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5.3 pm

Mr. Adrian Bailey (West Bromwich, West): Today I shall celebrate Christmas by talking about health. I shall describe some of the good practice in my constituency, which has some lessons for the health service as a whole, and flag up one or two issues that have been raised with me, which the Government need to take on board if they are to fulfil their strategic objectives for the health service.

In the debate on the health service, the concentration on the acute sector is understandable—perhaps, because of the passage of the Health and Social Care (Community Health and Standards) Act this year, it is inevitable— but it is potentially a cause for concern. The disputes and the debate about the acute sector have obscured the real progress that has been made at primary care level as a result of the Government's investment in that sector.

I represent an inner-city area, which, in common with many others, has poor health statistics. The worst are centred in the traditional Tipton area, which consists of three wards, Princes End, Great Bridge and Tipton Green. All have high death rates from heart disease, stroke, cancer and chest disease. Other problems that are part health-related, part social include high teenage pregnancy rates, smoking and alcohol intake.

Specifically in order to address areas with acute health problems, the Government introduced personal medical service pilots, which started in 1998 in Tipton and have

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now been rolled out to some 30 per cent. of the population. In my constituency, the Tipton Care Organisation was set up. It covers a patient population of 37,500, with eight GP practices—one with six doctors and four with only one. It set up a board with representatives of the voluntary sector, the local community health team, tenants and local government. There is a further board consisting of local GPs, one from each practice. That structure has brought together expertise from all sectors of the local health economy and has stimulated new ways of working to benefit the local community, at both primary and acute level.

The organisation has introduced several innovations that should be singled out for their implications for the NHS. It first appointed two salaried GPs to support the existing GP coverage. Tipton, in common with many other similar areas, is under-provided with GPs. According to its population it should have 22, but at the time in question there were 18. The employment of two female salaried GPs has meant that the organisation has been able to support the practices with only one or two GPs, by providing cover for training and enabling them to reduce waiting times. It has also improved the service by allowing women who prefer to be seen by a female GP the opportunity to do so. It has considerably enhanced the GP service in several areas.

The organisation has also employed stress counsellors. In conjunction with the Counselling in Primary Care Trust and the health service management centre at Birmingham university, it has provided a specific counselling service in local practices. It is obvious that many visits to GPs are the result of stress-related or psychosomatic illnesses. By providing a specific counselling service, the organisation has improved the well-being of patients and cut the number of visits to GPs by around 29 per cent. I cannot help feeling that if such a service were introduced nationwide, the benefits of the reduced pressure on local GPs would be significant.

Another project was the introduction of an integrated nursing service for elderly patients in hospital. By assessing their needs in hospital and visiting them regularly once they had returned home, the organisation provided a level of support that has cut the average stay in Sandwell hospital by one and a half days for patients from the Tipton area, in comparison with the rest of the local area. Obviously, this has enormous implications in terms of pressure on waiting lists in the acute sector. It is a clear demonstration of the beneficial impact that investment in the primary care sector can have on the acute sector.

Other projects involve dealing with diabetes in terms of a proactive chiropody programme. The identification of no fewer than 956 diabetics who were not attending chiropody services and the establishment of a proactive chiropody monitoring service has resulted in nearly 10 per cent. being identified as requiring acute treatment. It is estimated that nine amputations were prevented as a result of the provision of that treatment. Many elderly people with diabetes do not understand its impact on their legs and feet. The setting up of a chiropody service to monitor that brings potential benefits to their health and well-being, and there is a substantial impact on the health service.

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I remember that, when I was a young boy an elderly auntie who lived with us had diabetes, but did not reveal to anybody—not even her doctor—the extent of the problem with her legs. That resulted in an amputation and subsequently she died. So I know at first hand just how essential that sort of service is in benefiting individuals and the acute sector.

Another and startling approach is being made to the medical management of drugs in the community. A survey was done of people, mainly over 65 and mainly suffering from coronary heart disease or diabetes, who were taking more than four sorts of medication, to find out how effective the drugs were. To my surprise—or perhaps not to my surprise—many of those who were suffering from a range of ailments could not read the labels, did not understand the instructions, or could not access the drugs from the packet. As a result, there was a significant level of over-prescription and lower efficacy than was needed. That in turn can lead to hospitalisation or residential care. As a result of action and support for elderly people in that category, the need for hospitalisation and residential care has been reduced, as has the drugs budget.

All these programmes have been carried out as a result of the extra investment at primary health care level. They demonstrate clear cost benefits and benefits for the acute sector.

One or two concerns have been raised with me. The first is about the medium-term provision of GP services within areas such as mine. In my area, in common with many former industrial areas, the local health service is highly dependent on the first generation of Asian doctors who came here 25 to 30 years ago. They have done sterling service for the people of Sandwell in my constituency. However, many will come up for retirement in the next few years. Despite the 12,000 extra doctors, there is a real danger that these areas will not be able to attract the number of doctors needed to sustain the good work that has been begun. That is obviously a challenge for the Government.

One way of dealing with the problem is to follow the lead of the United States by training and recruiting physician assistants. The anomaly is that Tipton Care Organisation has recruited two American physician assistants. Other primary care trusts are doing the same. There is a recognised role and potential use of physician assistants, but this country does not train them or recruit enough of them. They are educated and trained to a high level, although not to the level expected of a doctor, and carry out a range of support services under the supervision of a doctor, releasing the doctor's time for more specialised purposes. Physician assistants are widely used in the United States.

Unfortunately, physician assistants do not have a professional body. Work is being done with the General Medical Council to recognise them, and Birmingham university is involved in establishing a training facility, but it needs funding. I hope that the Government will seriously consider the proposal as a way of bridging the doctor-provision gap, which may emerge over the next few years as a result of the retirement of so many ethnic minority doctors.

There is another possible source of support. It came as a surprise to me to learn that about 500 medical orderlies leave the Army services each year. Those

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people would not necessarily become doctors, but given their basic medical training allied with new courses to train physician assistants, they are a source of medical expertise that is currently lost and could be used within local health care economies. The Government should seriously consider recruiting and training medical orderlies to promote the Government's long-term health objectives.

My area is pioneering joined-up thinking, utilising the Government's extra investment in primary care to provide better local services and to relieve pressure on acute services. However, I am worried that that investment may not be sustained. I hope that the Government will invest in recruitment to ensure that the good work that has taken place over the past few years is not lost because of a lack of forward planning.

4.18 pm

Bob Spink (Castle Point) (Con): As this is the Christmas Adjournment debate, I wish you, Mr. Deputy Speaker, and all at the Palace of Westminster a very happy Christmas and a peaceful new year. But while we enjoy the warmth of our homes, friends and family this Christmas, let us remember those in need.

There are homeless people in Castle Point and we have failed far too many of them. We must find ways to make more housing units available to help the many worthy cases that have been betrayed by the system. I include myself, as well as the Government and the local council, in that criticism. We must treat homeless people with dignity and charity, and that should be remembered at Christmas.

My hon. Friend the Member for Romford (Mr. Rosindell) mentioned the celebrations of an anniversary regarding Gibraltar. I throw in my call for decent celebrations of the 200th anniversary of Nelson's day on 22 October 2005. The Canvey Island Conservative club and the nation at large have noted Labour's politically correct reluctance to celebrate that anniversary, which marks a remarkable victory of our country over the French. As the celebration may take place after the next election, I call on my Front-Bench spokesmen, who by that time will have formed the Government, to ensure that we have a substantial and appropriate celebration of that remarkable battle and victory.

In a previous Adjournment debate on 3 April this year, the Parliamentary Secretary, Privy Council Office said:

Since the Minister is so interested, let me tell the House what actually happened. At the time when the hon. Gentleman made those comments, Labour controlled the council, which had just 15 Conservative councillors. After the election, the Conservatives had 39 councillors and Labour just two. I ask hon. Members to join me in congratulating all 41 candidates who won that election, including the two Labour ones. I hope that they will serve their community assiduously and with dignity over the years.

I should like to start—yes, I have not even started yet—with three good news stories in a spirit of Christmas good will. First, stopping under-age drinking on the streets and tackling youth drunkenness is

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incredibly important, as we all know from our surgeries. A crucial weapon in allowing the police to do their job in that respect was contained in the under-age drinking Bill, which was intended to allow the police to remove alcohol from kiddies—perhaps 16-year-olds, or perhaps even 10-year-olds. I introduced that private Member's Bill in 1997, and the police were given those powers on its enactment.

The Prime Minister then removed those powers from the police with his Criminal Justice and Police Act 2001, in an act of political stupidity that is typical of this Labour Government. In fact, the Association of Chief Police Officers and communities throughout this country very much regretted that astounding move. The good news is that, following pressure from me and other hon. Members on both sides of the House, the Government did a U-turn, and in the Licensing Act 2003, they reinstated the powers that my Act originally gave to the police. I urge all police forces to use those powers fully to protect not just those in communities that sometimes feel under siege from youth street nuisance and crime, but the kids themselves, because 90-odd per cent. of first use of drugs by young people takes place under the influence of alcohol, and youngsters need protection from that.

Of course the second good-news story relates to Cliffe. An airport in the Thames estuary would cause serious quality-of-life and environmental damage to the people of south Essex and Kent, including noise and air pollution and much else that we all know about. So I thank the Government for rejecting the Cliffe proposal. My constituents will feel that I was right to give them their say—to consult them, when the Government failed to consult them on that matter—and to fight on their behalf. They will feel that we won an important battle. Can the Minister confirm whether any further scheme for an airport in the Thames estuary will be ruled out for the entire White Paper 30-year strategic planning period, so that my constituents will know that we have won the war?

While you are in the Chair, Mr. Deputy Speaker, I should reiterate my support for the excellent campaign against the extra runway at Stansted, which must now get off the ground, and I know that you will be leading that campaign in your usual excellent manner.

The third good-news story, of course, involves Canvey Island football club, which passes into the new year at the top of the league, with a remarkable string of performances based on great effort, fitness and ability on the pitch at Park Lane. The club looks set for promotion into the conference next year, but I shall say no more about that because I do not wish to tempt fate.

Hospice funding is very important, and I have raised the issue several times in the House, including with the Prime Minister. Adult hospices get 32 per cent. of their funding from public funds, and children's hospices receive an average of 4 per cent. Little Haven children's hospice in my constituency, however, receives only 1.5 per cent. public funding. That seems too low, and I will encourage Ministers to consider that, to recognise the care and dedication of the staff and volunteers in the hospice movement, and to recognise the generosity of spirit of fundraisers who raised the other 98.5 per cent. for Little Haven—I am thinking of the Hadleigh, Benfleet and Canvey Island Conservative clubs that, year on year, raise money for that hospice and for other

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local good causes. The answer is not, however, as the Government believe, to redirect lottery money from other good causes to the hospice movement. The answer is that public Exchequer funds should be made available at a rate of 40 per cent. for both children's and adult hospices, which can then move forward and provide their wonderful service to families and children at the most difficult time in their lives.

I move now to the old issue of Canvey's third road, for which I apologise to the House. With neighbouring councils changing political control—Basildon this year, and Thurrock, I hope, next year—councillors may be minded to take a more responsible, community-spirited attitude towards a third road from Canvey Island going across parts of their borough. I ask them to do that, to be co-operative and to think about the wider community interest in that.

I want to raise a few questions about the Child Support Agency. The agency wrote to me on 11 December:

by which, I think, it means assessing—

My question is: why is the scheme not working well now, after almost a year of operation? Why do we not yet know that the scheme is working well so that we can confidently make sure that everybody is on an equal footing? To use different schemes to assess parents on the arbitrary date of 3 March seems to me to be inequitable. I therefore urge the Minister to consider the matter with a view to bring all cases under the new scheme as soon as possible.

I now move on to an Essex county council letter that was faxed to head teachers across Essex on 16 December, which referred to the primary school meals service. Essex county council sought to review the matter and to seek new tenders, for instance, to improve food quality and to increase usage of fresh products. We can all agree with that. Nevertheless, Mr. Deputy Speaker, you may not know—I certainly did not—that a decision had been taken by Essex county council not to accept any of the tenders, and to stop suddenly the primary school meals service and to put the responsibility on head teachers, who, probably from April next year, must make their own arrangements. That may be the right move, it may be financially necessary, and it may enable head teachers and primary schools to provide better school meals for children. There has been no consultation, however. We cannot simply make such decisions and impose them without consultation in this day and age. I therefore call on the Minister to seek a consultation on the matter. May I also say to him that the reason for all this is that the Government have withheld reasonable funding from Essex county council in their wrong-minded move to shift money up to Labour-controlled councils further north?

I turn to the important issue of post office closures which, in Castlepoint, is as disastrous for local communities, pensioners and vulnerable people as it is

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in other constituencies. My hon. Friend the Member for Ribble Valley (Mr. Evans) made an excellent, stirring speech about the matter, so I shall not go into further details, save to cite the National Federation of Sub-Postmasters, which told me on 11 December:

As the NFSP says, Government policy is leading to post office closures, not staff retirement. If it were Government policy to make post offices viable, people would want to replace staff who were retiring. The public should not be in any doubt about who is to blame. They will, I am sure, let Labour know who is to blame at the next election.

Finally—I see that you are smiling, Mr. Deputy Speaker, at that word—the House will not be surprised if I return to a familiar subject in the usual suspects' debate. The hon. Member for Finchley and Golders Green (Dr. Vis) mentioned Cyprus in his opening contribution. I congratulate the opposition parties in north Cyprus on their success in recent elections in which they gained 50 per cent. of the seats and the majority of the popular vote. That is remarkable and praiseworthy in view of the widespread intimidation and corruption, multi-media bias and the rigging of the electoral register. Surely, however, pressure must be put on the Turkish Government to put pressure in turn on Mr. Denktash to make a settlement based on the Annan proposal so that, even at this late stage, a united island of Cyprus can accede to Europe in May 2004.

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