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9 Jan 2001 : Column 168WH

NHS (Somerset)

10.30 am

Mr. David Heath (Somerton and Frome): I am grateful for the opportunity to raise the important issue of the health service in my county of Somerset. The stimulus for so doing was a survey that we carried out last year, involving the delivery of a form to every household in my constituency. Furthermore, my colleagues in other constituencies have conducted similar surveys. Our intention was to gain an overall feel for levels of satisfaction in Somerset, to discover problems that people have recognised and identified in the delivery of NHS services and to provide an opportunity for people to express their appreciation. I was gratified by the level of response to the survey that was, in my experience, unprecedented. We received thousands of response forms from across Somerset, and people were happy to express their views.

I hope that the Under-Secretary of State for Health, the hon. Member for Birmingham, Edgbaston (Ms Stuart) has received the copy of the principal responses that I sent to her yesterday. If she has not, she will find it somewhere in her Department. I sent it so that she could be aware of our results and I hope that it will assist her.

Why did we conduct the survey after the Government had undertaken their consultation? Not only were our questions slightly different, but the Government's consultation--welcome though it was--reached a relatively small number of people. That analysis was borne out by our results: only one in five of our respondents had seen the Government's consultation paper.

It may help if I describe health services in my constituency, which is a rural area that contains two hospitals. The Verington hospital, which I was happy to visit last Friday, has a general practitioner unit, consultant beds, a small number of psycho-geriatric beds and a day hospital. I welcome its considerably expanded role in the local community; it is doing a good job as a relatively small unit. In Frome, we have the Frome Victoria hospital, in which I declare an interest, as a patron of its appeal to raise sufficient funds to equip what we hope will be a remodelled hospital. We seem to be successful in raising those funds and everything seems on track for the building of a new Frome Victoria hospital in the near future. For major acute services, however, my constituents must travel outside the constituency, either to Yeovil general, which is operated by the East Somerset NHS trust, or the Royal United hospital in Bath. I shall not read out all the survey results--that would be otiose and unhelpful. I simply want to pick out some important points and perhaps illustrate them with specific examples, in order better to make the case to the Minister.

In my constituency, we are well served by our general practitioners and I have little, if any, quarrel with the services that they provide. That view is clearly shared by my constituents, whose satisfaction levels are extremely high: 61.5 per cent. declare themselves very satisfied, while 33 per cent. describe themselves as satisfied. Overall, 94.5 per cent. of respondents are satisfied with their general practitioner. They are happy with provision in the surgeries and with home visits. Indeed,

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those who request a home visit receive it on the same day in 88.5 per cent. of cases, which is creditable in a sparsely populated rural area.

Last Friday, I spoke to a senior general practitioner who is retiring before he is required to do so. He noted that many of his colleagues were also retiring early and expressed concern about the ability to recruit new GPs into the service. If we cannot recruit GPs in Somerset, which has much to commend it to general practitioners, there is a problem. He said that a few years ago, a vacancy in a GP's surgery would have attracted a couple of hundred applicants, but today we would be lucky if there were more than a handful. That suggests concern for future GP recruitment.

Concern has been expressed to me about the effect of NHS Direct. I do not want to criticise it because it is a good initiative, but there is anecdotal evidence that it is increasing rather than decreasing demands on GPs. If people can lift a telephone when they would previously have been unwilling to attend a doctor's surgery and are told that they should see a GP, they will do so. One doctor told me in an irate tone that he had had to make a 2 am visit to someone who had telephoned NHS Direct with a stiff neck, which was nothing more than that.

It is interesting that those who propose that people should pay more often for GP services were given a firm rebuttal by the results of the survey because 89.5 per cent. of those who responded said that people should not have to pay to see their GP. They value the provision that the NHS should be free at the point of delivery and believe that new charges should not be introduced.

I turn to the more acute services and the more difficult cases requiring the intervention of a consultant. A major problem that has been identified elsewhere in the country and was confirmed by my findings is the increasing difficulty in making an initial appointment with a consultant. The Minister will agree that the waiting time comprises two parts: the time waiting for admission to hospital and, before that, the time waiting to see a consultant. Evidence suggests that the former is decreasing, but that the time waiting to see a consultant is increasing. One in three of those who responded to the survey had had to wait more than four months for an initial consultation. Four months is a long time for people who are worried because their GP has identified a condition that merits referral to a consultant. I shall illustrate some of the problems with examples from those who have written to me. I shall not refer to them by name because it was agreed that the survey would be confidential.

A lady from Yarlington in my constituency had two referrals to consultants from her GP. In the first instance, she was seen by a registrar. She was required to return to the hospital on a different occasion for an X-ray and was then required to attend a third time to see the consultant. That prolonged the process to months instead of days and, because she lived a long way from the hospital, she had to make an arduous journey with a difficult condition each time. The same lady had a back problem, which required attention. She saw her GP in August and was told that the earliest she could expect to be seen by a consultant was in January this year. She is still waiting for an appointment.

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A lady from Mells needed to visit the out-patient department of the Royal United hospital on a fairly routine matter. Unfortunately, she ran her own business in Frome--a one-woman operation. She found time to visit the hospital, but when she arrived, she discovered that four people had been booked into each time slot, so she would have to wait for hours. Eventually, she had to return to her business, travelling a 30-mile round trip, without seeing the consultant.

Another worrying case involved a lady from Charlton Mackrell who developed a lump on her throat. She saw her GP and the first referral was on 24 April the year before last. She did not see a consultant until 14 July and she had to wait until 4 February the following year for the thyroidectomy that she required. She had to wait 10 months between first referral and the operation. I do not want overly to dramatise these cases, but they constitute a period of anxiety for individual patients. If someone has a lump and believes that it could be malignant, having to wait for 10 months is a very long time and it is worrying.

Having said that, general satisfaction with consultations is high--91.5 per cent. There is no question of medical or surgical care being in doubt: it is simply the mechanics of the operation that causes problems. All that is thrown into sharp relief by the contrast with the consultation times experienced in the private sector. When we asked people who had recourse to private consultations the same question, we found that 96.5 per cent. were seen within four weeks. Often the same consultants in the same hospitals were involved, which provides much cause for concern about the operation of the NHS.

A family from Frome whose 28-year-old son died last March of hypertrophic obstructive cardiomyopathy provides a tragic case. It can be a hereditary condition and the rest of the family were advised to have an electrocardiogram and a heart echo test at the first opportunity. The ECG was carried out straight away in the local surgery and proved to be fine. However, there was no such early reassurance in respect of the heart echo test. The earliest they were able to book in was March this year--a year later.

In the end, the family decided that they could not wait that long: they had suffered a bereavement in the family and understood the effects of the condition. They went privately to the Royal United hospital and had the same treatment by the same surgeon using the same machine. It cost them £530 to be seen immediately. They ask, quite reasonably, how a routine 20-minute test could be achieved immediately on a private basis, when under the NHS it would take a year--an unpardonably long time.

I congratulate Ministers on achieving some improvement in admission times, but one in four patients still wait four to 10 months or longer for surgical admissions. My casework shows that people have to wait a long time for orthopaedic operations and that there is also a problem in coronary care, which is a priority for ministerial consideration. A few days ago, I received a letter from a gentleman who has been waiting since 2 February last year for admission to the Bristol Royal Infirmary for a bypass operation, for which he is a perfect candidate. He is 62 years old and in good health apart from the problem with his coronary

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arteries. The operation would make a huge difference to his quality of life, but there is no prospect of one because of congestion in the local hospital's cardiac unit.

A lady from East Pennard who has a history of coronary problems was referred to the Royal United hospital on 10 July by her general practitioner, as a matter of urgency. She could not be admitted to the coronary ward because it was full, so she was sent to the accident and emergency department and was extremely complimentary about the treatment she received there. However, she spent the whole night on a trolley because no bed was available at the hospital, which is the major acute facility for the area.

I am happy to report that satisfaction with the medical care provided in our acute hospitals is very high--92 per cent. of respondents were satisfied with the medical care that they received. Traditionally, in surveys of this kind, people are very appreciative of nursing care, so I was surprised that 12 per cent. of respondents to my survey said that they were not satisfied with their nursing care. That does not show a lack of ability, enthusiasm or care on the part of nurses; it illustrates the overstretch that nursing staff have to cope with. One lady wrote to me saying that she was heartbroken visiting a relative in hospital because the hospital was

A former midwife wrote to me as follows:

I fear that the position will get worse. I do not know whether my constituency is typical, but the profession's age profile suggests that there are more nurses at the upper end of the scale than at the lower end and that they will soon be retiring. Many have retired already.

Although I welcome the new career structures, they are not of great benefit to nurses who are nearing the end of their professional lives. Their only concern is whether they can cope with the job that they are being asked to do, or whether the difficult tasks that they are set stretches them beyond endurance. There is considerable evidence that nurses are finding it increasingly difficult to cope with unacceptable work levels. It is important to re-staff our hospitals to fill the gap in nurse recruitment and provide a structure that encourages the retention of nursing staff.

I must complete the picture on admissions to hospital by reporting my constituents' overwhelming rejection of the idea that patients should pay for what have been described as routine operations: 92 per cent. of respondents rejected that proposition and quite rightly so. It would put a heavy burden on many people who have paid into the national health service and expect to receive treatment when they require it without the need to fork out thousands of pounds for an operation which they probably cannot afford.

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I have raised the issue of dentists many times in the House. In common with many parts of the country, Somerset has a real problem in respect of the availability of NHS dentists. My survey backed up that point because 41.5 per cent. of respondents said that they had found it difficult to register with an NHS dentist. Assuming that a large number of people will already have been registered with an NHS dentist for a long time, that suggests a high level of difficulty. We have seen some amelioration through the Government's initiative. We have a new NHS dental surgery in Frome. I found it extraordinary that there was a queue of people all the way around the market place in Frome on the day that the surgery opened for new registrations. Thousands of people were so keen to put themselves on the list of an NHS dentist.

It may sound amusing, but it is not as it illustrates the need for more NHS dentists. Although the new surgery has helped the situation in Frome, the rest of my constituency does not have that benefit and there is still a great deal of difficulty. I know that the dentists who are still working in the NHS will continue to express their concerns. My dentist wrote to me recently and added as a postscript that I was due for my NHS check-up. I have not yet taken up that offer, but he made the important point that there is still a great deal of dissatisfaction. The loyalty bonuses that have been introduced have not met the need to keep people within the service. Indeed, for those who work part time, and many women dentists have worked part time over recent years within the NHS, the level of reward is, as he puts it, derisory. A bonus of £25 a quarter will not encourage professional people to stay within the system. It is almost an insult to their professionalism to offer such a reward.

My final point about the provision of the service relates to accessibility. This is particularly important in a rural area. Of those who responded to my survey, 96 per cent. said that they had difficulties in getting to surgeries and hospitals by public transport, simply because there is no public transport. At the same time we have had a reduction in the transport provided by the health authority, so people can be very isolated and can feel that they cannot get to a doctor's surgery. Moreover, if they are elderly they are often reluctant to call out a doctor. It is still part of the ethos in my part of the world that a doctor is called out only in an emergency, not for a routine matter. If they need to get to a hospital it can be a 40 or 50-minute round trip. Not only is it difficult for the patients themselves, who may have painful conditions, but it affects their relatives when they have to visit.

The geography of the area presents a problem for accident and emergency responses. I have raised in the House the matter of the ambulance service and the difficulties in, first, reaching the patient in distress and, secondly, getting them to the accident and emergency unit in Bath or Yeovil. We are talking about what can be extended response times, to which there are no easy answers. I am still persuaded that the air ambulance has a role to play, so I am disappointed that the Government appear unwilling to support that provision, which can be invaluable in saving lives. However, other action could be taken and that needs to be borne in mind.

The health authority has had what appears to be a relatively generous funding settlement this year with, I think, an 8 per cent. increase. I am grateful for that

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increased funding as it is a move in the right direction, but I am also realistic about its effects. First, the problem of bust followed by boom makes it difficult to use that funding successfully, and a nursing manager whom I met last week made that point strongly. It is much better to have a steadily increasing budget than a rapidly increased budget for one year. The health authority may have to find ways of using that increased funding effectively when it does not have the staff, equipment or ability to assimilate it.

The second issue is the amount of new money available. Pay and price inflation will take up much of the increase, but that is the case every year. The national clinical priorities, with which I do not argue, will also skim off quite a lot of the money. Therefore, the local health authority's flexibility is limited, but the year-on-year 2 per cent. efficiency saving still has to be made. Having been leader of a county council and involved in local government for years, I accept that efficiency savings can often be made year on year and that it is right to build them into a budget, but there is clearly a point at which that becomes counter-productive. There is always a degree to which organisations such as the health service can improve their productivity, but that does not release cash. Increasing throughput and making things work better can improve productivity, but that does not release cash for the budget.

It is too early to say what will happen this year because the budgets have not been formulated and we must wait and see, but I am greatly concerned that what appears to be a generous settlement will, in the short term, involve reductions in services. If that occurred, it would be a tragedy. I shall monitor the situation closely and discuss it with the health authority and trusts in my area, but I give Ministers a serious warning that that may be the result of this year's settlement.

I could have touched on many other services in this short debate such as community pharmacies, which are close to my heart, ophthalmic services--which the Minister may have expected me to mention given my previous career--and chiropody. Time is too short to do so, but I want to leave hon. Members with the clear results of my survey: people in Somerset value the health service enormously and recognise the level of care and the professionalism of those who work within it. They welcome, as I do, the opportunity to express both their appreciation of all that goes right and concerns about what goes wrong or less well than we had hoped. Our common view is that we want to improve, safeguard and develop the health service in Somerset for the future. It is our health service; we value it and want it to succeed.

10.59 am

Mr. Brian Cotter (Weston-super-Mare): I start by echoing my hon. Friend the Member for Somerton and Frome (Mr. Heath) on the value of the health service. The Minister will know that Weston-super-Mare has an excellent hospital. We value enormously the service that it provides: in earlier times, my constituents were dependent on services in Bristol.

I shall be brief, so as to allow time for the Minister's response. I want to deal with four subjects: epilepsy, speech and language therapy, paediatrics and mental health. My views on those subjects are based on contacts with constituents and my various investigations.

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I recently met the Weston-super-Mare branch of the British Epilepsy Association, which expressed concerns about the local and national approach to epilepsy. It believes that the condition of epilepsy has not been dealt with properly--medically or otherwise--for some time. The association believes that the Government have shown little commitment to improving the service in response to the findings of the Clinical Standards Advisory Group report.

Issues raised by epilepsy sufferers at local meetings include the insufficient emphasis on the condition and resulting problems in the health service, as well as over-reliance on self-help therapy, which also applies to other conditions such as autism. Individual sufferers can sometimes be more knowledgeable than professionals. An impersonal response from some consultants is another problem, as is the lack of information about treatment and medicines. A specialist service of nurses is called for.

I see that the Minister acknowledges the problem, but I would like to tell her what a leading Somerset consultant in neuropsychiatry, Dr. Jonathan Bird, said:

My second subject is speech and language therapy. I hope that the Minister will have noticed that I tabled an early-day motion recently, for which I received much cross-party support. One of my constituents is a young boy of five with speech difficulties, and the crisis in speech therapy has affected him. The problem does not affect Somerset exclusively, but it is a big problem there. In this case, the family had to wait five months for an initial appointment and then for a statement of special educational needs. The Minister would accept that speech and language therapy is just as important as nursing care, GPs, doctors and so forth. Speech therapy has many important aspects, yet some people have had to wait up to 18 months to receive it. The lives of many constituents, such as that five-year-old boy, could be affected in the long term if they do not receive the hoped-for response.

The Avon health authority and the Weston area health trust are doing their best to tackle the problem, in extremely difficult circumstances. They would welcome details of how the Government propose to tackle the national crisis in speech therapy.

The third issue is that of paediatric services. The Royal College of Paediatrics and Child Health recently issued new guidelines on quality control and standards of paediatric care. That led, rightly, to the cessation, for a short period, of operations at the paediatric department of Weston general hospital, while the service and quality were assessed. As the local Member of Parliament, I expressed great anxiety about the matter, and so did many of my constituents, as it meant

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that Bristol was the nearest place for children's services. I am glad that after a relatively short time the services at Weston were reinstated but if its paediatric service, which is of great importance, is not given the priority that it needs and is not of a sufficiently high standard, it will have a knock-on effect on hospital services generally.

The vast majority of patients going through the accident and emergency department at Weston general hospital are children. A further problem in Weston is that it is a tourist resort and the number of visits to A & E varies according to the time of year. In that respect, too, the majority of patients are children. If the paediatric back-up were not sufficient--that has never been suggested--it would affect the number of people who go to the hospital and thus the other services. It would be a pity if Weston, which has a good reputation for training and other matters, suffered in that way.

I hope that the Minister will investigate paediatric services at Weston. Although we accept that there must be centres of excellence, we want our hospitals to be viable; that is a key issue for Weston. Various options, suggested by people who are more experienced than I am, are being considered in Weston: extended day care, the availability of consultants and so on. I hope the Minister will ensure, when the final guidelines are issued, that there is a first-rate paediatric service in Weston.

My final point is about mental health. For some time, mental health services in my constituency suffered from significant underfunding. The percentage was below the national average, and I can give the Minister the details if she so wishes. That was recognised. The new mental health trust, which has taken over the reins in the past few months, has increased funding of mental health services in Weston, and is advertising vacancies for consultants, nurses, occupational therapists and others.

Mental health in Weston is a live issue. I frequently attend meetings of an organisation called Friend, at which between 20 and 30 people talk about mental health problems. I am encouraged by the fact that more funding is coming down the line, but I am anxious that it will be only for acute mental health conditions and that those with less serious conditions will be told to seek help from charitable trusts or the voluntary sector. There is a danger that some people will miss out. I hope that there will be full mental health services in Weston and elsewhere. Having met so many people with mental health problems, I cannot emphasise strongly enough how important it is to tackle the issue in the national health service.

I look forward to the Minister's response to the debate.

11.11 am

Mrs. Caroline Spelman (Meriden): It is not in my nature to be discourteous to hon. Members, but I am unable to congratulate the hon. Member for Somerton and Frome (Mr. Heath) on obtaining the debate, which, in his words, was stimulated by a survey. It is important to be aware that the survey contained questions that made untrue statements about Conservative health policy, which the debate legitimises. Question 10 of the survey is:

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I shall use the debate to refute those allegations about Conservative health policy and to place on record my belief that using a survey in that way and obtaining parliamentary time to legitimise questions that falsify the health policy of other parties is an abuse of the consensual nature of Westminster Hall.

Of course, there are problems with the NHS in Somerset that are mirrored throughout the country. The hon. Member for Somerton and Frome and the hon. Member for Weston-super-Mare (Mr. Cotter) drew attention to some of those problems. I, too, asked the Library for help in preparing for the debate; the hon. Member for Somerton and Frome gave too favourable an impression, if the hard evidence is to be believed. He referred specifically to cardiology and ordinary admissions; according to information from the Library, the position for patients waiting for treatment in Somerset health authority has deteriorated in the past three years.

Three years ago, six patients had waited up to 11 months for cardiology, but now eight patients have waited up to 17 months. I am not sure where the hon. Gentleman found the information that there had been improvement in cardiology. According to the hon. Member for Weston-super-Mare, the position in paediatrics has deteriorated, and double the number of patients in that discipline are waiting for admission.

The debate could usefully be used to highlight some serious problems. I want to articulate a concern that was brought to my attention about the need for a radiotherapy unit in Somerset. Perhaps we shall hear an announcement from the Minister this morning on that point. A local charity called Sure has campaigned long and hard for a radiotherapy unit that would help patients who sometimes have to embark on a 100-mile round trip to Bristol for treatment. The unit is long overdue.

There are specific omissions from the presentation of the state of the NHS in Somerset. There is a substantial problem with bed blocking. The root cause of that problem is that the Liberal Democrat-controlled council has made no extra financial provision for care in residential homes. If we are to take a view in the round of the NHS in Somerset, we should look at that. I acknowledge that there is £25.4 million extra funding this year, but local NHS executives are quick to point out that replacing wartime buildings is extremely difficult to balance with waiting list initiatives within the financial package. So while there is extra money, there are serious concerns about whether there is enough.

I do not want to take more time than I have to, because this is very properly a debate about Somerset health authority and hon. Members wish to hear from the Minister on the matter. I felt, however, that I should clarify some of the damaging material that was sent out in the survey. It is in no small part a political stunt. There will be obvious publicity from it and I should like to make it clear that it falsifies the Conservative health policy. The problems of the NHS in Somerset are part of the wider problems with which we, as Members of Parliament, are all too familiar.

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The Prime Minister has fired the starting gun for the general election following "Breakfast with Frost". We are here to debate the results of a survey that is designed to harm the chances of the candidates of another party. We need to be mindful of what is going on here. In my view this is simply not on. The Government will have to answer for their failure to deliver on the high expectations that they raised of improving the NHS in this country. The Liberal Democrats will be exposed at the general election for their lack of realism about how to tackle the problems of the NHS, as they have no idea how to raise the kind of money that would be required to meet the complete desiderata of their health policy. I am sorry to speak in a harsh tone, but the survey is extremely damaging. It is being produced nationwide and it is important that Parliament should know what it contains.

11.17 am

The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart ): I should like to return to the consensual atmosphere of Westminster Hall and to congratulate the hon. Member for Somerton and Frome (Mr. Heath) on securing this important debate. Surveys that show great satisfaction levels are equally valuable as those that show up deficiencies. I was delighted that he put on record the fact that he feels that Somerset is well served by its GPs. They received a high satisfaction rate. He also highlighted some of the areas where further improvement is needed. We readily recognise that. Historically, in common with much of the NHS across England, the health service in Somerset has had its problems.

At this point I should like to mention briefly the contribution of the hon. Member for Weston-super-Mare (Mr. Cotter). He raised a number of specific issues: epilepsy, mental health, paediatric services and speech and language therapy. I can assure him that health authorities and regional offices read Hansard carefully, so his concerns will have considerable distribution. I will take note of his comments and I shall answer his specific questions in writing.

We have already addressed some of the problems experienced by patients in Somerset and I shall describe how we intend to make progress. We have to deal with the legacy of decades of chronic under-investment in the NHS that left it with too few beds, too few doctors and too few nurses. In addition, services were delivered to patients using systems that were rooted in the past. We are committed to the modernisation of the NHS. Our NHS plan sets out a clear programme for investment and reform, because the two must go together. We must have a health service that is designed around the needs of patients. We are backing that plan with money. In last year's Budget, the Chancellor of the Exchequer announced the largest ever sustained increase in NHS funding. I was delighted that the hon. Member for Somerton and Frome recognised that a long-term, sustainable investment is important--not just a large, lump sum investment. I was also delighted that I did not have to refer to boom and bust--a cycle that does not serve anyone. We have committed ourselves to consistent and continuous increase through the new strategy.

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Somerset health authority has received an initial allocation of around £318 million, which represents a cash increase of 8.7 per cent. and a real terms increase of 6.1 per cent. Importantly, the authority also received more than £3.5 million in special allocations targeted at areas of need, such as the expansion of critical care services, assisting the prevention of delayed discharges, the flu vaccination programme and improving ambulance response times.

The hon. Gentleman raised the issue of the performance of the ambulance service. That service has received an additional £1.5 million to help it reach the new national standards. I am fully aware of the problems experienced by the service, particularly in Somerset and in areas where the geography makes it difficult to fulfil the targets. There have been improvements, but I am the first to acknowledge that considerable improvement still needs to be made. The NHS provides paramedics for ambulances, so it is not the case that we do not fund them at all. The evidence on how helpful air ambulances are is mixed. They often arrive at a scene first so they play a vital part, but the case to prioritise them has not been fully made.

I should like to say more about the two trusts in Somerset because they have also considerably expanded their service. In Yeovil, the East Somerset trust has created an extra 21 beds together with admissions and discharge lounges--an expansion of capacity and of delivery of service--while £360,000 has been used to set up rapid access chest pain clinics with the appointment of a second cardiologist and his team. The Taunton and Somerset NHS trust last year saw the opening of a fifth general operating theatre and a third orthopaedic theatre. Funding for a third ophthalmic theatre was announced in December. However, as the hon. Member recognised, the major constraint on the NHS is no longer shortage of money but shortage of staff.

We need more nurses in the NHS, so we have expanded the number of training places to get more people into the profession. There are 16,000 more nurses working in the NHS than in 1997. The hon. Gentleman is right to point out that not all those nurses work full time. In order to expand capacity, particularly in areas of relatively high employment, it is important that people can come back to the profession after career breaks and fit that in with their domestic patterns. The fact that some of those new nurses do not work full time does not diminish the significance of that increase. It is a question not just of getting new people but of getting people to stay. Retention has been a problem but it is now being addressed. In Somerset the number of nurses working in hospital and community health services increased by 92--an increase of almost 5 per cent.--between September 1997 and September 1999. Over the same period an additional 34 hospital and community health doctors were appointed--an increase of 8.7 per cent. There has also been an increase in the number of GPs.

The hon. Gentleman also mentioned dentistry. Between December 1998 and June this year, the number of dentists providing general dental services in Somerset increased by just over 5 per cent. I was delighted to hear that. Somerset must be one of the few parts of the country where people queue to register with a dentist. I remember once being told that dentistry is the one

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area that no one wants to think about, not because dentists are not terribly delightful people but because of what they do to us.

In Somerset, more than £200,000 has been invested in eight dentistry schemes, which have generated more than 18,000 new registrations. There was clearly a need and we hope to meet it. I understand that discussions are taking place about a dental access centre in Somerset. It has been agreed in principle, but further local negotiations are taking place.

Experienced Filipino nurses who have worked at British and American hospitals in the United Arab Emirates have been recruited, 17 of whom will start work this month at Taunton and Somerset NHS trust. A further 20 will start at East Somerset NHS trust in early February. As a result of the recruitment drive at Taunton and Somerset NHS trust, the number of nursing vacancies has been reduced from 120 in October last year to 56 today. More progress needs to be made, but it is important to note that sustainable progress is being made.

In addition to recruitment, both trusts have made special efforts to improve their levels of nurse retention. They have introduced a range of family-friendly working practices such as new flexible working patterns, term-time contracts and job sharing. East Somerset NHS trust has doubled the size of its staff creche to 40 places, and both trusts are increasing training and career development opportunities for their nursing staff. NHS staff, not only doctors and nurses but all the supporting staff, are our biggest asset. Those trusts have succeeded in reducing staff turnover from some 13 per cent. in 1999-2000 to a projected 8.8 per cent. this year. Again, that is progress.

The NHS plan calls for more consultants, GPs, therapists and other health professionals. We have made announcements about the creation of 1,100 extra medical school places, and under the plan there will be a further increase of up to 1,000 in the number of places. Similarly, the number of nurses and midwives undergoing training has been increased by 6,000 compared with four years ago. By 2004, an additional 5,500 nurses, midwives and health visitors will be trained each year compared with today. That will benefit the whole country, including Somerset.

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From the patient's perspective, the single biggest problem is still the wait to see a consultant or to have a subsequent operation. We inherited huge waiting lists, but it must be recognised that progress is being made on both those areas. Waiting lists must be seen in the context of increased activity. In Somerset, the number of patients waiting for in-patient and day-care treatment peaked in September 1998 at nearly 13,000. It has now been reduced by nearly 14 per cent. With all those improvements, Somerset health community is on course to deliver its challenging waiting list targets for this year. The number of patients who had to wait more than 12 months for treatment was 434 on 1 April last year, and the health authority intends to reduce that figure to 25 by 31 March this year. It is right to say that the maximum wait of 18 months is too long, which is why the NHS plan is committed to reducing that to six months by 2005. The maximum wait for an initial out-patient appointment will be reduced to three months. Improvements are being made gradually.

There have been some good initiatives, such as the joint commissioning by the health authority and Somerset county council of mental health services, and the formation of the Somerset Partnership Social Care and NHS trust, which brings together social services and the mental health NHS in a single provider. We very much welcome such co-operation between health and social services.

I have visited one of the Beacon projects in Bridgwater and opened an A & E department at Yeovil hospital. I have seen many improvements, but it is important to realise that sustainable improvements have been made and that that process will continue. The NHS and Somerset county council have been working closely to minimise delayed discharges, and winter planning has been robust. Most importantly, a solid foundation for the modernisation of the NHS in Somerset has been laid. I echo the hon. Member for Somerton and Frome, who said that his constituents value the NHS enormously and recognise its achievements. The Government's commitment to a tax-funded NHS for everyone, not one backed by private provisions, will be welcomed by his constituents and people throughout the country.

9 Jan 2001 : Column 179WH

9 Jan 2001 : Column 181WH

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