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Mr. Robertson: I am grateful to the Minister for his considered response. He will be aware, however, that the number of people treated by NHS dentists in Gloucestershire has fallen in the past six years. I am not seeking to make a political point, as the issue is too serious for pensioners and the many other people who cannot afford dentists to make it political. Does the Minister see the future as one of private provision, or will the Government be able to ensure that there are sufficient NHS dentists for people in Gloucestershire who need that treatment?
Mr. Hutton: The hon. Gentleman was wise not to try to make a party political point. He will not mind my pointing out that he is in a slightly difficult position, because the Government whom he supported presided over a major contraction in access to NHS dentistry. He and his right hon. and hon. Friends are now opposed to the extra investment that will put that right. He asked specifically whether we see the future as being one of private practice. The answer is clearly nothat is the policy adopted by him and his right hon. Friends.
Dr. Evan Harris (Oxford, West and Abingdon): I do not want to disturb the unity of the Labour and Conservative parties, but the Minister will be aware that the number of people registered with a dentist in Gloucestershire has fallen from 44 per cent. to 36 per cent. under his Government, whereas under the Tories, the national figure did not fall by much more than 3 per centfrom 59 per cent. in 1992 to 54 per cent. in 1997. English coverage is now only 47 per cent. How, without more registrations, can holistic, preventive care be given to people with dental problems, rather than the emergency treatment-only provision which is the Government's one-club strategy?
Mr. Hutton: Uncharacteristically, the hon. Gentleman failed to paint an accurate picture of what is happening. He likes facts and figures, so he will be interested to know that 1 million more courses of NHS-funded dental treatment are provided now than in 1997, and that nearly 2,000 more NHS dentists are providing services to NHS patients. I am not saying for a second that all the problems have been solvedclearly, they have notbut we are getting the investment in and easing the problems that we inherited. To continue doing so, we shall carry on making investment available and I hope that we have the support of the hon. Gentleman and his right hon. and hon. Friends for doing so.
The Parliamentary Under-Secretary of State for Health (Mr. David Lammy): The average cost of a call to NHS Direct in 2001 to 2002 was about £17.92, although that is expected to fall significantly in the future as call volumes rise. The National Audit Office has found that half of callers are directed to forms of care that they would not have chosen, which tends to be care of a lower level and with a lower cost of intervention.
Mr. Bryant: My hon. Friend may have seen press speculation that the cost of calling NHS Direct is higher than the cost of going to an NHS GP. However, the people who are raising those issues are missing the point. Is it not true that NHS Direct is expanding access, improving the service to patients and making sure that they get the right care? Will my hon. Friend assure the House that he will be looking not only at extending NHS Direct but at using other forms of new technology to make sure that we are always at the cutting edge of innovation around the world? In particular, will he look at the experiments in broadband technology which might assist the NHS in many different ways?
Mr. Lammy: My hon. Friend is exactly right. NHS Direct is probably the best example in recent times of the use of information technology in Government. Yes, costs are higher than those of seeing a GP, but one would expect that with a new service. Costs are expected to fall over time. The important thing about NHS Direct is that satisfaction levels are between 90 and 97 per cent. One would have to look hard to find similar levels in private life, so to speak, and in other areas. Certainly, we will continue to look at ways of extending and expanding NHS Direct over the years ahead.
Miss Anne McIntosh (Vale of York): Can the Minister tell the House the number of house calls that GPs have made, particularly to the elderly infirm, since NHS Direct was introduced? Can he give me an assurance that NHS Direct will never ever become a substitute for house calls to the elderly and to those with particularly serious conditions?
Mr. Lammy: No, it will not. I will write to the hon. Lady with the details in due course. The important thing is choice, diversity and access. NHS Direct, alongside GPs, increased use of paramedics, and reform in accident and emergency services, will bring about a reformed service. That is what we are working towards.
Andy Burnham (Leigh): May I draw my hon. Friend's attention to a pilot seen by the Select Committee on Health at the West Yorkshire NHS Direct centre, where patients with chronic conditions are supplied with self-testing equipment and transmit data daily to the NHS Direct call centre, where the data are examined so that potential problems can be spotted? That service could have great benefit in an area such as mine, where there are high levels of chronic illness caused by industrial injury. If rolled out nationally, the service could unlock the full potential of NHS Direct.
Mr. Lammy: I am grateful to my hon. Friend for drawing that to the attention of the House. It is excellent practice and is an expansion of NHS Direct. By 2004, hopefully, people will be able to ring up the NHS Direct
Tim Loughton (East Worthing and Shoreham): Given the current delays with NHS Direct, there is obviously much work to be done before emergency calls can be routed by it. What assessment has the Minister made of the impact on nurse vacancy levels in hospitals caused by the large number of experienced nurses who have transferred to NHS Direct from those hospitalsabout 900 out of 1,150? Why, with all the cost£110 million in the current yeardoes one in five callers still have to wait for 30 minutes to get a response from NHS Direct, and why is there precious little evidence of success in taking pressure off GPs, who cost half as much?
Mr. Lammy: The numbers are coming down. The hon. Gentleman should be aware of two important facts. First, NHS Direct employs about 1,500 nurses out of a work force of about 350,000, so he is speaking of a very small number. He should also be aware that many of those nurses are disabled or work injured; many of them work part time; many of them work for NHS Direct and in other parts of the NHS.
Secondly, when the hon. Gentleman cites figures for call waiting times, he should be aware that the National Audit Office found that people were being called back within 20 minutes, and 82 per cent. of people were receiving calls within 30 minutes. Those numbers are improving all the time.
Jeff Ennis (Barnsley, East and Mexborough): As the Minister will be aware, there is no 24-hour carers' helpline, so NHS Direct doubles up as that service. Are we monitoring how many carers are using NHS Direct; if not, does the Minister agree that we should?
Mr. Lammy: More than 11 million people have used NHS Direct since it came into being, and more than 110,000 will use it this week alone. Two to 3 per cent. of those people become aware of the severity of their complaints through having rung NHS Direct, so it is saving lives. My hon. Friend is right to say that it is important, as the service expands, to examine ever more closely the profile of the people who call it, and to ensure that it is better integrated into the NHS as a whole. It represents the best example of the introduction of information technology in the NHS, and compares well with the failed Child Support Agency that Conservative Members introduced when they were in government.