Health and Social Care Bill

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Mr. Hilton Dawson (Lancaster and Wyre): Does the hon. Gentleman recognise that in drawing attention to what he calls fragmentation, he overlooks the excellence of NHS Direct? He should note the comments of Mrs. Jean Jones of Pickthorn close, Lancaster, who spoke of the tremendous benefit that she derived from NHS Direct on new year's day 2001. It gave her excellent, comforting, reassuring advice when medical services were not available to her husband.

Mr. Swayne: I could detain the Committee for some time, Mr. Maxton, but you have informed me in a note that there will be a stand part debate, so I shall confine myself to the narrow subject of the amendment on out-of-hours access. I am reassured to learn from the Minister that what we would like included in the Bill, by way of amendment No. 169, will be dealt with in regulations.

I am not entirely sure that I understood the compromise that the Minister was outlining with respect to amendment No. 168. Am I right in thinking that he was suggesting a regional structure?

Mr. Denham: To use an example from my locality, Southampton and South West Hampshire health authority might decide to accept the judgment of Portsmouth and South East Hampshire health authority in accrediting a service that was offered across both health authority areas. However, there would not be a requirement on the Southampton and South West Hampshire health authority to accept another health authority's judgment. That allows for cases in which it is thought that the quality of service might vary between areas.

Mr. Swayne: I now understand the Minister. That leaves us with reservations about the bureaucratic hurdles that a provider might have to negotiate if the health authorities were not minded to accept one another's accreditations. However, seeing the clock, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

The Chairman: Order. I wonder whether it would be for the convenience of the Committee if I mentioned that while, as Chairman, I am reasonably tolerant of amendments if they help the debate, in the previous debate my tolerance was stretched a little.

Question proposed, That the clause stand part of the Bill.

Mr. Swayne: We welcome the principle of the clause. It is appropriate and desirable that a high standard of out-of-hours care should be available throughout the country. I am sure that all hon. Members will be aware of the need for that from their postbags and constituency case work. The health service ombudsman has drawn attention to existing problems.

Some concerns remain, however. The first is that the clause has resource implications for the administration and scrutiny of the accreditation process. What is the Minister's estimate of the effort and cost that health authorities will have to face with the new duty?

I received a brief from the Royal College of Nursing that detailed a concern pertinent to the clause, although it also affects a number of others. It sought assurances that the new accreditation conditions will not exclude nurse-led practices under the new personal medical services dispensation. Some nurse-led practices employ GPs, but the RCN fears that, because nurses cannot act as principals, they will be excluded from acquiring accreditation under the clause. Will the Minister deal with that concern?

We understand that, by 2004, a single phone call to NHS Direct will be a one-stop gateway for out-of-hours access to health care, with NHS Direct passing on the calls to the GP or the out-of-hours provider. Our concern is that that should not be the only gateway; it should be a one-stop shop or gateway but not the only one.

The independent report ``Raising New Standards for Patients -New Partnerships in Out-of-Hours Care'' proposes, in recommendation 7:

    Service level agreements incorporating all the Quality Standards should be established, between NHS Direct and all providers of out-of-hours services.

We are concerned that these regulations will be used to push all out-of-hours providers into accepting NHS Direct as the only gateway to their services.

Mr. Simon Burns (West Chelmsford): Has my hon. Friend ever rung NHS Direct? Unlike the hon. Member for Lancaster and Wyre (Mr. Dawson), I phoned on new year's day 2001 to get some advice on a child's health but, after 25 minutes of waiting to get through, I had to give up.

Mr. Swayne: I have only rung NHS Direct when I have been prompted to do so by constituents who have complained to me about the service. I always use pharmacists rather than the assistance that can be had over the phone from medical professionals, for precisely the reasons to which my hon. Friend drew attention.

We fear that these regulations will push us towards a situation in which someone wanting to access any out-of-hours provision must do so via NHS Direct.

Mr. Hammond: Although my hon. Friend has not stated this explicitly, he knows well that pilots are being considered in which access to the 999 ambulance service is also obtained via NHS Direct. The experience of my hon. Friend the Member for West Chelmsford (Mr. Burns) could be alarming in that context.

Mr. Swayne: I am aware of that, and the prospect is most alarming. We have the same concern with those pilots as we have with these regulations: that they will be used as a means of enforcing the provider to allow access to his service only through NHS Direct.

Lorna Fitzsimons (Rochdale): Whatever the experiences of the hon. Gentleman and his colleagues, will he also accept that I am deluged with complaints about surgeries that leave inadequate answer phone messages? In some cases, the contact number for an emergency doctor is cut off halfway through, and no information is given about when the surgery will next be open or about any service alternatives. That leaves the person no choice but to go to an accident and emergency department or to contact NHS Direct.

We are lucky enough in my area to be able to access NHS Direct. It is a safeguard for many people who find themselves in the same situation as the hon. Member for West Chelmsford when he had to phone to get advice about a sick child. I have used the service and found it invaluable when the ordinary surgery has let me down.

11 am

Mr. Swayne: I should be interested to know how long the hon. Lady waited to get through. She draws attention to a legitimate concern in saying that there needs to be a safety valve. The problems that she has highlighted should be rectified by the regulations that we have discussed, so that a high quality standard of provision is assured. Our fear is that NHS Direct will become the only means by which out-of-hours services can be accessed. We do not believe that it is proper to move to such a situation until the case for NHS Direct has become much sounder than it is at the moment. The jury is still out.

My hon. Friends have already drawn attention to the problems that many people perceive with NHS Direct. Only last year, the conference of the British Medical Association voted that the £80 million currently being spent on NHS Direct would be better spent on renovating their surgeries [Laughter.] I can understand there being a measure of self-interest among general practitioners, but those are the very people who must have confidence in that service. It would be improper of us to use these regulations to require them to make their out-of-hours services available only through NHS Direct before there is sufficient confidence in NHS Direct to bear the weight of that requirement.

Mr. Dawson: Does the hon. Gentleman accept that the experience of the present pilot project for NHS Direct is that, despite some initial scepticism from GPs, the project has been successful and has developed largely because of the co-operative attitudes of GPs and the medical profession?

Mr. Swayne: Experiences differ as, no doubt, the National Audit Office report will tell us. However, at the moment the jury is very much out. A snapshot survey of 500 calls to NHS Direct from 5 to 11 January last year showed that 33 per cent. of patients were advised to take care of themselves, 23 per cent. were told to go to their GP immediately, 18 per cent. were advised to see their GP as a routine visit and 6 per cent. were told to go to their hospital accident and emergency department, of which 2 per cent. were to be as emergencies. In addition, 18 per cent. were told to seek advice from another health professional or to get more information. Most of the calls involved young children and young women, with a low rate for older adults.

The survey showed that almost half those who ring NHS Direct go to their GP as well. A call to the service costs the NHS £8. A visit to the GP costs £10.55, and one to an accident and emergency department £42. When a patient talks to NHS Direct and then goes to the doctor—as so many do—it costs a total of £18.55, so we are increasing the cost to the national health service by sending so many of the people who have rung NHS Direct to their doctors. They may as well have gone straight to the doctor and saved the additional cost.

Mr. Adrian Bailey (West Bromwich, West): Does the hon. Gentleman acknowledge that many people phone NHS Direct for advice about whether they should go to the GP? When the advice is that there is no need to go to the GP, there is a potential saving to the NHS that should be incorporated in the figures.

Mr. Swayne: The answer to the hon. Gentleman is that very few of those who ring NHS Direct are saved that trouble, because so many subsequently visit their GP.

Mr. Hammond: Labour Members are jumping up and down like Jack-in-the-boxes to extol the virtues of NHS Direct. The fact is that the Government have rolled out the programme without a robust evaluation of its success and cost effectiveness. Now, our best hope is that the National Audit Office will undertake a full investigation into NHS Direct and its cost effectiveness, and only after that will sensible decisions about its role be taken. Until then, neither Labour Members nor anyone else can make an effective evaluation of the part that NHS Direct plays in our health system.

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Prepared 25 January 2001