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Rev. Martin Smyth: The hon. Gentleman referred to consultants and the health service. Is he not concerned that the 10,000 GPs who are expected to man the health service will not be in post as quickly as the Government had imagined? Will that not impose additional pressure when the health service is moving in the direction of primary care as well as hospital care?
Dr. Fox: There are two aspects to the important point made by the hon. Gentleman. One is the rate at which doctors are taking early retirement; there is quite a haemorrhage of those who are approaching retirement. As well as the loss of numbers, the loss of quality care is extremely worrying, not least in primary care. Fewer junior doctors are going into primary care, but we want to encourage them to do so. There is a cultural problem in the health care system regarding young doctors' experience of pre-registration training in primary care, which affects their willingness to go into that discipline. As well as doing six months in medicine, all junior doctors should do six months in accident and emergency and six months in general practice as part of their training. That is important in terms of what patients receive and what it provides us--
The Parliamentary Under-Secretary of State for Social Security (Angela Eagle): Will the hon. Gentleman fund the increase in social services' budgets?
Dr. Fox: Will the hon. Lady hold back? I am happy to take interventions, but I should be grateful if, for once, she had some manners while I answer the point made by the hon. Member for Belfast, South (Rev. Martin Smyth).
It is important that we have doctors with all-round skills and that their experience is appropriate to an increasingly integrated service. For a consultant to qualify without ever
having worked with a district nurse or for a GP to work in a rural area without having done accident and emergency is the result of a poor-quality medical education. Those things must be addressed, and entry into and departure from general practice must be tackled together.
Mrs. Alice Mahon (Halifax): The hon. Gentleman accuses the Government of ideology. However, is it not pure ideological dogma that leads the hon. Gentleman to oppose NHS Direct? According to all the evidence, NHS Direct has left millions of people satisfied and happy with the service. A constituent of mine recently told me that NHS Direct led her to seek immediate medical help that almost certainly prevented a stroke. She asked me to thank my right hon. Friend the Secretary of State--I did so last night--for the establishment of NHS Direct. Is not the constant undermining of the scheme by the hon. Member for Woodspring (Dr. Fox) merely ideological dogma? Is not it time that he welcomed a terrific Government initiative?
Dr. Fox: I am happy to answer the hon. Lady's question directly. I do not object in principle to NHS Direct. I shall be giving evidence to the National Audit Office inquiry on it next week. I shall say that the idea potentially has great merits, but that it must be trialled and worked properly. We must, however, consider the evidence to ascertain where it is working well and not working well. For all the anecdotes that the hon. Lady can supply on where it is working well, we also have anecdotes about the mistakes that are being made.
We must consider where the scheme is giving us good practice and where it is not. When I speak to the NAO next week, my words will reflect the Opposition's position that there is still a case to be made. If there is evidence to suggest that it works well, we will welcome it. That is a reasonable and sensible position. People with reservations about NHS Direct are often concerned that it was rolled out too quickly. That is one of the reasons why the NAO is considering a joint referral from the Liberal Democrats and the Conservatives about the workings of NHS Direct and whether it provides value for money in a health care system. One of the measures of its performance must be whether expenditure on it is a good use of the money that is available within a finite budget.
Mrs. Mahon: If NHS Direct prevents elderly people from having strokes and from having to go into hospital, and if it prevents health problems among people who would not usually bother the doctor, surely it is working. It is certainly working in Halifax; I am sorry that it is not working in Woodspring.
Dr. Fox: The important word is "if". The question is whether the case has been made and whether sufficient proof exists. I am afraid that anecdotal information is not enough. We must know whether the scheme is an appropriate use of money and whether it provides the best clinical outcome for that money throughout the system. That is exactly why the NAO is right to consider the matter. It is reasonable to expect any publicly funded body to provide better value than would be achieved spending the money in any other way.
Dr. Stoate: I thank the hon. Gentleman, who is being generous with his time. In reply to an earlier intervention,
he made an interesting observation about training doctors. He said that he felt that all doctors should spend six months in general practice and six months in accident and emergency. He will already know that general practitioners must have a minimum of four years' postgraduate education before they can take up that position, so his points are covered in so far as the majority of doctors have accident and emergency training. Personally, I agree that hospital consultants also should have significant training in general practice to enable them better to understand its pressures. However, will the hon. Gentleman give a commitment that Opposition Members would be prepared to pay the significant extra cost that would have to be met to ensure that all doctors received such training?
Dr. Fox: I do not agree that there would be extra cost. There would be no extra cost in merely asking those who are currently paid at senior house officer level to undertake six months in medicine and six months in surgery. Of course, there would be administrative disruption in the system, especially in the first year.
Dr. Stoate: Will the hon. Gentleman give way?
Dr. Fox: No. I have already given way several times and I shall do so again later.
Let me consider the Bill on tobacco advertising. It is clear that smoking in the United Kingdom must be reduced. Smoking is currently a particular threat to young people and especially to young women, among whom it is rising. The test for the House must be the evidence on measures that could be taken to reduce smoking's prevalence. I have an instinctive, uncomfortable feeling about banning advertising of any legal substance. Of course, tobacco is a substance on which the Treasury is annually raking in a fair amount of money. However, I am willing to put that to one side if there is scientific evidence to suggest that any particular mechanism can achieve a reduction in smoking prevalence.
I think, therefore, that the onus is on the Government to demonstrate as they introduce the Bill that there is evidence to show that banning the promotion and advertising of tobacco would produce the reduction in smoking that they seek. The House, irrespective of its views about the libertarian aspects of the Bill, must consider the evidence on its merits.
The Government will have difficulties because there are enormous loopholes--not least in terms of product placement and goods carrying labels such as Dunhill or Marlboro--that go beyond the advertising of tobacco. The Government will face a difficult balancing act, but we will take the evidence produced at face value and judge it accordingly. That is a reasonable basis for the Opposition to proceed with any Bill. I give the Secretary of State a commitment that I will be open-minded about the issue.
At the European summit, the Prime Minister must raise a matter that offends Members on both sides of the House--the enormous sums of money used through the common agricultural policy to grow tobacco in Europe which is then parcelled off to the third world. That is a national and international disgrace. If we are serious about reducing smoking, ending that practice should be an integral part of our policy.
Mr. Kevin Barron (Rother Valley): Is the hon. Gentleman telling the House that he is not satisfied that
the ban on the advertising of cigarettes and tobacco products on television and radio for the last 30 years has been justified?
Dr. Fox: Despite those measures, smoking rates are beginning to rise. We are going beyond television and radio advertisements to address wider issues, so it is not as simple as the hon. Gentleman makes out. Questions arise about our health education--for example, whether it has conveyed the right message and whether it has been aimed at the right age groups. My view is that, very often, we have sent the wrong message, aimed at the wrong age group. We need the correct message, which must be sustainable and receive proper funding. All those matters go together. We cannot simply say that a ban on advertising on its own makes a difference.
Mr. Geoffrey Clifton-Brown (Cotswold): Is my hon. Friend aware that since the Government came to power, the proportion of cigarettes smuggled has increased from one in eight to one in four and that the figure for hand-rolled cigarettes has increased to three in four? During debates on the Finance Act 1997, the Opposition pushed the Government to change their decision to reduce the number of staff of Her Majesty's Customs and Excise, which was one of the first things that the Government did. We asked them also to provide much better X-ray equipment to try to stop some of the smuggled cigarettes getting into this country. Would not the Government be better doing that, rather than proposing an anti-advertising Bill?
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