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10.38 am
Mr. Douglas Hogg (Sleaford and North Hykeham): I associate myself with the remarks of the hon. Member for Ilford, North (Linda Perham) in welcoming the maiden speeches of the hon. Member for Birmingham, Erdington (Mr. Simon) and of my hon. Friend the Member for Billericay (Mr. Baron). In respect of my hon. Friend's contribution, I suspect that my hon. Friends on the Front Bench—especially the Whips—will be hoping that he is not as idiosyncratic as his predecessor. However, both he and the hon. Member for Birmingham, Erdington made robust speeches; the House enjoyed them and we look forward to hearing many more speeches from both hon. Members.
I want to say something about the health service in my constituency. I want to identify at least three points at which the health service is breaking down in a grave manner. Those examples are intended to illustrate that, on the ground, there is a serious problem in the delivery of the national health service to our respective constituents. I do not for a moment pretend that the Government and Ministers are exclusively to blame for what has happened,
but they are now in a position to address the problems and therefore the responsibility is theirs. It is right that we should look to them to bring about solutions.I shall focus on three issues within the NHS. The first is beta interferon. The second is the fact that in my constituency, particularly around Sleaford, it is impossible for my constituents to get on to the national health service dental list. Lastly, my constituents are waiting 68 weeks to get an appointment to see a consultant neurologist after referral to Pilgrim hospital. None of those things is right, and they point to a serious deficiency in the service.
Many hon. Members have constituency problems to do with beta interferon and will be familiar with them, but the House should know the problem in my constituency. Many patients from my constituency are suffering from multiple sclerosis. Beta interferon has been prescribed by their consultant clinician but they are not getting it. The reason why they are not getting it, it is said, is because there is not enough money. The health service has set aside £200,000 per annum to fund that particular drug, and once that funding has run out there is no more available.
I have a letter, from which I will quote in part, from Professor Blumhardt, who is a man of great distinction at the University hospital Queen's medical centre and who has been made responsible by Lincolnshire health authority for dealing with patients from my constituency and, indeed, from others. He has written to me many times but I shall quote from a letter of 17 December 1999; the position is still broadly the same. He said:
- "Since July 1995, I have been screening at the specific request of Lincoln Health, all patients referred from their Region for this treatment. There have been 99 referrals of whom 44 were unsuitable for this therapy. 55 referrals were suitable and in my clinical opinion needed this treatment as soon as possible. Lincoln Health"—
- "provided funding for 11 of these patients, ie. only 1 patient in every 5 . . . In my clinical opinion as a consultant neurologist, I have prioritised all 55 for treatment. It should be noted that it is not possible to prioritise patients within that 55, as we cannot predict who might respond better or who might be in greater need of this therapy outside of the current evidence base . . . Many of the 44 patients who are untreated have continued to deteriorate for variable lengths of time between 1995 and the present. They have suffered from unpleasant disabling neurological attacks, sometimes requiring hospital admission and have undoubtedly accumulated further disability and are at higher risk of significant progressive disease in future years as a result of not being treated.
In other words, there is no way that we can clinically justify treating 11 patients out of the 55 prioritised cases in Lincoln. There is no rational way for me or any other clinical neurologist to choose patients from within that 55 that I have . . . found to be eligible."
- "This means that the current unmet need for interferon over this period of several years amounts to 81 per cent. of the patients for whom I wished to prescribe this effective treatment."
Bob Spink: My right hon. and learned Friend raises an important point. I will raise the matter in my own speech, but does he recognise that it is a fact that the earlier the treatment is given, the more likely it is to be successful,
and that if treatment is not given early, irreparable damage and disability can follow from the delay? Will he say a word about the delay by the National Institute for Clinical Excellence, which the Government have allowed, in bringing forward its recommendations? It has been considering the matter for two years. Surely the rule should be that beta interferon can be used while we wait for the recommendations to be made. We should not have to wait for those recommendations.
Mr. Hogg: I agree that if the treatment is not administered early, it is likely that damage will be done to the patients and that they will suffer. I also agree that the delay in receiving the NICE report is too long. I believe that we will receive it in the latter part of this year, but it is a long time since it started work.
There are two points of principle in any event. First, why is it that in Lincolnshire patients are getting a worse deal than in many other parts of the country where beta interferon is more readily available? Secondly, why should Lincolnshire health authority, by cash-limiting the budget, frustrate the recommendations of the clinicians to whom it has entrusted the task of distinguishing the patients who need it from those who do not? I am very worried about the situation.
The second issue covers much the same ground: dental services in and around Sleaford, where it is impossible—I mean impossible—for persons who are not on NHS dental lists to get on to them. There are no vacancies on any NHS dental lists in and around Sleaford. A few months ago, the health service was bullied, by me inter alia, to establish an emergency clinic. It is using a retired dentist. I do not say that in any critical sense—I am grateful to him for providing his services—but the clinic will be open one day a week and for emergency only. The advice given to my constituents who want to be on an NHS list for routine treatment is, "Get it out of county." What kind of service is that, in God's name? My constituents are simply being denied what they have a right to expect: NHS dental facilities for ordinary treatment.
I do not want to be unfair to the health service. A clinic in the adjoining village of Heckington will be opened, I hope, at the end of this year, but for months and months and months the service has not been available. I have written to Ministers and to the health service many times. I get told about emergency schemes, initiatives and this and that, but my constituents still cannot get on to NHS dental lists. I suspect that the reason why they cannot is because the Government are not prepared to put the money into the remuneration of dentists. Whenever I have talked to dentists about why they are not willing to come to Sleaford, it comes down to fees. That is the responsibility of the Government.
Jeremy Corbyn: Does the right hon. and learned Gentleman agree that the NHS employing many dentists as salaried practitioners would be one way out of the problem of dental treatment being unavailable on the NHS? At the moment, many private dentists do NHS work only if they cannot get enough private work to keep them going. Is not the issue one of asking a dentist to work for the public as a whole through the NHS?
Mr. Hogg: I have suggested to Lincolnshire health authority that it should contemplate engaging dentists on a salaried basis in order to provide routine NHS work
until such time as other practices can be established that are willing to do NHS work, so to that extent the hon. Gentleman and I agree. There may well be a need for salaried NHS dental practitioners in order to provide routine treatment. That is a suggestion that I have made to the health authority.My next point is on consultant neurology, and specifically on two constituency cases that I have encountered since the last general election. One particular person, whom I shall call Mr. H as I do not want to be more specific, had a heart complaint. He went to Pilgrim hospital, in Boston, which is the hospital that services my constituency in some important respects. Staff there identified the fact that he might have Parkinson's disease, and consequently that he required an appointment with a consultant neurologist.
Mr. H sought an appointment with a consultant neurologist. He was told, however, and I have the letter to hand, that it would be 68 weeks—17 months—before he would be seen for his first appointment. He is not the only person in that position. I have another such case—someone to whom I shall refer as Mrs. H is in a similar position. In the past three weeks, therefore, I have encountered two constituents who require access to a consultant neurologist but who have been told that they will have to wait 68 weeks before being able to see one.
I tabled a parliamentary question on the matter. The Under–Secretary of State for Health, the hon. Member for Pontefract and Castleford (Yvette Cooper), to whom I am grateful, replied:
- "The vast majority of neurology outpatients—about 95 per cent.—are seen within 26 weeks and the average waiting time in England is 11.04 weeks. More than 58 per cent. of hospitals are able to give appointments within 13 weeks."—[Official Report, 16 July 2001; Vol. 372, c. 71W.]
I wrote to the consultant to express surprise at the delay. I do not want to be unfair to him; he may have thought that I was trying to bounce one constituent ahead of another in the queue, which is not what I intended to do. He may have misunderstood what I was doing. I want to make that clear because of what I shall now say about the reaction that I received. That particular gentleman's response was to suggest that he did not particularly like to spend his time replying to that type of complaint. I got the very clear impression that the clinician to whom I wrote did not feel that he had to account for that type of delay. As a matter of fact, he blamed the delay on funding, and he may well be right about that.
My point is that professionals are indeed obliged to account for things. The day has passed when professionals, whether they be legal or medical, can simply say that they are living in a tower and should not be approached and obliged to account for their behaviour. As a member the Bar and as an hon. Member, I have to account for my behaviour, and I expect doctors and surgeons and the like to do so as well. When I write on behalf of my constituents, I expect a prompt, full and courteous reply. When I do not receive one, I want to know the reason why not.
I have one other point to make on Pilgrim hospital, and it is again not a very happy situation. Another constituent of mine was suffering from secondary cancer. He attended
Pilgrim hospital and was referred to Leicester for a consultant's appointment. After a rather long wait, he went to Leicester. When he arrived, he found that Pilgrim hospital had not provided his medical records or X-rays. Consequently, the appointment was a complete waste of time. It could not be conducted, and another appointment has to be made.People like me are not experts in the health service and I do not pretend that I am, but I can draw the lessons from what people say to me and what is disclosed to me in correspondence. The service is breaking down. Beta interferon is not available; national health service dental facilities are not available; 68 weeks to wait to see a consultant neurologist—intolerable; and papers and X-rays not furnished at the appropriate time.
There needs to be a proper grip on the health service. I do not dispute that it may be in part a question of money, but by God it is also a question of management. We need to have that service managed properly. If that involves introducing private sector management schemes and new means of funding, I am in favour of it. Above all, we have to make it absolutely plain to the Government that our constituents are not receiving the service that they require. The Parliamentary Secretary and other Ministers are responsible for delivering that proper service.
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