---

Mr. Hutton: I am grateful to the right hon. Gentleman for giving way and for the tone of his remarks, with which I have a great deal of sympathy. He might not be aware that we have recently announced some additional resources for primary care trusts serving constituencies such as his, in rural areas where out-of-hours service providers will undoubtedly face additional costs. We are trying very hard to ensure that those additional costs are reflected in the allocations.

Mr. Hague: Yes, I am aware of that. I do not know whether the Minister was in the Chamber when I spoke about the resources going into vehicles, cell phones and satellite navigation. Those resources are certainly being deployed. We do not know whether they will be sufficient to deal with the task, but it is necessary to have additional resources for sparsely populated rural areas, and I think that it is necessary to consider whether exactly the same rules should be applied to such areas in negotiating contracts and working hours or whether exceptions should be made.

The working time directive leads to a wider debate that I do not want to go into, except by joining many people in the country in expressing astonishment that the European Union should make any such rules at all. I do not see why it is in the interests of people living in France, Germany or Italy to regulate the working hours of doctors in this country, and I do not see why such decisions should be made in any other place than this country. When the Minister has to come to the House and say how much the Government are trying to fight court judgments that we all agree are manifestly not in the interests of this country, it shows how much power has passed to unaccountable institutions. That is a wider debate, however; the Prime Minister wants us to have it in great detail over the next 18 months, and we will enjoy that.

My point about the working time directive is simply that it is another of the forces that makes things more difficult for sparsely populated areas. The Minister spoke about the small hospital trusts and the attention that has been given to them, and recognised that the problem is more difficult for them. In terms of rotas, it is more difficult for hospitals that have access to a limited number of consultants and junior doctors to cope with
 
21 Apr 2004 : Column 332
 
such issues. He is trying to give them particular help, but my point is that such issues accumulate over the years. Changes in the training requirements that may be set by royal colleges and agreed with the Department of Health have made things more difficult for small hospitals. It continually becomes more difficult for small hospitals to continue their existence. I am not being alarmist about that—there is no threat whatever to the Friarage hospital in Northallerton—but I know that it gets harder every year for people to run a small hospital. That requires either that exceptions be made or that greater resources be given to such hospitals.

Notwithstanding the point that the Minister has just made, account of population sparsity is not systematically taken in the allocation of health service resources. If we are to continue to apply sweeping national or supranational rules to situations that are unusual and needs that are difficult to satisfy many miles from the nearest hospital, we will have to take into account in funding allocations the needs of the particular rural areas involved.

I hope that that will be borne in mind in future. I do not think that any changes can be made to the contract now and I am not proposing any such changes. Obviously, that contract is signed and done, so I am not saying that any immediate action can be taken. However, I think that we will have to address these issues and that the Department of Health should be conscious that, when it considers matters from an urban and suburban point of view, as is often the tendency in Whitehall and in this House in what is mainly an urban and suburban country, we need to give increasing attention to the particular problems of rural areas.

2.38 pm

Dr. Howard Stoate (Dartford) (Lab): It is always a pleasure to take part in health debates, especially because, as the House knows, I still carry on a certain amount of medical practice myself.

We are debating a very serious issue and, as the right hon. Member for Richmond, Yorks (Mr. Hague) rightly highlighted, it will cause a certain amount of anxiety among constituents. I acknowledge his point about thinly populated rural areas where services are sometimes difficult to provide. None the less, debates such as this give us the opportunity to debate some of the issues in public so that people can be reassured about what the Government are doing to address them.

We have to balance the needs of service provision—ensuring that patients have access to appropriately trained, alert and awake medical personnel of all types, specialties and subjects—against the need for training requirements of a high standard and teaching requirements to ensure that personnel pass on their knowledge to others, as well as the need to ensure that they can carry out research and have a decent family and out-of-work life. All those things require a delicate balance that it is sometimes very difficult to achieve. Of course, we must also ensure that we balance all those issues against financial management and the best possible use of resources for the taxpayer.

This afternoon, we have talked extensively about the new GP contract, which I welcome and which, for the first time, allows GPs to provide a wide range of evidence-based services. One of the main advantages of
 
21 Apr 2004 : Column 333
 
the new GP contract compared with the old GP contract is the enhanced, additional services that GPs can provide. The evidence-based services are based on evaluated research and proper evidence, so GPs can be sure that when they carry out, for example, diabetes care, care for people with hypertension or care for people with Alzheimer's, it is based on research-based evidence, and they can be sure that the care is worth while. That improves GPs' morale enormously, because they know their work has a measurable benefit and a measurable outcome.

The old GP contract was full of what the people who wrote it may have perceived to be good ideas, but the ideas were not evidence-based. Many GPs found the contract extremely difficult to understand, and they often felt that they were wasting their time, which had a serious deleterious effect on the morale and recruitment of GPs. During my career as a GP, I noticed recruitment falling, with fewer good quality young people coming forward to be GPs. Young doctors often said that they could not understand the way general practice was going, that a GP's work was not based on sound science and that becoming a GP did not seem to be a good career progression, and they therefore turned away from general practice into the hospital sector, which was regrettable.

The new GP contract has improved morale and recruitment, and John Chisholm, who chairs the GP committee of the British Medical Association, is enthusiastic that it will produce the GP recruitment drive that we need. The BMA rightly points out that the country is short of GPs, and there is serious under-recruitment for general practice. It is vital that we attract the best quality graduates into general practice as a career choice—and, for the first time in many years, the new GP contract provides hope that that will be the case.

If GPs are to provide enhanced services during the day to allow patients to see them within 24 hours, where they feel that that is necessary, and to access services within their communities in GP surgeries, we must use other health professionals to fill in the gaps. It is not credible that we can expand the work load indefinitely without asking other health professionals to share it. I am pleased that we are working on a new pharmacy contract, which will allow pharmacists to take away much of the burden currently carried by GPs.

Pharmacists are highly motivated, highly trained professionals, who do not always use their skills to the best of their abilities because the current pharmacy contract does not allow them to do so. The pharmacy work force will be acknowledged by the new contract that Ministers are currently negotiating with the profession, which will add enormous extra depth to the health care provision. The new contract will apply equally to out-of-hours and in-hours services because many pharmacists already provide an extended-hours service at weekends and in the evenings, and they are accessible without an appointment simply by patients dropping in to see them. That is one more strand of improved health care provision to which we can look forward.

I am also pleased that the BMA has negotiated a new consultant contract with the Government. I am concerned that many trusts have not yet implemented the new consultant contract, and I have recently met
 
21 Apr 2004 : Column 334
 
BMA members who share my concern that there are serious local implementation issues. Some trusts have not taken up the new consultant contract in the right way, and I would like to know what the Minister can do to make sure that the new consultant contract is developed to the maximum and that all consultants will benefit from it. The consultant contract allows extra resources and more productive career development patterns for consultants, but it requires local negotiation.

If we look back a few years, we can see what the medical work force used to be like. I was a junior doctor not that many years ago—it is certainly within living memory. When I was a junior houseman, I worked a "one in two", which meant that my contract for a fortnight was 208 hours—one week I worked 136 hours, and the following week I worked a mere 72 hours. Those were my contracted hours, but the work often overran because of sickness, holidays or study leave, so the situation was even worse than that. When I was a junior doctor, a one-in-two contract was the norm, and most doctors were working those hours. I am pleased that those days are long gone because I do not want to see such contracts again.

Even when I was a junior GP, I was expected to work a full night shift, which often meant getting out of bed several times during the night, and to get into work at 8 o'clock in the morning to carry out a full morning surgery. It was unrealistic to expect doctors to undergo such pressure and provide good care to patients. After a night on call, for example, I was on a ward round in the morning and was confronted by the consultant, who said, "Would you like to explain this new patient who arrived last night?" I said, "What new patient?" He said, "This one in this bed." I said, "I am sorry. I have not seen this patient before." The nurse jabbed me in the ribs and handed me the notes. I had clerked in the patient during the night—I had made extensive notes that turned out to be quite good—but I could not recollect the case in the morning because I was so tired. That sort of thing is clearly bad for patient care, and I am glad that those days are long gone. Things have moved on tremendously in the health service, and I am pleased that doctors' hours now allow them to undergo the right training and research and to have lives of their own, which ensures that they are not overtired and do not potentially put patient care at risk.

I should like to address one or two local issues in my constituency. Yesterday, I visited my local hospital, the Darent Valley hospital in Dartford, to witness the opening of the first new operating theatre of its type in the country. It is called OR1, and it is a state of the art, brand new, fully automated, computerised operating theatre, where the entire range of medical instruments and equipment hangs from the ceiling and the consultant has a fully computerised control panel. While the world's media watched via a video link to the hospital's postgraduate centre, Mike Parker, the surgeon, carried out an operation with the new equipment while Andrew McIrvine, his colleague, relayed information to us in the postgraduate centre as we watched an interesting operation to remove a patient's gall bladder.

The new equipment is fantastic, and it is wonderful to see Dartford at the forefront of the process, because the technology is brand new and Darent Valley hospital is
 
21 Apr 2004 : Column 335
 
the first hospital in the country to use it. The resources, commitment and investment are going into the health service, and future patients will benefit from that. I am sure that such equipment will be installed in hospitals around the country because of the Government's investment.

There have been enormous improvements in NHS training and patient care, and there have also been improvements in general practice. Many general practices are being rebuilt to improve access to care for patients, and many GPs are taking on extra medical and nursing staff to allow them to provide extra care. However, the work force's needs must be balanced against patients' needs and taxpayers' needs to ensure that we get best value. Adjusting the skill mix to use the right profession in the right way is clearly the bedrock of ensuring the delivery of best quality care.

I welcome new initiatives such as the GP contracts, and I welcome the working time directive, which allows us to rethink how we provide medical care in this country. The working time directive is a challenge and, as the Minister says, it presents significant problems in some parts of the country. I am sure that all hon. Members recognise that there are difficulties in some areas and that the new arrangements must be bedded in before we can make the best use of them.

The situation has improved so much in the past few years. We look forward to sustained growth, development and investment, which will allow hospitals to improve their facilities, and GPs and pharmacists to improve their range of services, which must be the way forward to ensure that everybody in this country has increased health care and life expectancy. I welcome the debate, I am pleased to have had the opportunity to address the House this afternoon, and I look forward to the Minister's reply.

2.48 pm

---