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Sandra Gidley (Romsey) (LD): The national service framework has been widely welcomed and it would be churlish of me not to welcome it too, especially given that most of those who welcomed it will have to implement it and were probably involved in shaping it. However, I would be remiss in my duty if I did not ask some questions.

I am especially delighted that maternity is included in the NSF and it is therefore perhaps appropriate to describe it as motherhood and apple pie. That is not to decry it; most of us believe that motherhood and apple pie are very good things. Who can argue with standards such as:

"Women have easy access to supportive, high quality maternity services, designed around their individual needs and those of their babies"?

Clearly, everybody wants and aspires to that. I believe that there is no political difference between parties' perception of that. However, I shall comment on some of the specifics of the standard later. I want to begin with some points about national service frameworks generally.

Dr. Ladyman: For once, we are not considering a matter that politicians dispute. I believe that all politicians support the choice agenda. However, as my hon. Friend the Member for Braintree (Mr. Hurst) and the hon. Member for Southport (Dr. Pugh) pointed out, doctors, practitioners or those responsible for designing services often do not realise the need to provide choice. The national service framework states that choice is a right for people and that it needs to be implemented in the next 10 years.
 
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Sandra Gidley: I am delighted to hear that statement from the Under-Secretary because before I came into politics, I was involved with maternity services and worked with the National Childbirth Trust. We did much to try to empower women to ask for choice. In some ways, maternity services are ahead of the game. In parts of the country they have some way to go, but they have come a long way in 20 years. However, their attitudes have not always been transferred to other parts of the health service.

The choice agenda is welcome and we are gradually seeing the back of the consultant-as-God, doctor-knows-best mentality. Doctors are more welcoming of patients having a say and accept that there are well-informed patients and parents who want a choice in their services. However, some parents are not so well informed and they should not simply be told what to do. They have the right to have choices discussed with them, whether in the community or with their health visitor. Sometimes, hard-pressed staff do not have the time for what they regard as the luxury of going through the options with people. If we can change hearts and minds, and staff realise that it is a necessity, not a luxury, that will be welcome.

I want to make some general points about the national service frameworks. The early NSFs, such as coronary heart disease, attracted match funding to help achieve the aims and objectives. The Under-Secretary mentioned that earlier and said that anyone who talked about it missed the point, which is to change attitudes. Although I accept that, he should accept that when I visit my primary care trust in Hampshire, I find that it struggles with the "must dos" and the waiting list targets and to make the books balance. The Under-Secretary will claim that the Government have put in more money than ever. However, it does not seem like that to some of the chairs of primary care trusts, who worry about the future of their jobs.

Genuine pressures exist and anybody who faces them might be tempted to concentrate on the "must dos" and view a national service framework that has standards but no targets as something that can wait because there are 10 years in which to effect it. I am therefore worried that there is no political imperative to achieve the standards.

I take on board the fact that the Minister says that it will be down to local primary care trusts to develop the services in the way in which they see fit. However, they will have quite a lot of leeway over a 10-year period. I would have liked to see the onus placed on the PCTs—it might be written somewhere in the framework document; I have not seen it yet—at least to have their own individual plan for implementation within a year or two as a set piece of work.

Monitoring is obviously important, but if the examples of other national service frameworks are anything to go by, the Government tend to take a step back and pass the buck to other bodies. They say, "It's nothing to do with us. The PCTs are monitoring this, and that is the strategic health authority's responsibility." This relates to NSFs in which targets have been set. I am concerned, therefore, that if there is yet another reorganisation of the statutory bodies within the national health service, the monitoring will fall through the gaps. It is clear in the case of the older people's NSF that the vast majority of targets have not
 
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been met. Perhaps I am being cynical, but have the Government given up setting targets simply because they know that they will come back to haunt them two or three years down the line? That is one interpretation; I know that the Minister has another. Time will tell on how this pans out.

I am not sure how certain other things will be achieved. For example, much is being made of having better speech and language therapy services, and I know that many interested parents will be saying, "Hurrah! This is welcome news." However, the stark reality is that even statemented children do not necessarily have access to a therapist for whom a need has already been clearly identified. I should declare an interest in this issue, because my son needed speech therapy. However, he was lucky enough to need it 15 years ago when the provision seemed to be greater, or perhaps the demand was not so great.

Tim Loughton: That was under a Conservative Government.

Sandra Gidley: I do not think that it was down to the Conservative Government.

I will develop my point, which is that this issue relates not only to young children. Other people needing speech therapy services include older people or people who have suffered a stroke. Could a conflict build up here, in which the NSF for children says that they need greater access to such services, but the NSF for older people is less clear on access to rehabilitation services? Will the resources be switched to young children, depriving older people? That is a tension to which the Minister, in his other role, should give some attention, to ensure that all people have access to these services, which are clearly deficient at the moment.

As I said earlier, the framework has gained wide acceptance, and that is a good thing. Dr. Simon Lenton, vice-president of the Royal College of Paediatrics and Child Health, was generally very welcoming, but he made a telling point when he said:

"The real challenge will be engaging all the people who are involved in children's services".

I know that the children's trusts are being set up, but some local authorities are expressing concern that, amid all the focus on children, there seems to be a lack of focus on the fact that children have parents who have needs that are sometimes not so easily met. I am delighted that there seems to be more involvement with parents in this NSF, but a close eye needs to be kept on that matter.

Beverley Malone, general secretary of the Royal College of Nursing, said:

"We do worry that, as implementation is left entirely to local discretion, some areas may have difficulty in making sure the standards become a reality".

I know that that will be monitored, but I should be interested to hear from the Minister what sanctions will be imposed if, four or five years down the line, the primary care trusts are not implementing the services fast enough.

Enthusiastic individuals will use the NSF as a tool to develop the services that they want locally, which will be good. However, some of my research into the older people's NSF has shown that, while it is great if there is a local enthusiast, if there is no local champion to drive
 
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the framework forward, implementation happens much more slowly. Professor Aynsley-Green has commented that children's leads in primary care trusts may be too junior or may have some other portfolio to deal with as well. Therefore, what impression will be made on the primary care trust that this is important, that it should not just be a junior lead, and that it should be higher up the political agenda? It is all very well having it written down, but further impetus is needed.

On an initial reading, the NSF seemed a little weak in a few areas, such as poverty, housing, bullying and community safety. As one reads on, one finds that those issues are not necessarily dealt with in the parts of the NSF where one might expect them to be, but it was pleasing that some of those issues were included.

My other concern, on which I have touched already, is that the NSF focuses on children exclusively, apart from in the maternity section. Children are usually part of the family network, so a little more attention needs to be given to improving services for those carers as a route to improving services for children.

Much of what is in the NSF seems very community based. We have focused quite a lot on hospitals today, and have not said much about district nurses, health visitors, school nurses and so on. Such people come into closer contact with children, perhaps in more informal settings, but their roles have been stretched recently and numbers have not increased as much as they might have liked. There is an opportunity in that area to address some problems as they emerge, rather than dealing with them when they hit primary care, in the doctor's surgery, or when they hit the hospital. In that respect, I would like a little more emphasis on the community.

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