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Dr. Stoate: The hon. Gentleman raises the issue of paying for personal care, but surely he accepts that that would put a huge financial burden on the taxpayer, which is not necessarily a bad thing. Can he clarify the matter for the House and say whether his party would commit itself to raising the finance to pay for that?
Mr. Harvey: My party has been committed to that and will go into the election with a manifesto that retains such a commitment. I accept that it would be quite expensive, but in the past month the Government have seen fit to allocate £2.5 billion to resolve their problems with fuel protesters and a similar amount to deal with the pensions problem. The royal commission's proposal would cost nothing like that. Had the Government accepted the commission's recommendation, they would have helped the people who need personal care and improved their ability to run a health service that copes with pressures not only in winter, but all year round.
I can only echo the words of the chairman of the British Medical Association's community care committee, Dr. Andrew Dearden, who said:
- It seems patients themselves are going to be responsible for the personal caring element of the way they are looked after. This will be related to their ability to pay. In nursing homes their need for help with personal care is likely to be much greater as these patients are usually more dependent. Perhaps the Government should recognize this and look at providing an element of that personal care.
If individuals have to pay for this increased level of personal care it is almost like a tax on being sick. I don't believe that is an ethos the NHS should be satisfied with.
On the Government's proposals to abolish community health councils, I have talked to many people concerned with community health, all of whom recognised the need for a big shake up and reform of patient representation and advocacy. The Government's suggestions in the national plan on how that should be done worry me for two reasons: first, the lack of independence and, secondly, the fact that there is no way for the various parts of the new service to operate together. The whole may be less than the sum of the parts.
The patient forums will be funded by, and will draw their staff support from, the very NHS and primary care trusts that they are supposed to observe. I do not understand how patients can have the slightest confidence in the independence of such bodies if they are funded and staffed by the trusts that they monitor. That is palpably absurd. They should be independent of the NHS. If the Government are not prepared to go that far, surely they must consider it more logical for forums, and the patient advocates who work with them, to be funded by health authorities instead of by the trusts that they are set up to monitor.
Local authorities are to be asked to take on the role of statutory consultee. I am not clear as to how they are to do that if they do not undertake the monitoring and inspection roles that CHCs have carried out in the past, and if they do not have contact with patient groups on whose behalf, in part, they act because they are not in touch with the individual complaints work that is undertaken.
I urge the Government to consult far more openly. It is generally recognised in the House and in the country that a significant reform is needed, and the propositions that the Government have put on the table might, if suitably refined, offer a way forward. If the Government would only openly discuss the issues with all involved, I believe that they would find a way forward that commanded a reasonably broad consensus. However, by conducting the consultation as they have done so far--by holding four seminars for hand-picked attendees and not opening the door to anyone who wants to offer their view--the Government appear to be putting on their tin helmet and sending the message that they have devised a method, they are going to implement it, and that is their last word on the subject. I urge them to think again, because the issue is extremely important. The Select Committee on Health identified major problems in connection with patient representation and made a string of excellent suggestions on how to improve matters. Improvements should be founded on that report, not on the breaking up of the various components of CHCs' functions.
The ban on tobacco advertising is welcome, albeit belated. I am glad that the domestic difficulties that caused the delay have been resolved and that the correct
course of action is now to be adopted. I can think of no other industry that needs to recruit 100,000 new customers a year to replace those who have died as a result of consuming its product. No one should doubt that that is a significant element in the tobacco industry's motivation to advertise on the scale that it does.We shall examine the measures that the Government introduce in the coming Session. We welcome the general direction indicated by the Government's NHS plan, but we regret that they have not gone further faster. We believe that the NHS will experience significant winter pressures this year; the Government can do little about some of those pressures in the short term, but they can do something about others.
There is no better way in which the Government could act to relieve the pressure than to ensure that social services departments throughout the country have adequate budgets to provide care for people in the community. That is the best way in which to reduce the number of people going into hospital, to ensure the earliest possible discharge from hospital, and to avoid the spectre of emergency readmission of people who have been released from hospital only to find that inadequate care is available for them in the community. Such a system of care could be swung into action almost immediately. Many social services departments face budget crises this winter. If there is one thing above all others that the Government can do to relieve winter pressures, it is to get emergency funding to social services departments as quickly as possible.
2.8 pm
Dr. Howard Stoate (Dartford): I welcome the great commitment that the Government have shown to the national health service, especially the 50 per cent. increase in cash terms and the one third increase in real terms in the resources available to the NHS over the next five years. That is extremely good news, and compares well to the Opposition's woolly statements on the subject. Today it has become apparent that although their funding commitment to the NHS extends to hospitals, it seems that primary care, and central matters such as the Food Standards Agency, the Public Health Laboratory Service and the child immunisation programme, occupy a less certain position in Conservative plans for the future.
Given the investment they are making, the Government are right to expect significant changes in they way in which the health service is managed and health care delivered in this country. Society is changing rapidly, as are people's expectations--and rightly so. People deserve different provision of health care. People who work expect the services that they use to offer longer opening hours; they expect services such as banking to be available at the weekend, and, to an increasing extent, they believe that they should have access to health services at the weekend. Therefore it is right that society should change its views on the way in which it wants its health services to be delivered. It is also right that the Government should expect changes in delivery--first, in response to society, and secondly, in response to the real money and commitment that the Government are putting into the NHS.
Let us consider how some of the proposed changes might function. As the House knows, I still do some general practice, and one of the key proposals for general
practitioners is that by 2004 a patient should be able to see a doctor within 48 hours, and a practice nurse within 24 hours. On the face of it, that seems a great challenge, but about 50 per cent. of GPs can already provide that service, and many more become able to do so year on year. There are another four years before the programme will become a deadline, but I understand the real concerns of the British Medical Association and others that some practices will face a significant challenge in trying to meet the targets.I look to the Government to do what they can to ensure that the practices that are struggling receive the extra help that they need in terms of more doctors, nurses and receptionists, and enhanced premises. I am pleased that the Government are on course for achieving many of those aims by ensuring that general practice is much better resourced, so that patients can receive a better service without putting undue and impossible strains on GPs, who are under great pressure. The fact that the Government are focusing on providing extra resources will go a long way towards easing some of the burdens.
We have heard a good deal about private finance initiative hospitals. I am pleased to say that in my constituency there is a brand new PFI hospital up and running. It has been open for two months, and is providing an excellent service for people in the area. It is true that it is smaller than the hospitals that it replaced; it has 400 beds, whereas its predecessor had 500. There is no question but that bed numbers are extremely tight. I shall concentrate on how the system is working, and explain some of the difficulties and challenges, and some of the solutions that we have reached.
There is a clear change in the way in which hospitals are run, and how patients are treated. Hospital stays are now much shorter. The average bed stay is down to about two or three days. When I was a junior doctor, it was quite common for somebody having a varicose vein operation, for example, to be in hospital for more than a week. Such a patient would now go home on the day of the operation. Medical practices have changed tremendously. Most people would like to be at home as soon as possible, and not lie in a hospital bed for seven days after an operation. It is right that community resources are being directed to ensuring that nursing and other care is available in the community to enable patients to go home sooner.
Given the way in which hospitals are delivering their care, perhaps the 400 beds in the new PFI hospital in my constituency could be sufficient. We do not know yet how things will settle down over the next few months. The acute trust in Dartford and Gravesham has spent a vast amount of time, effort and energy ensuring that community services are available. Stroke rehabilitation teams are in place, and there is a "closer to home" strategy to allow some people to be nursed at home throughout their illness, and others to be returned home much more quickly.
As Darent Valley hospital is brand new, with brand new services, it will take time to bed down. We are heading for the first winter under the new system, and it has taken time for the new teams in the community to be fully staffed, fully trained, fully used to the system with which they are dealing, and to get up and running. About 40 patients at any one moment are subject to delayed
discharges. They are ready to move out of the acute hospital, but services are not available in the community to enable them to be moved. That is a real issue.The hon. Member for Woodspring (Dr. Fox) mentioned a patient with chest pain who had been left on a trolley for 17 hours at the Darent Valley hospital. He was mentioned in this context in the Daily Mail yesterday. It is important to put it on the record that that charge is mischievous and not true. To be left on a trolley for 17 hours with chest pain would be extremely frightening for my constituent, and frightening for me as a doctor.
I have taken the trouble to ascertain the truth, and I have received a statement from the acute trust in Dartford and Gravesham, which sets out the reality. The statement clearly says:
- The Accident and Emergency Department
- has the same facilities as a Coronary Care Unit for monitoring patients.
There were two patients in a similar situation, and the statement says that they were
- monitored, treated and cared for on beds in the Majors area of the Accident and Emergency Department.
Following assessment by the Consultant Physician that morning, the decision was made that these two patients required Cardiac monitoring. The Trust has 4 areas that provide this service, one of which is in the A&E department. Clinically, it would have been unsafe to place them in any other area, therefore they were in the most appropriate area for their clinical needs.
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