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The Minister of State, Department of Health (Mr. John Denham): Will the hon. Gentleman enlighten the House on whether his party is promising free social care?
Mr. Amess: If the Minister gives me a chance, I will come to that.
Ms Julia Drown (South Swindon): Will the hon. Gentleman also point out that Age Concern welcomes moves to improve local accountability in the health service, welcomes the new statutory duty on health bodies to consult on and involve local people in planning, and welcomes proposals to improve the provision of general dental services? Those are just three of many welcomes throughout its briefing.
Mr. Amess: The hon. Lady will be pleased to know that I have the Age Concern briefing in front of me and have highlighted comments in it, but I am in injury time and have an awful lot to get off my chest in the remaining six minutes of my speech.
Never mind Age Concern's briefing--perhaps the Library briefing will please the Minister. It quotes Gordon Lishman, director general of Age Concern England, as saying:
- The Government is continuing to dodge the issue of principle--that personal as well as nursing care should be free.
The Government are obviously not interested in Age Concern, but perhaps they will listen to the BMA and reflect on the implications of clause 17--if Ministers understand it. According to Dr. John Chisholm:
- Patients with equal clinical needs must have equal access to high quality GP services, so the BMA shares the Government's aim for there to be an equitable distribution of family doctors. Inequalities have been drastically reduced over the past 52 years as a direct result of the operation and influence of the Medical Practices Committee.
The Department of Health must have been having its Christmas party when it came up with the ridiculous traffic light system. Health authorities, NHS trusts and primary care trusts are to be categorised red, amber or green. The system is complete nonsense. The Royal College of Nursing supports measures to improve standards in the NHS, but remains concerned about the system of judging such bodies and allocating resources accordingly. The briefing states that in particular the RCN does not believe it is right for the proportions of NHS bodies to be categorised as "green", "yellow" and "red". Its briefing goes on to destroy the argument for such categorisation. The next few clauses after clause 17 cover care trusts, with which my right hon. Friend the Member for North-West Hampshire (Sir G. Young) dealt.
Labour, which is obsessed with joined-up government, plans to unite the NHS and social services. Does it really think that the general public will be taken in by such a claim before an election? It is an absolute fiasco.
Finally, there is the proposal with which even this Government are a little uncomfortable: the proposal to abolish community health councils. When Labour was in opposition, it loved CHCs and was always quoting their work. Since the CHCs have been critical of this rotten Labour Government, however, the Government have thought, "We'll abolish them; we mustn't have any insubordination in the ranks. We've managed to silence the House of Commons and now those well- intentioned"--this is the Government being patronising--"individuals on CHCs must be silenced too." The way in which the Government are not prepared to be scrutinised is a disgrace.
Mr. Paul Truswell (Pudsey): Will the hon. Gentleman give way?
Mr. Amess: I am sorry, but I have only one minute left.
The attack on my right hon. Friend the Member for South-West Surrey (Mrs. Bottomley) and the way in which my right hon. Friend the Member for North-West Hampshire was heard were an absolute disgrace. Those former Ministers spoke a great deal of sense.
Yet again, this rotten Labour Government are letting down the country and the people of Southend, West, and once again particularly undermining the wonderful staff in our national health service.
7.47 pm
Mr. Paul Truswell (Pudsey): I would like to be able to say that it is a pleasure to follow the Vaudeville rant of the hon. Member for Southend, West (Mr. Amess), but I am afraid that I cannot.
As many hon. Members have said, the Bill has much to recommend it, but it is often in the nature of Government Back Benchers to be churlish and to dwell on elements that they question rather than those with which they wholeheartedly agree. Before I do that, I want to answer one question that has been festooning posters the length and breadth of the country--where has the money gone? I know where a great deal of the money has gone in Leeds: it has gone on refurbishing accident and emergency units at St. James' hospital and Leeds general infirmary; on boosting the funding of Leeds health authority by 40 per cent. in the next financial year; and in helping to fill the huge chasms in the service created by the previous Government.
Mr. Hammond: What is the current out-patient waiting time for orthopaedic consultations at St. James' hospital, Leeds?
Mr. Truswell: It is far longer than it should be; that is an admission. Every Leeds Member of Parliament has been pursuing that issue and will continue to do so. They were pursuing it just as vigorously under the previous Government, who created much of the problem.
Rather than be deflected by that intervention, I shall mention the fact that, at long last, the neglected Wharfedale general hospital, which serves my community, is to rebuilt. Plans to do so have been kick-started by this Government. That hospital was left to rot by the previous Government. We have seen the earmarking of £45 million to rebuild our mental health services in Leeds; that is long overdue. Their
state was largely down to the previous Conservative Government. So much for the question, "Where has the money gone?"I should like to raise one or two concerns to which other hon. Members have referred. The first is on performance funding. We appear to have a system of performance funding at the moment, which, to some extent, penalises Leeds.
I make a plea that target setting should be sufficiently reasonable and sophisticated to recognise the difference between various health districts and health trusts. Leeds is a centre of excellence and, as such, patients are often referred to its hospitals because other trusts believe that Leeds possesses the expertise to deal much more effectively with cases that they can. I am talking not just about tertiary referrals, but about an increasing number of secondary referrals within districts. That being the case, the capacity in Leeds to manage its waiting lists is diminished because of this skew in the case mix, which perversely enhances the case mix of those authorities that make the referrals.
I welcome the recognition in the NHS plan of the importance of advocacy services, which complement existing services in such places as Leeds where they are provided by the voluntary sector. I urge Ministers to ensure that the advocacy provided is the most effective, so that advocates represent the interests of patients in a truly professional way and as they would represent their own personal interests. I am not sure how that role fits in with PALS as a welcoming face at a hospital reception, important though that is for customer care. Advocates--whether through PALS or the independent advocacy system--must not only be independent of the NHS, but must be seen by patients to be so.
I am delighted by my right hon. Friend the Secretary of State's announcement that he and his colleagues are considering the possibility of local authorities providing advocacy services. In the 1980s, as a then local authority member I was closely involved in establishing a local authority advocacy scheme--I think that it was the first in the country. It was based on the pioneering work of one of the London CHCs. I remember just how much opposition we had from the health service. The medical profession found it threatening, and health professionals felt that the term "advocacy" was adversarial and felt threatened by what they saw as an intrusion. They tried to reduce our advocates to interpreters for minority ethnic groups or people who would reiterate the professional message.
We finished up having to change the name of the service to the patients advisory service. The rose by another name still smelled as sweet, and it was advocacy pure and simple. If a change of name was necessary to get the system into the health service, we were prepared to make that compromise. That is why it is important for an advocacy service to be truly independent; otherwise it will be moulded and influenced by the inherent--some may say paranoid--mistrust of the concept of advocacy in some areas of the NHS.
Advocates provide support to individuals and to their families. They can play an equally important role in aggregating individual experiences into a much broader picture of what is happening on the ground in the NHS
and feeding that into the process of lobbying for change. I am not certain how that can be done within the arrangements promulgated in the NHS plan and in the Bill. Like many other hon. Members, especially Labour Members, I would like answers to those questions--if not immediately, then during the passage of the Bill.CHCs play a major role in supporting patients through the labyrinth that is the complaints process. They often employ specialist complaints officers. I continue to work closely with my local CHC, which provides my constituents with experience and expertise that, I admit, I could not provide. Some Members may be sufficiently well versed in the complaints procedure, but I am not one of them. The role that the CHCs play is crucial.
It is essential that PALS, or the independent advocacy service if that is to be separate, are able to provide such experience and expertise, and to assist patients in following through their complaints from the beginning of the informal exchanges with the trust and service providers right through to the more formal and heavy end of the complaints process if necessary.
That is the nub of my concern about the new proposals. We run the risk of losing a valuable element of the CHC experience: that is, the co-ordination and cross- fertilisation of services to which many colleagues have referred. None of the services provided by the CHCs or the bodies intended to replace them should operate in isolation. Inspection, monitoring, commenting on service changes, advocacy, complaints and support for nominees to health bodies should inform and complement each other, rather than be fragmented across a range of different bodies, as my hon. Friend the Member for Romford (Mrs. Gordon) said.
I do not subscribe to the view that what the Government Front-Bench health team are suggesting will prevent criticism from being voiced within the NHS; the reverse is the case. Many different groups and bodies will be set up, so the Government are increasing the number of platforms for criticism. I would be surprised if the people who serve on those various bodies did not use them in that way.
I should declare an interest as a former member of a CHC for two years. I became a member when the previous Government ejected local authority nominees from health bodies. The Tories frequently talk about cronyism, but their practice can only be described as toadyism. People with no aptitude for the job were appointed--their only qualification was that they owned a Conservative party card and pursued an unswerving devotion to the Conservative cause.
I attended my first meeting as a CHC observer. The chair of that authority happened to be the chair of the Yorkshire regional Conservative association--so I am not talking about a run-of-the-mill Tory.
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