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3.13 pm
Mrs. Marion Roe (Broxbourne): I listened to the speech by the Secretary of State for Health and, like many others, I have come to the conclusion that the Labour party is still up to its old tricks--promises, promises, promises, all delivered with spin and grin, to be followed inevitably by failure, failure, failure. The Secretary of State appears to be living in a world of his own.
It is time that the Prime Minister and his colleagues realised that the people of this country are not as daft as the Government would like to think. Certainly in my constituency, people are carrying out comparisons between what the health service was like before 1997 and what it is like now.
The Labour party is now being rumbled. The electorate know that at the last general election, Labour bribed them with pledges which they had no hope whatever of delivering, particularly on health. The message that is being put about nowadays is that the Labour Government cannot be trusted.
Nearly every day, one reads in the newspapers or sees on television a crisis in the NHS caused by mismanagement and inefficiency and my constituents now know that they have been let down badly by an ambitious Labour Prime Minister and his party. There is no doubt that in spite of their dedicated commitment to the NHS and in spite of coping with the enormous burdens placed on them, all those working in the NHS have become disillusioned, disappointed and frustrated that their high expectations of a promised improved NHS have been shattered. It is no wonder that their morale is so low. I pay tribute to them for their magnificent achievements under very difficult circumstances because we all know that under Labour the NHS has become worse.
I quote from a letter dated 4 September, which I received from my constituent, Mr. John Rose, of Hoddesdon:
- I rang my GP practice today in an attempt to make an appointment to get attention and advice on what is at this time a non-emergency minor ailment and was astonished to find that the earliest appointment that could be made with any doctor in the practice was for the afternoon of 11 September, i.e. eight days time.
This does not seem good enough to me and so I contacted the Area Primary Care Unit at the County Hospital in Hertford to enquire if this was an unreasonable time to wait for attention and was told that locally this was "about par for the course" . . .
I also contacted the Community Health Council in Ware, who agreed that a period of eight days is too long to wait for an appointment and I understood from them that the government in the shape of the Prime Minister has stated that appointments with GPs should be available within 48 hours. I presume that this is a distant aspiration because it is a considerable distance from the actuality.
I would stress that my major concern is not my individual case but the generality that people must wait eight days for an initial consultation with a doctor. How many non-emergency cases can become emergencies within that length of time?
I also received a letter, dated 1 October, from Mrs. Darlow of Waltham Cross. She wrote:
- Dear Mrs. Roe,
I wonder if you could help me please. I am due to have an operation for a hysterectomy and was put onto a fast-track system of 3-8 months waiting time. It is now 19 months later and I am still on the waiting list which only gets updated on a 6 month basis. My next update is end December which will take it up to 22 months. I have also been on their emergency cancellation list for months now, but still no joy.
Some elderly patients are now raiding their meagre savings to pay for private health care because they cannot face the pain, agony and discomfort of their condition during a wait of 18 months or more for an operation in the NHS--that is known locally as Labour's privatisation of health care by stealth.
Three and a half years ago, the usual maximum waiting time for elective surgery at the QE2 hospital in Welwyn Garden City was 12 months, but patients frequently had their operations much sooner. Within six months of the Labour Government coming to power, the waiting time rose to 18 months as the norm. So much for Labour's promises at the last general election about improving the NHS. My constituents now feel that they were conned.
There has, however, been one organisation within the NHS structure that has had the full respect and confidence of patients and all those working within the NHS and on which they have relied for impartial and independent help and support. I am, of course, referring to the community health councils.
My constituency does not have a district general hospital. In consequence, my constituents go to three major hospitals, two of which are outside the county. My local community health council, East Hertfordshire, has monitored all three hospitals from the point of view of Hertfordshire residents. It conducts up to 50 monitoring visits a year, and has a reputation with the three hospitals and the health authority of carrying out effective quality monitoring, making constructive recommendations and achieving changes to services for the benefit of patients. Its skill and expertise have been built up over many years. I cannot see this work being effectively continued by parochial local patients forums in each hospital, where my constituents will be in a minority.
We have one small community hospital in my constituency. It owes its existence to the efforts of myself, the borough council and the CHC, which resisted plans to
abolish it some years ago. In the past month, the CHC alerted me to the closure of the hospital's minor injuries service--done without consultation or notification--and, in turn, informed the health authority and the borough council, neither of which were aware of what had happened.This is the CHC performing its watchdog role on behalf of patients and residents. The Government are proposing independent local advisory forums for each health authority. In Hertfordshire's case, this will probably mean one for the whole county. The forums will perform some of CHCs' current functions. I cannot imagine such a forum being local enough to know that such a closure had happened, or independent enough to stand up for the people who use it in the face of an NHS trust decision.
I have indicated that the nature of health service provision in my constituency is diverse, with many services coming from out-of-county providers. That has sometimes meant that the health authority has not always concentrated its attention on what could be seen as a peripheral part of its area. The CHC has unfailingly--and sometimes exasperatingly--insisted that my constituents and their health needs should not be forgotten. The CHC has championed the cause of those neglected services such as mental health and learning disabilities to some effect, so that services have improved. It has worked constructively with the health authority, primary care groups and NHS trusts to remedy other deficiencies.
East Hertfordshire CHC has always provided an independent service to the residents of its district, giving help and information about the national health service and, in particular, giving advice and support to those patients or their carers wishing to complain about the treatment that they have, or have not, received. Complainants have been grateful that such a body exists. It is perceived as separate from the rest of the NHS, yet knowledgeable about its workings and the workings of its complaints procedure. Crucially, it is perceived as independent enough to give impartial advice and help. The NHS plan for PALS--patient advocacy liaison services--with staff in every trust to act as customer relations officers and local troubleshooters does not replace what CHCs do. There will still be a need for independent advice. Current examples of PALS provision have continued to rely on the existence of CHCs, and the present proposals leave a gap that reformed CHCs could more than adequately fill.
Community health councils have been accused of being dinosaurs. That is not my experience. My CHC has been innovative over the years in a number of ways. Apart from producing an effective and well-thought-out monitoring system, it successfully instigated a conference on clinical effectiveness at a local level involving the six NHS trusts that provide the majority of services to my constituency. It has, in the past two years, originated a new approach to its role in consultation over major changes in services. With the other Hertfordshire CHCs, it has held public inquiries, based on the principles of a Select Committee of this House. All interested parties have been called to give account before a panel of CHC members and to express their views on the proposals. The result of that approach has been to secure guarantees about future developments, which have safeguarded public interests.
Such public inquiries have also clarified the issues for the public and for professionals. This approach has been welcomed and supported by the health authority, NHS trusts, primary care groups, local authorities and, most importantly, the public. It has been copied by at least one local NHS trust.
In Hertfordshire, community health councils are respected by all parts of the NHS, by local authorities and by social services departments. They are appreciated by the voluntary sector and the general public. That respect has had to be earned. That has been achieved by the professional and competent way in which their functions have been carried out, and by the wide local knowledge base that they have built up.
In my constituency, the CHC has a clear overall understanding, drawn from fulfilling its different functions, of the complex way in which services are provided, what needs exist, how they are or are not met and how different agencies interact. The proposals in the NHS plan fragment these functions, and mean that no one organisation will have an overarching view of the issues in a local district.
The Government have made much of the fact that CHCs and their national body, the Association of Community Health Councils for England and Wales, have recognised the need for reform. East Hertfordshire CHC has long recognised that need; it proposed, through the national body, that CHCs' powers of inspection or monitoring and consultation should be extended to cover primary care. Its members would also have welcomed changes in the way appointments are made.
The CHC would have welcomed constructive change. However, it did not expect or deserve to be abolished. That abolition, without warning, and with only a belated acknowledgement of the contribution that CHCs have made since their inception in 1974, was like a slap in the face. Its effect was instantly demoralising.
The abolition of CHCs will mean that the NHS will run the risk of losing invaluable knowledge and skills. It will lose the CHCs' particular experience of relating to the general public, as well as an objective, informed, independent, lay contribution. It will also lose the hours of voluntary time and enthusiasm given unstintingly by CHC members.
With ill-conceived policies such as the abolition of the community health councils and a persistent quest to centralise control, it is no wonder that under this Government the NHS is failing the people whom it was designed to serve.
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