the first day of operation in west Yorkshire, a call came in from an old lady who said that she was just ringing to make sure that the service would be there when she needed it.

Mr. Simon Hughes (Southwark, North and Bermondsey): How does the Secretary of State expect the necessary staff to be employed and retained in NHS Direct and everywhere else in the health service when twice in a week the Government have broken their word to the two largest groups of employees in the

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health service? On 1 February, the Government promised that the recommended pay increases for nurses would be paid in full from 1 April. Most, if not all, NHS nurses have received no additional pay in their April pay packets and may not receive it until September. Today we hear that, having agreed a few years ago that junior hospital doctors would work for only 56 hours a week, the Government are proposing in Europe that they should be allowed to work for 65 hours a week. Do the Government not realise that they cannot save the NHS when they are undermining its key groups of staff?

Mr. Dobson: All that I can say in response to that question, which was allegedly about NHS Direct, is that we have had no difficulty in recruiting nursing staff, including disabled staff, to serve at NHS Direct. I expect that trend to continue. The service is very popular. The hon. Gentleman also mentioned the working time directive. The Government have no intention of increasing the hours of work of a single junior doctor in the United Kingdom. We are still committed to implementing the new deal for junior doctors' hours, which we inherited from the previous Government. About 15 per cent. of junior doctors still work longer than those hours. We want to get those hours down. We are also making provision for better sleeping and feeding arrangements. My hon. Friend the Minister of State had a sensible and worthwhile meeting with junior doctors about those issues last week.

Primary Care Groups

2. Mr. Denis MacShane (Rotherham): If he will make a statement on progress in the introduction of primary care groups. [81808]

The Secretary of State for Health (Mr. Frank Dobson): Four hundred and eighty one primary care groups came into operation on 1 April. I pay tribute to the hard work of all those who have made possible that voluntary change, and I congratulate general practitioners on agreeing for the first time to share decision making on primary care with other professions and lay people.

Madam Speaker: Am I to understand that Question 3, tabled by the hon. Member for Altrincham and Sale, West (Mr. Brady), is to be linked with Question 2?

Mr. Dobson: If you wish it, Madam Speaker.

Mr. MacShane: I welcome my right hon. Friend's reply. Has he had a chance to read the new paperback book called "Satan's Children", written by the Opposition deputy spokesman on health, the hon. Member for Rutland and Melton (Mr. Duncan)? On page 319 there is a reference to the need to impose charges on users of the NHS as a deterrent. Will my right hon. Friend repudiate such nonsense and the other nonsense from the queen of the underworld--the shadow Secretary of State--and her exotic sidekick?

Madam Speaker: Order. A little more temperate language would be in order.

Mr. MacShane: I apologise, Madam Speaker. Does my right hon. Friend welcome the sensible speech of the right hon. Member for Hitchin and Harpenden (Mr. Lilley), which almost seemed to be on the new Labour wavelength?

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Will my right hon. Friend consider the training of primary care groups, as the training of all involved in the partnerships--from GPs to receptionists--must be an integral part of making PCGs work? Will he instruct his officials to ensure that training is a part of the PCG programme in the future?

Mr. Dobson: I hesitate to correct my hon. Friend, but I believe that the book to which he referred is called not "Satan's Children" but "Saturn's Children"--which may account for the fact that the Tories seem to be running rings around one another all the time. They are certainly not running rings around any one else.

I will consider the question of the training of those serving on the boards of primary care groups. I believe that some training has been provided. Now that the PCGs have been established, I expect that the time taken by those serving on the boards will be reduced. We all know that a process of change or take-off is rather more time-consuming than what happens when one is cruising along. The PCGs are now established, and most are cruising along effectively.

3. Mr. Graham Brady (Altrincham and Sale, West): If he will make a statement on appointments to primary care group boards. [81810]

The Secretary of State has clearly forgotten that he asked for Questions 2 and 3 to be linked. He has also forgotten, apparently, that it is customary in the circumstances to attempt to answer both questions, not just one. [Hon. Members: "Get on with it."] That is very rich coming from Labour Members. The Secretary of State made not even a passing reference to appointments to primary care group boards.

Given the information that has come to light already--that, in respect of appointments to health authorities and trusts to date, 84 per cent. of the councillors appointed have been Labour councillors--is it not ludicrous that the Department, in a written answer on 19 April from the Minister of State, Department of Health, the hon. Member for Southampton, Itchen (Mr. Denham), told me that it did not even intend to provide information about the political affiliation of those appointed to primary care groups? Is it not obvious that the Secretary of State is adding to the scandal of the political bias of the appointments made by the Department a further scandal--that of attempting to cover it up?

Mr. Dobson: Since Labour took office, 50 per cent. of the appointments to NHS boards have been women--a step in the right direction--and 11 per cent. have been black or Asian, which is one way of dealing with the institutionalised racism in the health service that we inherited from the Conservative party. As for primary care groups, we do not keep records because the bulk of the members of the groups are elected by GPs. It would be wholly improper for me to inquire into the political affiliation of the people whom GPs or local nurses elect to represent them on the boards of primary care groups.

Mr. David Borrow (South Ribble): GPs in my area of south Lancashire were involved in the pilots that operated prior to 1 April, and they were enthusiastic supporters of

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the change. However, they are concerned that the structures under primary care groups are too prescriptive. Will my right hon. Friend consider allowing more local flexibility as the new system beds down, to allow a greater recognition of the differences between one locality and another?

Mr. Dobson: I certainly wish to do that. Most of the detailed advice that we provided was at the request of the British Medical Association and the Royal College of General Practitioners which, at almost all stages, asked for further and more detailed guidance than we were giving them.

Miss Ann Widdecombe (Maidstone and The Weald): How much confidence can primary care groups have in their local hospitals when junior doctors will be obliged to work 65 hours a week instead of 56? If that is not the case, why did the Secretary of State propose it to the European Commission?

Mr. Dobson: We did not propose that to the European Commission. We are not proposing that any junior doctor should work longer hours than at present. The right hon. Lady knows that, and she should stop pursuing this daft line of argument.

Miss Widdecombe: If that was not proposed to the European Commission, why have I received a statement that says:

If there has been no proposal, how does the Commission know about it, and why does it say that there has been such a proposal?

Mr. Dobson: I find it extraordinary that a member of the anti-European Tory party should quote with approval criticisms of the Government of a sovereign state by a public official of the European Union.

Talks are going on in Europe in which the various Governments are considering the impact of the working time directive on doctors in their countries. We should be judged not by what is happening now but by how we end up. We are determined to end up with a system in which our junior doctors--and the interests of the national health service--are properly protected, and are not trapped by any rigidities imposed from Brussels.

Miss Widdecombe: When the European Commission says that it received a proposal from the British Government yesterday to raise junior doctors' hours from 56 to 65, is it misleading us, or is the Secretary of State having an incredible fit of imagination?

Mr. Dobson: Neither. As far as I know, the European Commission has not issued any official response to what we have said. Certainly, no one with any authority has done so.

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