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Dr. Richard Taylor (Wyre Forest) (Ind): My one fear and regret about this debate is that I might not be as welcome as I believe that I am at the moment to sit on
 
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this side of the House after I have said what I am going to say, and that the kind Opposition Whips who alerted me to the debate might not do so again.

I had an Adjournment debate on this very subject last November and the Minister who responded was all too aware of the worries resulting from the European working time directive. Also in November, the all-party group on local hospitals held a meeting which was addressed by the Minister of State, Department of Health, the right hon. Member for Barrow and Furness (Mr. Hutton). We were impressed by the amount of work that he had done on this matter and the urgency with which he viewed the situation. I am, therefore, slightly encouraged, as I was encouraged by some of the things that the Minister said.

The Minister said that the Department of Health was giving priority, when implementing the working time directive, to maintaining quality and access to care. That is crucial. He also said that redesign—not relocation—would take place around the needs of local people. He added that we must not substitute tired consultants for tired junior doctors. I sympathise with the comments made by the hon. Member for Dartford (Dr. Stoate). I was a junior doctor rather before he was. He was on a one-in-two rota, but I was on a one-in-one rota at a hospital that used to exist about half a mile from here. That really went far beyond a joke. I did not just forget things like he did—I actually cracked up in the middle of the job. It is therefore essential that we do not substitute tired consultants for tired juniors, and that we take note of the working hours involved.

The Minister also said that the role of the Department was to support the NHS to meet the requirements of the directive. I want to take a few minutes to emphasise that I believe that the Government have another supremely important role to play. They have to take the part of citizens and patients, in some cases almost against the doctors. I want to draw to the attention of the House a letter in a recent edition of the British Medical Journal from a Scottish consultant neurosurgeon who was writing on the ills that afflict the NHS. He wrote:

"These include the new deal, the consultants' contract, the general practitioners' contract, the European Working Time Directive—all man-made artefacts and all preoccupied with the welfare of doctors, not patients."

I want to bring that letter to the attention of the Government so that they can be aware of how some people might look at the changes and to note some of the snags involved, some of which have already been mentioned today and on other occasions. They are worth mentioning. The first—and, to me, the biggest—involves the risk to the continuity of care. With full-shift systems, the same doctor never looks after a patient for any length of time, and, given the pressure of work, handover processes can sometimes be rushed. Continuity of care is therefore crucial.

The second snag involves training. Junior doctors, particularly surgeons, and trainers are questioning whether the reduced hours are giving them enough exposure to the practical procedures and operations in which they have to be supremely competent when they achieve consultant status.

The third involves lifestyle. The Royal College of Physicians recently studied 57 hospitals across England and Wales, and found that 63 per cent. of the medical
 
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specialist registrars on full shifts were working seven nights in a row. That cannot be comfortable for family life and it is not popular. Certainly, trainee obstetricians have found cover on full shifts very unpopular. Particular problems have been raised in relation to anaesthetics, obstetrics and paediatrics, which are services that cannot be covered in hospital at night by a generic doctor. Those specialisms pose extra problems. The answers obviously involve employing more doctors and the Government have given us figures to prove the numbers that are coming on stream. We have also heard a lot about doing things differently and there are some very good plans in that respect.

It appeared from what the Minister said in his opening remarks—I hope that the Minister of State, the hon. Member for Doncaster, Central (Ms Winterton) will confirm this—that the review being carried out in Europe might well lead to some delay in the implementation of the changes. The British Medical Association warns that, even if there is a suggestion of delay, implementing legislation to bring it about could cause further delay. The NHS Confederation makes a good point in a recent briefing note, saying:

"We recognise that it is the Government's responsibility to ensure that the working time directive is implemented but where despite trusts' best efforts it is not possible to achieve compliance, it is vital that there is a positive and supportive rather than a punitive response from the Department of Health and SHAs."

Given the snags with the new deal that I have mentioned, the working time directive and the new contract, hospitals are at risk, particularly certain large hospitals that are situated relatively close together. I am thinking of some in my own part of the country, including those in Telford and Shrewsbury and those in Gloucester and Cheltenham. The Government must ensure that it is possible for all those hospitals to preserve the emergency facilities that the people in those areas require. There is a particularly worrying triangle in the north-east of England, around Hartlepool, Middlesbrough and Stockton. Their hospitals are all close together and are all providing all the services at the moment. As we are well known in my part of the country for campaigning, Hartlepool has already been in touch with us to ask what it can do to protect its hospital.

There are also many smaller hospitals throughout the country that are somehow managing to maintain accident and emergency services. One has only to think of Banbury, Hexham, Workington, Bridlington, Newark and Louth. I could provide a long list of others. Those hospitals must be at risk. All this is taking place against the background of the Department of Health's paper published in February last year, "Keeping the NHS local: a new direction of travel", which I welcomed. It expressed the intent of Government policy to keep the NHS local, which is certainly compatible with local wishes. The Government will recognise that, if that is not possible, there will be a risk of political flak from various communities.

An excellent leader appeared in the British Medical Journal recently, written by Andy Black, the well-known health service management consultant. He stressed the political risks involved in downgrading emergency services and made two useful recommendations. The first was that the Royal Colleges should find a way of connecting with the public perception of the need for local access to emergency
 
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services. The second was the use of real "managed clinical networks", which would result in a real sharing of services. It is no good having an accident and emergency unit, and, 20 miles away, as is the case in Worcestershire, a minor injuries unit that is totally separated from it. If they worked together, with the same staff rotating between them, the staff working in the major unit would know the problems of the minor unit and the sorts of cases that the minor unit could see, which would avoid unnecessary journeys. Andy Black put his finger right on it when he said:

"If the price of moving the complex emergency to an appropriate centre of expertise is that this patient is accompanied by another nine or 10 patients who are not complex acute cases then another set of problems is launched."

That is exactly what we are seeing in Worcestershire—those nine or 10 patients who did not need to be moved are causing tremendous other problems.

On the GP contract, I was puzzled by the Minister's comments on community hospitals and I hope that his hon. Friend will return to the matter in her wind-up. I must admit that I thought that community hospitals were going to be at risk with the new contract.

I will say little about the consultant contract. I am slightly worried about today's announcement of 25,000 extra orthopaedic operations. Will that take NHS consultants away from NHS duty and make continuity of care even worse?

I ask the Government to remember that the NHS is for the patients. It is up to the Government to be the ordinary citizen's advocate and to ensure that changes are acceptable to the public, not bulldozed through as some previous changes have been.

3.21 pm

Sir George Young (North-West Hampshire) (Con): It is a pleasure to follow the hon. Member for Wyre Forest (Dr. Taylor), who speaks with such authority on this subject and whose very presence in the Chamber is a reminder to us all of the potency of health as a political issue in our constituencies. He mentioned that he was approached by Hartlepool, whose local hospital is threatened, for advice. I hope that he advised that an independent candidate should stand against the Labour Member there to achieve some results.

I want to speak briefly about the new GP contract, which I broadly welcome. Of course, it makes sense to reduce the number of hours that doctors work. If it makes no sense for MPs to be up all night and then be expected to do a proper day's work, it makes less sense for the country's doctors and GPs to have to attend to their patients when they have not had a decent night's rest.

I sound a brief note of caution before Ministers make claims about the impact of the new contract on patients. The Minister of State, who is normally alert and fleet of foot, does not understand the depth of concern in constituencies about what will happen when the new out-of-hours contract is introduced. The evidence that I have seen is that patients in my constituency will feel worse off because the level of service will be manifestly less than it is at the moment. If steps are not taken before 1 July, when the new out-of-hours opt-out contract starts in Hampshire, Ministers may find it difficult to
 
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convince my constituents about their investment in primary health care and their commitment to a quality service.

There are three areas of concern on which I want to touch: first, cover at Andover hospital—the position is the same at other smaller or cottage hospitals; secondly, the loss of Saturday surgeries; and thirdly, the operation of the new out-of-hours contract, which in my case is with Primecare. None of that is the fault of the local PCT or the local GPs. Simply, the money saved by not paying GPs to provide out-of-hours cover, even when topped up by new money from the Department, is not enough to replicate the service that GPs currently provide, mainly because it was provided on the cheap.

Let me begin with Saturday surgeries, which have not really featured in this debate. At the moment, I can see my GP in Andover on a Saturday. For those who commute from Andover or who work long hours, that may be the only time that they can see their GP without taking time off work. Last Saturday, my GP saw 15 patients and processed a number of repeat prescriptions. With the new contract, Saturday is out of hours, so the local GPs are not contracted to provide any service on that day. They could do so if the local PCT bought it in as a local enhanced service, but my PCT does not have the resources to do so, a point to which I will return in a moment.

My PCT is struggling with funding for taking over the out-of-hours service. It has been allocated 6 per cent. of what is called the global sum, part of the GP income stream, and GPs have taken a commensurate reduction. But that is simply not enough to replace the service. I know of only one GP practice that is going to open extra-contractually on a Saturday and that is a dispensing practice in a neighbouring constituency that can do so from the dispensing surplus. None of the surgeries in Andover will be accessible on a Saturday.

In fairness, there are plans for a replacement GP service. On Saturday and Sunday, there will be five sessions at Andover hospital operated by a GP or GP registrar. It may be bookable, but, basically, it is open house. Of course, one will not see one's own GP and the GP whom one sees will not have access to one's records. For most people, the hospital is more difficult to access then their local medical centre, so by any definition, the service offered on a Saturday will be seen by my constituents as reduced.

Then we have the position of Andover hospital. Andover is the largest town in my constituency, with a population of 40,000 and growing. The Andover War Memorial hospital hosts a range of services, including out-patients, diagnostic imaging, day surgery and so on. For anything more serious, one must go 15 miles to Winchester. At the moment, out-of-hours cover at that hospital is provided by local GPs, so one can go to the minor injuries unit at any time and be treated. A nurse deals with the patient and, if required, a GP will be called out. Although details of the contract after 1 July are still being negotiated, it looks very much as if there will be no local GP cover at the hospital out of hours. From 6.30 pm to 11 pm, some service may be provided by nurses, but from 11 pm to 8 am, it looks as if the minor injuries unit will be closed. At the moment, people can look in at 2 am and get treated. As from 1 July, those
 
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who want that treatment will have to drive 15 miles to Winchester to get it—by any reckoning, a reduction in service.

Finally, there is the operation of the new out-of-hours service to be provided by Primecare and funded through the PCT. At the moment, calls from patients in Andover are answered by a local nurse until 11 pm and thereafter by the on-call doctor in person. In future, the plans are to route calls initially to Birmingham and then to Southampton—the local hub—and if a GP is required, he will drive from Southampton or possibly Winchester. At the moment, cover in Andover is provided by a rota of local doctors and the response is obviously much quicker. However that is presented, it will be seen locally as a reduction in service.

I want to end on a theme that, I am afraid, I have mentioned previously. The reason for all this is that Hampshire, and particularly Mid Hampshire PCT, is simply underfunded. For every £100 that the average patient in England gets, Mid Hampshire gets £80. At that level, it is simply not possible to provide the quality of service that Ministers and I, as the local MP, want. That is why in all the debates on heath services in Hampshire, whether primary care or secondary care, we return to the underlying structural imbalance in the way that funds are distributed. Until Ministers address that fundamental point, they will continue to have difficulty persuading my constituents that the NHS is as good as they make out.

3.28 pm

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