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Mr. John Burnett (Torridge and West Devon): My hon. Friend talks about local government having a greater say in such matters, and refers to public health issues. He will be aware that a survey by the Department of the Environment, Transport and the Regions and West Devon borough council of the incidence of radon in properties on Dartmoor with private water supplies was published yesterday. Does he agree that that should precipitate immediate research on the problem?
Mr. Harvey: I am aware of that, because the issue affects my constituency, too. If local government had responsibility for public health, and had the wherewithal to undertake the necessary research, it would be able to make a valuable impact on public health issues at community level. That is another example of why it would be better to give it a greater role.
In conclusion, the Bill contains many measures with which we agree, and others about which we have major reservations. We do not feel able to support its Second Reading today, but doubtless it will proceed to Standing Committee, where Liberal Democrats will do what we can to amend the Bill along the lines that I have suggested.
5.40 pm
Mr. John Austin (Erith and Thamesmead): First, I apologise to the hon. Member for Woodspring (Dr. Fox) for missing the opening couple of sentences of his speech as I was in the Lobby voting.
Like my hon. Friend the Member for Wakefield (Mr. Hinchliffe), I greatly welcome many of the measures in the Bill, which addresses some of the inequities in health service provision, emphasises primary care and addresses the crucial issue of the joint working of social services and health authorities.
In relation to the primary care trusts, I recognise that the changes in the allocation of cash-limited and non-cash-limited funds to health authorities and PCTs
could in time help to tackle the unequal distribution of GPs across the country. The Government are right to redress the situation in under-doctored areas and improve GP services in some of the most needy and deprived areas. However, if they are to succeed, guarantees are needed to ensure that additional funding is spent on primary care services and not diverted into secondary care. I hope that, in his reply to the debate, my hon. Friend the Minister can give such guarantees.While I fully understand and support the Government's intentions to drive up standards in the NHS, I have some reservations about how the green, amber and red traffic light system will work. I have similar reservations about the way in which Ofsted has labelled some schools as failing and the impact that that has had on morale and the recruitment and retention of staff. To label an organisation as failing can have adverse effects. I am much more in favour of using carrots rather than sticks. Although I can see how the green and amber traffic lights would work, I have some reservations about the red ones.
In his speech to the Royal College of Nursing in May last year, my right hon. Friend the Secretary of State described his vision of the NHS as:
- A health service of all the talents.
- nursing values are health service values. Caring. Compassionate. Professional. Dedicated. The needs of the patient at the core of all we do.
A health service of all the talents will require the involvement of all relevant staff, not just in service delivery but in planning and policy formulation and in management. It means involving all the relevant professions on working groups, taskforces and committees.
I deal now with the staff terms and conditions elements in the Bill. I welcome the new powers to be given to the Secretary of State to make regulations about the terms and conditions of staff. Most staff in the NHS are employed according to nationally agreed terms and conditions, most professional staff coming within the terms of the pay review body. The Secretary of State and the Minister will know of my concerns about staff who are outside the pay review body, such as medical laboratory scientific officers whose pay has fallen way behind that of nurses and other professions allied to medicine that are within the purview of the pay review body. They will recall my early-day motion 68, which was supported by right hon. and hon. Members on both sides of the House.
I wish to be one of the first to join my hon. Friend the Member for Bolton, South-East (Dr. Iddon) in welcoming the Secretary of State's recognition of a long-standing problem that was ignored for so long by the previous Administration and yesterday's announcement of substantial pay increases to some of the lowest-paid
professionals who provide an essential diagnostic and preventive service as well as playing a key role in treatment.I want to mention briefly some of the positive changes in the NHS that have occurred under the Secretary of State and his predecessor, my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), especially with regard to the nursing profession. My right hon. Friend the Secretary of State has recognised that, in the past, a nurse had narrow career options, and that in order to advance the only paths were to enter nurse education and the realms of management.
There is no problem with those choices: we need able nurses in management and we should welcome the increasing number of nurses who make it as chief executives in the NHS. Equally, nurse education needs some of the best nurses to ensure that the next generation of nurses is adequately skilled. It has, however, been frustrating for good clinical practitioners who want to remain with their patients. Since the Halsbury report of 1974, the profession has sought genuine opportunities for a clinical career grade--a desire wholly ignored by previous Governments, but which the Labour Government have taken on board, providing nurses and the nursing profession with a real chance to break new ground in building solid options for a clinical career.
One group of nurses mentioned earlier--practice nurses employed by individual GPs--are not technically part of the NHS, although they clearly work in and for the health service. Their terms and conditions should be brought within the remit of the NHS.
Dr. Brand: Does the hon. Gentleman agree that those practice nurses should not lose out by being brought into the framework of the NHS? In my experience, practice nurses have much better and more flexible employment opportunities than some of the nurses employed directly by the NHS.
Mr. Austin: That is so and it is all to the good. However, in many cases practice nurses are at a disadvantage compared with their colleagues.
The issue of practice nurses is a key part of the Bill. Yesterday, my hon. Friend the Member for Wythenshawe and Sale, East (Mr. Goggins) described an excellent example of the role that practice nurses are playing in his area. There are examples of initiatives of nurse-led practices under the Government's innovative personal medical services pilots where a nurse is actually responsible for managing the practice and employing a salaried GP--leading to a better service for patients and freeing up time for the GP to see those patients who need to consult a doctor. Why cannot those nurses legally be principals in their own right?
I welcome what the Government have done in the Bill to extend nurse prescribing. I was among the first to criticise Opposition Members, but I pay tribute to Baroness Cumberlege who pioneered the concept of nurse prescribing. None the less, it was the Labour Government and my right hon. Friend the Secretary of State who developed and extended that concept.
I welcome the PMS initiative. I am pleased that all the schemes submitted by Bexley in the recent wave have been approved. However, I have written to the Secretary of State about some anxieties that were expressed as to
whether sufficient growth funds to support the additional salaried GPs and nurse practitioner posts will be available. I await his reply with interest.The Minister of State, my hon. Friend the Member for Southampton, Itchen (Mr. Denham), will be aware that I first joined the CHC in the area where I lived in 1974 as a local government nominee, having been elected to the local council in three successive elections. At the time, I worked in a neighbouring borough for a local voluntary organisation and registered charity. Some years later, when my term of office on the CHC in the area where I lived expired, I was appointed to the CHC in the area where I worked, having been chosen in an election process involving all the local voluntary organisations with an interest in health--including Mencap, MIND, the Multiple Sclerosis Society and the Association of Disabled People--as well as general interest groups, such as residents and tenants associations and ethnic minority organisations.
In speaking of CHCs, the Under-Secretary, my hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart), has referred to a democratic deficit in the NHS. In reality, until now CHCs have been the most democratic and accountable part of the NHS; they are not directly elected--although some of their members are appointed from local authorities--but are an innovative experiment in representative democracy. That experiment has worked and it has worked in the interest of patients.
Some people have pointed out that not all CHCs worked well. I could say the same thing about hon. Members. I venture to suggest that my appointment, first as a democratically elected local councillor nominated by the local council, and subsequently as the choice of a consortium of voluntary and community organisations serving the community, made me a more democratic choice and more accountable to the community that I served than any of the health authority and trust board members appointed under the patronage of the Secretary of State.
We need no lessons in democracy and accountability from Opposition Members. With my colleague, my hon. Friend the Member for Eltham (Mr. Efford), I also served for a period on my local health authority. He chaired the social services committee, and I was one of his predecessors. The right hon. and learned Member for Rushcliffe (Mr. Clarke) removed all local authority and elected representation from health authority boards, and the right hon. Member for South-West Surrey (Mrs. Bottomley) was the Minister of State at that time. My hon. Friend and I were replaced on the health authority by a computer salesman and a double glazing salesman, after which the health authority got into some dodgy financial deals, some of which I suspect to have been not exactly lawful. That left the authority with a substantial financial loss.
I also served for two years as chair of the Association of Community Health Councils for England and Wales. It will not surprise anyone, therefore, that I have grave reservations about the proposals to abolish CHCs, notwithstanding the assurances that I received from the Minister of State, my hon. Friend the Member for Southampton, Itchen, this morning. I believe that the Secretary of State went further in his statement this afternoon.
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